Hi all, I'm new to the Board and am very grateful to have found it. I'm new to the world of nursing homes and have to admit my mom and I don't have the hang of it yet. My 90 year old mom received a 30 day discharge notice today. She loves the facility and has been very happy there so she was shocked and saddened by this.

The first reason cited is that my mom drank some Ensure when she was on fluid restrictions (against doctor's orders). This is true, but the doctor eliminated the fluid restriction order a week later, so it wasn't life threatening. The second reason is that I called the nursing home each day when my mom had pneumonia to find out doctors orders, etc. I was not told that this was a bad thing to do. I was told that calling the doctors was a bad thing to do and that I should go through the charge nurse to obtain information and she will communicate with the doctor. So this is what I have done. No one indicated any problem with my phone calls until today.

They thought my mom was going to be private pay when they admitted her, but she ended up qualifying for Medicare. Could this be the real reason for the letter? Isn't this a bit cold-hearted and cruel?

I live out of state so phone contact is essential as I have POA and am the only one responsible for her healthcare decisions besides her. Please straighten me out. I'm clearly out of synch with nursing home expectations. Thanks.

I just saw this old post of mine from five years ago! Can it be that long ago? Wow! Let me give you all an update.

After a rough entry into that nursing home (which was in Massachusetts), things went quite well and my mom got great care, made friends, and got a private room (even though she was on Medicaid).

My dad went into the same NH, didn't do well, and ended up living with me in Connecticut. My mom, of course, wanted to be transferred down to Connecticut to be with us. It took a while, but I got her down here. Had problems with the NH here, had to get the ombudsperson, external doctors, and Legal Aid involved, but it all got straightened out and she's doing quite well.

Now my dad will be admitted to the same facility on Tuesday, assuming he cooperates and all goes well. He already has made a friend there with another male and he'll be on the same floor as my mom. She'll still have her private room (they can't be in the same room with each other, tried it, doesn't work).

Thank you all for the wonderful advice and support you gave me during a very stressful time. (Not that this isn't stressful, but I'm not so new at this stuff any more, so I can handle it better.)

Katie , thank you so much for showing us there are good facilities.Your offer to help others with concerns is so thoughtful.I do believe the stigma that is attached to the care facilities causes most to want to avoid them.Unfortunately, there are mucho bad ones.I do believe the area in which you live makes the difference. Our seniors are from a time when they recall the tratment others got in the earlier years.I so wish we could believe that they all truly had our loved ones best interest at heart.

Hello - I read this thread with interest. Perhaps I can offer a bit of a different perspective. First of all - let me say that my mother is in a SNF - in an Alzheimer's unit. I also work in the same SNF - in the financial area. I chose this facility for my mother before I knew I would end up working there.

An intent to discharge is usually only issued as a last resort. The most common reasons I have seen are behavorial issues - usually significant enough to put other residents at risk or non-payment. If the facility is certified as a Medicare facility - a change to that payor source should not matter. However, the resident would need to meet specific guidelines for that to happen - including a recent hospital stay of at least 3 midnights. If she is trying to qualify for Medicaid -public assistance(various states call it other things - ie MediCal, etc) that might be an issue if the facility does not accept Medicaid residents.

Most often a doctor will no longer treat a patient due to non-compliance.

While I cannot speak for other facilities or other nursing home and assisted living organizationse, I can tell you that the staff at our facility absolutely has the best interst of every resident at heart.

Like I said - I am looking at this from both side - as family and staff. If you are not happy with the treatment, or if you have questions that are not getting answers, make sure you are talking to the people who can do something about it - like the Executive Director or Administrator. If I can offer any help or suggestions, I would be happy to do so. Best of luck in your situation.

Hi
I am going through the same thing. I thought you might like to read this. I live in NY.



