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Medicare Basics
Learn about the different Medicare options available and how they may help offset the costs of a nursing
home stay.

Learn more about what long-term care insurance covers.

Nursing Homes: Learning the System

To get good care for your loved one, you need to understand how the nursing home system works, how to solve problems, where to go for help, and what are the residentsí rights.

Communication Is Key There are many reasons why nursing home care breaks down. At the first sign of a problem, itís best to discuss it with the nursing home staff. Friendly, open communication and relationships with nursing assistants, charge nurses, the director of nursing, the social worker, the administrator, and other staff will help keep problems from becoming serious. When a problem persists, however, chances are that other families and residents are also concerned.

Communication among families is so important that Medicaid and Medicare nursing homes are required to allow families to form councils that meet privately in the facility. Ideally, the council is a place for families to talk freely among themselves and present concerns or complaints to the staff. Find out if there is an established family council already meeting. If not, think about starting one as soon as possible. Dialogue is always the best step to avoid or solve problems.

Periodically, nursing homes must also hold care planning meetings to discuss residentsí needs and changes the facility should make for their care. Residents and their families should participate in these meetings, which involve a team of nurses and other staff. Feel free to request that certain staff, such as nursing assistants, attend. The long-term care ombudsman, a member of the clergy, or a close friend could also come to the meeting to provide support.

Solve the Problems If the nursing home is poorly staffed or managed, it may not give good care until residents and their families put a foot down and take matters to a higher authority. Never hesitate to do this. The purpose should not be to hurt the facility, or its employees, but to get better care for a loved one and the other residents. A written record is crucial when you file a complaint. Keep track of when the problem(s) occurred and who was involved. These are some places to go for advice or investigation:

  • Long-term care ombudsman
  • Citizen advocacy groups
  • Legal services
  • State licensing and certification agency
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Families often fear that if they complain, someone will take it out on their loved one. For this reason, loved ones even ask family members not to speak up. This is the primary reason families hesitate to complain about poor care. But nursing home staff assert that families who call attention to problems get results. So don't hesitate to pursue problems. You should:

  • Use the care planning conference to discuss problems with staff; this meeting creates a natural setting to address concerns without raising them to the level of a formal complaint.
  • When filing a complaint about a staff member to a supervisor, share concerns about retaliation against your loved one.
  • Use the group support of the family council to more effectively solve problems in the nursing home.
Nursing homes should be dignified places where residents receive the care they need. Together, families can ensure this.

When the Nursing Home System Fails If nothing you try improves the care of your loved one, consider joining a citizen advocacy group. If none exists, form one. Ask the family council group for help, and check with the local AAA or ombudsman program about how to get a group started in your area.

Protecting Rights and Dignity Too often people lose even the simplest rights when they become nursing home residents. These include the loss of:

  • Privacy when they sleep and bathe
  • Freedom to go wherever and whenever they want to visit friends and relatives
  • Choice of what they eat or wear
  • Control of their money
  • The right to choose their own doctor or make decisions about medical treatment
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The Nursing Home Residentsí Bill of Rights defends the rights of residents to keep their privacy and dignity. It protects basic rights such as whether or not staff knock on the door of a personís room before entering. These rights apply to all residents who live in Medicare- and Medicaid-certified nursing homes.

Demand Good Care Neglect emerges quickly when nursing homes provide poor quality food, fail to keep residents clean and dry, and ignore changes in their conditions. Such neglect leads to dangerous medical situations. Some signs to watch for are:

  • Dehydration
  • Malnutrition
  • Bedsores such as decubitus ulcers or pressure sores
  • Physical restraints
  • Chemical restraints or drugs used to control a residentís behavior
  • Contractures, or muscles that are becoming too stiff to move easily

Just as scary as physical neglect, psychological and physical abuse happens in nursing homes. Itís critical that you confront any such problem the moment you suspect it. Look for the early signs, such as unkind words or rough treatment toward your loved one or any resident. If supervisory staff fail to act immediately to address your concerns, contact one or more of the following authorities:

  • The long-term care ombudsman
  • The local adult protective services agency
  • The police

Nursing homes should be dignified places where residents receive the care they need. Together, families can ensure this. Never lower your expectations for the respect your loved one deserves.

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© 2003, 2004, 2007 AARP. Reprinting by permission only.

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