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Message #683 Nursing homes: Resident rights

mp3 # 683 Nursing Homes - the Rights of Residents (mp3 file)

The Federal government, in 1987, adopted a detailed list of residents' rights for people who live in skilled nursing facilities, commonly called nursing homes or convalescent hospitals. These residents rights are listed in Public Law 100-203, enacted December 22, 1987, 101 Statutes 1330-165.

Residents' rights include the rights to free choice, freedom from restraints, privacy, confidentiality, accommodation of needs, grievances, participation in resident and family groups, participation in other activities, examination of inspection reports, transfer and discharge rights, access and visitation rights, equal access to quality care, admissions policies, protection of residents' funds, and management of personal funds. In this message, each of these rights will be explained.

The first right of nursing home residents is free choice. Free choice is the right to choose a personal attending physician, to be fully informed in advance of any changes in care or treatment that may affect the resident's well- being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment.

The second right of nursing home residents is freedom from restraints. This is the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. Restraints may only be imposed to ensure the physical safety of the resident or other residents, and only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances).

The third right of nursing home residents is privacy. This is the right to privacy of accommodations, medical treatment, written and telephonic communications, visits, and meetings of family and resident groups. This does not include the right to a private room.

The fourth right of nursing home residents is confidentiality of personal and clinical records.

The fifth right of nursing home residents is accommodation of needs. This is the right to reside and receive services with reasonable accommodations of individual needs and preferences, except where the health or safety of the individual or other residents would be endangered, and to receive notice before the room or roommate of the resident in the facility is changed.

The sixth right of nursing home residents is the right to grievances. This is the right to voice grievances with respect to treatment or care that is (or fails to be) furnished, without discrimination or reprisal for voicing the grievances, and the right to prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.

The seventh right of nursing home residents is participation in resident and family groups. This is the right of the resident to organize and participate in resident groups in the facility and the right of the resident's family to meet in the facility with the families of other residents in the facility.

The eighth right of nursing home residents is participation in other activities, such as social, religious, and community activities that do not interfere with the rights of other residents in the facility.

The ninth right of nursing home residents is the right to examine inspection results. This is the right to examine, upon reasonable request, the results of the most recent survey of the facility conducted by the Federal Government or a State with respect to the nursing home, and any plan of correction in effect with respect to it.

The tenth right of nursing home residents is the right to remain in the facility, and not be transferred or discharged. A resident may be involuntarily transferred or discharged for the following reasons only:

the transfer or discharge is necessary to meet the resident's welfare and the resident's welfare cannot be met in the facility; or, the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; or,

the safety of other individuals in the facility is endangered; or,

the health of other individuals in the facility would otherwise be endangered; or,

the resident has failed, after reasonable and appropriate notice, to pay an allowable charge imposed by the facility for an item or service requested by the resident and for which a charge may be imposed; or,

the facility ceases to operate.

The eleventh right of nursing home residents is to receive notice of any planned transfer or discharge. Before transferring or discharging a resident, a nursing home must notify the resident (and, if known, a family member of the resident or legal representative) of the transfer or discharge and the reasons for it. The notice must usually be made at least 30 days in advance of the resident's transfer or discharge, except in an emergency.

The twelfth right of nursing home residents is to have access and visitation rights. The nursing home must permit immediate access to any resident by any representative of the Federal Government, by any representative of the State, by a state ombudsman, or by the resident's individual physician. The nursing home must permit immediate access to a resident by immediate family or other relatives of the resident, subject to the resident's right to deny or withdraw consent at any time. The nursing home must permit immediate access to a resident by others who are visiting with the consent of the resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time. The nursing home must permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time. The nursing home must permit representatives of the State ombudsman to examine a resident's clinical records with the permission of the resident (or the resident's legal representative) and consistent with State law.

The thirteenth right of nursing home residents is to have equal access to quality care. The nursing home must establish and maintain identical policies and practices regarding transfer, discharge, and covered services for all individuals, regardless of source of payment.

The fourteenth right of nursing home residents is in the area of admissions policies. In its admission policies, a nursing home must not require individuals applying to reside or residing in the facility to waive their rights to benefits under Federal Medicare or under a State Medicaid plan. A nursing home must not require oral or written assurance that such individuals are not eligible for, or will not apply for, Medicare or Medicaid benefits. A nursing home must prominently display in the facility and provide to such individuals written information about how to apply for and use such benefits and how to receive refunds for previous payments covered by such benefits; and a nursing home must not require a third party guarantee of payment to the facility as a condition of admission (or expedited admission) to, or continued stay in, the facility.