Rights of Nursing Home Residents

The Nursing Home Reform Amendments of OBRA 1987 require that nursing facilities "promote and protect the rights of each resident." The resident’s rights must be displayed in the nursing facility along with a contact number for the state’s Long Term Care Ombudsman (a third-party resident advocate).
The general goals of the law are:

(1) Quality of Life: The law requires nursing homes to "care for the residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident." A new emphasis is placed on dignity, choice and self-determination for nursing home residents;

(2) Provision of Services and Activities: The law requires each nursing home to "provide services and activities to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident in accordance with a written plan of care which. . . is initially prepared, with participation to the extent practicable of the resident or the resident’s legal representative;

(3) Participation in Facility Administration: The law makes "resident and advocate participation" a criteria for assessing a facility’s compliance with administration requirements; and

(4) Assuring Access to the Ombudsman Program: The law grants immediate access by ombudsmen to residents and reasonable access, in accordance with state law, by ombudsmen to records; requires facilities to inform residents how to contact ombudsmen to voice complaints or in the event of a transfer or discharge from the facility; requires state agencies to share inspection results with ombudsmen.

Specific Resident Rights

1. Rights to Self-Determination: Nursing home residents have the right:

to choose their personal physician;
to full information, in advance, and participation in planning and making any changes in their care and treatment;
to reside and receive services with reasonable accommodation by the facility of individual needs and preferences;
to voice grievances about care or treatment they do or do not receive without discrimination or reprisal, and to receive prompt response from the facility; and
to organize and participate in resident groups (and their families have the right to organize family groups) in the facility.
2. Personal and Privacy Rights: Nursing home residents have the right:

to participate in social, religious and community activities as they choose;
to privacy in medical treatment, accommodations, personal visits, written and telephone conversations and meetings of resident and family groups; and
to confidentiality of personal and clinical records.
3. Rights Regarding Abuse and Restraints: Nursing home residents have the right:

to be free from physical or mental abuse, corporal punishment, involuntary seclusion or disciplinary use of restraints;
to be free of restraints used for the convenience of the staff rather than the well-being of the residents;
to have restraints used only under written physician’s orders to treat a resident’s medical symptoms and ensure her safety and the safety of others; and
to be given psychopharmacologic medication only as ordered by a physician as a part of a written plan of care for a specific medical symptom, with annual review for appropriateness by an independent, external expert.
4. Rights to Information: Nursing homes must:

upon request provide residents with the latest inspection results and any plan of correction submitted by the facility;
notify residents in advance of any plans to change their rooms or roommate;
inform residents of their rights upon admission and provide a written copy of the rights, including their rights regarding personal funds and their right to file a complaint with the state survey agency;
inform residents in writing, at admission and throughout their stay, of the services available under the basic rate and of any extra charges for extra services, including, for Medicaid residents, a list of services covered by Medicaid and those for which there is an extra charge; and
prominently display and provide oral and written information for residents about how to apply for and use Medicaid benefits and how to receive a refund for previous private payments that Medicaid will pay retroactively.
5. Rights to Visits: The nursing home must:

permit immediate visits by a resident’s personal physician and by representatives from the licensing agency and the Ombudsman Program;
permit immediate visits by a resident’s relatives, with the resident’s consent;
permit visits "subject to reasonable restriction" for others who visit with the resident’s consent; and
permit ombudsmen to review resident’s clinical records if a resident grants permission.
6. Transfer and Discharge Rights: Nursing homes "must permit each resident to remain in the facility and must not transfer or discharge the resident unless:"

the transfer or discharge is necessary to meet the resident’s welfare and the resident’s welfare cannot be met by the facility;
appropriate because the resident’s health has improved such that the resident no longer needs nursing home care;
the health or safety of other residents is endangered; or
the resident has failed, after reasonable notice, to pay an allowable facility charge for an item or service provided upon the resident request; and
the facility ceases to operate.
Notice must be given to residents and their representatives before transfer:

Timing: at least 30 days in advance, or as soon as possible if more immediate changes in health require more immediate transfer;
Content: reasons for transfer, the resident’s right to appeal the transfer, and the name, address and phone number of the Ombudsman Program and protection and advocacy programs for mentally ill and developmentally disabled; and
Returning to the Facility: the right to request that a resident’s bed be held, including information about how many days Medicaid will pay for the bed to be held and the facility’s bed-hold policies, and the right to return to the next available bed if Medicaid bed-holding coverage lapses.
Orientation: A facility must prepare and orient residents to ensure safe and orderly transfer or discharge from the facility.

7. Protection of Personal Funds: A nursing home must:

not require residents to deposit their personal funds with the facility; and
if it accepts written responsibility for resident’s funds:
keep funds over $50 in an interest bearing account, separate from the facility account;
keep other funds available in a separate account or petty cash fund;
keep a complete and separate accounting of each resident’s funds, with a written record of all transactions, available for review by residents and their representatives;
notify Medicaid residents when their balance account comes within $200 of the Medicaid limit and the effect of this on their eligibility;
upon a resident’s death, turn funds over to the resident’s trustee;
purchase a surety bond to secure residents’ funds in its keeping; and
do not charge a resident for any item or service covered by Medicaid, specifically including routine personal hygiene items and services.
8. Protection Against Medicaid Discrimination: Nursing homes must:

establish and maintain identical policies and practices regarding transfer, discharge and the provision of services required under Medicaid for all individuals regardless of source of payment;
not require residents to waive their rights to Medicaid, and must provide information about how to apply for Medicaid;
not require a third party to guarantee payment as a condition of admission or continued stay; and
not "charge, solicit, accept or receive" gifts, money, donations or "other consideration" as a precondition for admission or for continued stay for persons eligible for Medicaid.


Available from ElderCare Online™ www.ec-online.net ©1998 Prism Innovations, Inc.

I'm thrilled for you

Finally a doc that will step up to the plate and provide care for your Mother. That is wonderful news.

I love the idea of sharing your story to enact legislation to change the laws. Now it is time to focus on other aspects of your life. I know that feeling.

Vicki

Sugarlips

Hi All, Thought I'd give you the end (I hope) of the story here. After four months of exhausting all possible resources (nursing home ombudsperson, Legal Aid, Medical Licensure Board, Medicare, etc.), I finally was able to locate a doctor who who take responsibility for my mom's care, so I switch my mom's physician from the Medical Director of the nursing home to this other doctor. I have had offers from the media, including a nationally syndicated eldercare radio program, to tell this story to the media, but I don't want to cause any more problems for my mom as she is happy in the nursing home. Some day I will share this story with the media and lobby for legislation so that no 90 year old resident of a nursing home EVER has to face this situation. Jacqueline Marcell, author of the book, ElderRage, was incensed by this situation with my mom and offered to put me on her radio program. So a big sigh of relief for now. Both my mom and dad are doing well and I must get back to the important business of my career,home, and family. They've been neglected for the past four months, I'm afraid. Thanks for all your support.

P.S. JT. I am the Mistress of Understatement. "Not half bad" means I like your idea a lot! Sic 'em Gail Susan!

"Whatever tomorrow brings, I"ll be there-with open arms and open eyes"

Thank you "Just Tired" (boy can I relate to that name) for pointing the way to a thread I was hunting for! Not a half bad suggestion for Gail Susan either! Welcome to the forum JT and I hope you'll post again!

Gail Susan, I don't have any advice for you that you haven't already received. I'm just hoping something worked for you and that you'll post again and let us know what's happened. I've been wondering if you found an answer, This situation is simply outrageous. I'll be looking for you to post- I hope-Take care of yourself-Melissa

"Whatever tomorrow brings, I"ll be there-with open arms and open eyes"

Dear GailSusan:
Many TV stations have a consumer reporter or
trouble shooter. Try calling one and tell them
your story. The last thing the doctor or
nursing home would want is bad publicty.

CactusRose

Welcome to the forum. Can you tell us a little about yourself and the person you care for?

Vicki

Sugarlips

If a nursing home has agreed to accept medicare or medicade they cannot put a person out.They have signed on to this with the state and have to accept her when her funds run out.Have you re read the admission papers.Look at it very carefully.The one thing that I did learn from this high priced lawyer is when they have an agreement to accept medicade they cannot change their rules .I know this becauseI told her of a friend that was facing taking her mom out of a facility because her own funds ran out.She told me to have this lady contact her because they are breaking the law .Many places will not accept medicade and have the private pay runs out the patient leaves.She did say that many assisted living facilities will not accept medicade.Look at the contract and see if it is binding.