The fifteenth right of nursing home residents is in the area of protection and management of resident's funds. The nursing home may not require residents to deposit their personal funds with the facility, and once the facility accepts the written authorization of the resident, must hold: safeguard, and account for such personal funds under a system established and maintained by the facility as follows:

The facility must deposit any amount of a resident's personal funds in excess of $500.00 in an interest bearing account, that is separate from any of the facility's operating accounts, and credits all interest earned on such separate account to such account. With respect to any other personal funds, the facility must maintain such funds in a non-interest bearing account or petty cash fund.

The facility must assure a full and complete separate accounting of each such resident's personal funds, maintain a written record of all financial transactions involving the personal funds of a resident deposited with the facility, and afford the resident (or a legal representative of the resident) reasonable access to such record.

Upon the death of a resident with such an account, the facility must convey promptly the resident's personal funds (and a final accounting of such funds) to the individual administering the resident's estate.

The facility must usually purchase a surety bond, to assure the security of all personal funds of residents deposited with the facility. The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under the Medicare or Medicaid Program.

If you as a nursing home resident, or your friend, relative, or legal representative, feel that a nursing home is denying any of these rights, you may receive help by calling the local county Department of Aging, and asking for the nursing home ombudsman. Complaints may also be made to the California Department of Health Services, Health Facilities Licensing Section, which inspects nursing homes. These county and state agencies are listed in the white pages of your telephone directory.

The California Health and Safety Code section 1599, and the California Administrative Code, Title 22, Section 72527, also list residents' rights in nursing homes. These are similar to, but not identical to, the Federal rights you have just heard.

California rights also include the following:

The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility.

Each patient shall show evidence of good personal hygiene, be given care to prevent bedsores, and measures shall be used to prevent and reduce incontinence for each patient.

The facility shall provide food of the quality and quantity to meet the patients' needs in accordance with physician's orders.

The facility shall provide an active program staffed and equipped to meet the needs and interests of each patient and to encourage self-care and resumption of normal activities. Patients shall be encouraged to participate in activities suited to their individual needs.

The facility shall be clean, and in good repair at all times.

A nurses' call system shall be maintained in operating order in all nursing units and provide visible and audible signal communication between nursing personnel and patients. Extension cords to each patient's bed shall be readily accessible to patients at all times.

Each patient shall be fully informed, prior to or at the time of admission and during stay, of services available in the facility and of related charges, including any charges for services not covered by the facility's basic per diem rate or not covered under Medicare or Medi-Cal.

Each patient shall be fully informed by a physician of his medical condition, unless medically contradicted, and to be afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research.

Each patient shall have the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal.

Each patient shall be encouraged and assisted throughout his period of stay to exercise his rights as a patient and as a citizen, and to this end to voice grievances and recommend changes in policies and services to facility staff and/or outside representatives of his choice, free from restraint, interference, coercion, discrimination or reprisal.

Each patient shall manage his personal financial affairs, or to be given at least a quarterly accounting of financial transactions made on his behalf should the facility accept his written delegation of this responsibility.

Each patient shall be assured confidential treatment of his personal and medical records and to approve or refuse their release to any individual outside the facility, except in the case of his transfer to another health facility, or as required by law or third party payment contract.

Each patient shall be treated with consideration, respect and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs.

No patient shall to be required to perform services for the facility that are not included for therapeutic purposes in his plan of care.

Each patient may associate and communicate privately with persons of his choice, and to send and receive his personal mail unopened, unless medically contraindicated.

Each patient shall retain and use his personal clothing and possessions as space permits, unless to do so would infringe upon rights of other patients and unless medically contraindicated.

Each patient shall, if married, be assured privacy for visits by his/her spouse and if both are patients in the facility, to be permitted to share a room, unless medically contradicted.

Each patient shall have daily visiting hours established.

Each patient may have members of the clergy admitted at any time, at the request of the patient or the patient's guardian.

The facility shall allow relatives or persons responsible to visit critically ill patients at any time, unless medically contradicted.

Each patient shall be allowed privacy for visits with family, friends, clergy, social workers or for professional or business purposes.

Each patient shall have reasonable access to telephones, both to make and receive confidential calls.

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