Oh, the comfort, the inexpressible comfort of feeling safe with a person, having neither to weigh thoughts nor measure words, but pouring them all out, just as they are, chaff and grain together, certain that a faithful hand will take and sift them, keeping what is worth keeping, and with a breath of kindness blowing the rest away.

quote:

---

Originally posted by GailSusan:
Hi all, I'm new to the Board and am very grateful to have found it. I'm new to the world of nursing homes and have to admit my mom and I don't have the hang of it yet. My 90 year old mom received a 30 day discharge notice today. She loves the facility and has been very happy there so she was shocked and saddened by this.

The first reason cited is that my mom drank some Ensure when she was on fluid restrictions (against doctor's orders). This is true, but the doctor eliminated the fluid restriction order a week later, so it wasn't life threatening. The second reason is that I called the nursing home each day when my mom had pneumonia to find out doctors orders, etc. I was not told that this was a bad thing to do. I was told that calling the doctors was a bad thing to do and that I should go through the charge nurse to obtain information and she will communicate with the doctor. So this is what I have done. No one indicated any problem with my phone calls until today.

They thought my mom was going to be private pay when they admitted her, but she ended up qualifying for Medicare. Could this be the real reason for the letter? Isn't this a bit cold-hearted and cruel?

I live out of state so phone contact is essential as I have POA and am the only one responsible for her healthcare decisions besides her. Please straighten me out. I'm clearly out of synch with nursing home expectations. Thanks.

---

Private pay, Medicare,and Medicaid should have nothing to do with your Mother"s eviction notice.If you feel like it is, notify your/her social services case worker and local ombudsman.

I'm so sorry this is happening to your Mom. I hope you find some help with the care manager. Please post again and let us know what you found out.

Vicki

Sugarlips

Using a care manager may make things easier, unless you move your parents to where you are or you move to them. One thing you will want to keep in mind is that you should not use your money for this. A care manager will also help find another Dr. She is not loosing her insurance, she just has to use a new one. It would be much better to have a care manager that can be there and see the situation as well as deal with it. I am certain the care manager will help find a new place, as this facility seems to be totally unacceptable and help your Mom with the adjustment.

Edyth Ann aka Bubblehead aka Queen Bubble
AOL IM EdythAnn12
edythann@netzero.net

Addenda to ...

I will take this opportunity to add the following links for those seeking help from a professional care manager

http://www.caremanager.org/ home page of National Association of Professional Geriatric Care Managers

to find one in your area---click on The Association to get this page

http://www.caremanager.org/gcm/Association.htm and then click on chapters to get to where you can search on a map.
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Use today wisely,
It's the only one we get.

Oh, for so short a time,
we are on loan to each other.

Jim

Hi Vera, I have taken your advice and used the link you provided to contact a geriatric case manager. I had used one in the past, who went through our savings like there was no tomorrow, but this time, I requested a one time consultation. So hopefully that will be within our budget.

Hi Edyth, My mom has Blue Care 65 coverage (because my dad is still in the community and he his insurance is through her retiree policy). With Blue Care 65 you MUST have a Blue Care 65 physician. There is only one viable Blue Care 65 physician who comes to the nursing home and that is my mom's current doctor who is also the Medical Director of the NH.

Hi May, The irony is that the social worker's family owns the nursing home! I guess they don't see a conflict of interest in that!

I'm at my wits end. Let's hope that geriatric case manager can help. Thanks.

Gail, Edyth is right.What does one have to do for another.All this because of ensure.Sound like they are not happy with medicade and the fact that you are standing up to them.Sounds like you need to find good eldercare attorney.You certainly are caught between a rock and a hard ball.SO DIFFICULT TO DEAL WITH THIS LONG DISTANCE.What I want to know is the social worker who has teir office in the facility, paid by the facility?If they are how are they no in a conflict of interest.

"Beauty is in the eye of the
???beholder, but it may be necessary
???from time to time to give a stupid
???or misinformed beholder a black
???eye." - Miss Piggy

Gail,

I don't understand what the Dr. has to do with your Mother's medical insurance? How can the medical insurance drop your mom because that one dr. will not be her Dr.?

Edyth Ann aka Bubblehead aka Queen Bubble
AOL IM EdythAnn12
edythann@netzero.net