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This country made a wrong turn some time ago. It wasn't intentional. In 1965 President Johnson and the Congress, when they allowed Medicare to provide payment to nursing homes (and now Medicaid accounts for almost 3/4 of all payment), had no idea what long-term care would look like. Today, it's too often an unpleasant picture. If I heard someone say, "I can't wait to go live in a nursing home," I would recommend they receive psychiatric help. Nursing homes are coping with serious systemic problems. They have entrenched themselves into government and our personal lives because, when it come down to it, they offer a price the elderly and the sick and the public can afford to pay.
If ever there was an improper use of a word, it's the "homes" in nursing homes. A home is a place where you have a regular looking bed and doors with locks and your knickknacks scattered around the rooms. It's not a place where you have to wake up early every morning, have dinner at 5 PM every night, and where the ordinary pieces of life - listening to music, gardening, watching a movie, or just having a conversation are turned into scheduled events with an activity director.
Who is to blame for the poor care in our long-term care facilities? Difficult question. The owners must shoulder some of the blame. Yes, Medicaid reimbursement is sometimes inadequate, direct caregiver jobs go unfilled, and the new Medicare laws and PPS have reduced reimbursement dollars (but Congress has returned some of this money). But the corporations have not acted responsibly. They expand and overpay for independent facilities. They overleverage their balance sheets while managing their long-term care facilities becomes an afterthought. Profits are plentiful and corporate looting common. To learn more about the long-term care industry, click on any subject.
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Providing expert advice and consulting about the long-term care industry.
So how do we improve the quality of life in nursing homes in America
and prevent the abuse and neglect now becoming more and more common?
Lawmakers must require minimum staffing levels for nursing staff. They must require air conditioning when the temperature outside is greater than 90º. And there must be consequences, not long drawn out appeal procedures and inconsequential fines, for facilities for failing to obey the law.
The introduction of plants and animals into a facility can help eliminate the loneliness, helplessness, and boredom experienced by too many residents. Alzheimer's Disease patients and other dementia related residents benefit from these live animals. The Eden Alternative is a program which offers concrete advice on how to accomplish this, as well as a different approach to managing the nursing assistants and other direct caretakers.
Corporations such as Beverly Enterprises, Mariner Post-Acute Network, Vendor, Entreated Health Services, Genesis Health Ventures, and others must be punished for placing profits before people. This primarily manifests itself in the form of inadequate staffing which is often the underlying cause of neglect and abuse. Residents with Alzheimer's Disease and other problems need lot of care. If you suspect an instance of abuse or neglect from a fall, dehydration, bedsore, or some other problem, contact an attorney. Almost all lawyers offer a free consultation.
And finally it is the small acts - the visit by a small child running up and down a hallway, an ice cream run by a family member for the residents of a floor, the nursing assistant who takes the extra time to comb your mother's hair, or a joke which makes an old timer laugh, which improve the quality of life in a nursing home. You can't demand that someone care, you can't "in-service" dedication, and you can't legislate compassion. Sometimes it's only the little things which are remembered.
Federal law states that facilities (those that receive Medicaid & Medicare funds) must provide services and activities to attain or maintain the highest practical physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. Facilities must prevent the deterioration of a resident's abilities to bathe, dress, groom, transfer and ambulate, and other activities of daily living. Sometimes, and often because of inadequate staffing and training, problems occur. Seven categories of abuse and neglect have been identified by the United States Department of Health and Human Services:
Physical Abuse * Misuse of Restraints (chemical & physical) * Verbal/Emotional Abuse
Physical Neglect * Medical Neglect * Verbal/Emotional Neglect * Personal Property Abuse
Possible Signs of Nursing Home Abuse or Neglect
Any injury resulting from restraining a confused resident. Rapid weight loss. Unexplained or unexpected death. Development of a bedsores ("pressure sores" or "Decubitus ulcers"). One nursing home resident injures another. Heavy medication and sedation is used in place of adequate nursing staff and supervision. Caretaker cannot adequately explain condition. An occurrence of a broken bone, especially a fractured hip. A resident who is suddenly and unexpectedly emotionally upset or agitated, or withdrawn and non-communicative.
If abuse or neglect is suspected, contact an attorney who specializes in elder law areas. You can seek compensation for damages and under certain circumstances, and in certain states, one may also seek punitive damages in a civil lawsuit to deter such conduct in the future. Most lawyers will accept a case for a contingency fee, that is they will be paid a percentage of the recovery money only if they can prove there was negligence. If one lawyer does not believe you have good case, you might get a second opinion from another attorney. Some attorneys have a better understanding of nursing home negligence law than others. Almost all attorneys offer a free consultation by phone or in person. For additional legal information and to find an attorney who specializes in elder law near you, CLICK HERE. Assisted living facilities are popping up everywhere. Problems with care in assisted living can also occur and people should be aware of this.
RESTRAINTS The use of restraints is one of the most negative features of nursing home care. Approximately 300,000 nursing home residents remain physically restrained, despite a federal mandate to the contrary. In an attempt to limit their use, the Nursing Home Reform Act of 1987 states, "residents have the right to be free from...any physical and chemical restraint imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms".
Restraints are generally regarded as protective devices and it is this protective rationale that explains their prevalence and the historical basis of clinical management decisions. While the belief persists that they minimize resident's falls and injuries, a growing body of research has shown that they may actually exacerbate serious injuries. And there is also the psychological impact resulting from using restraints - anger, fear, humiliation, embarrassment, discomfort, and demoralization - are some of the undesirable effects documented.
BEDSORES Elderly residents who are bed bound for all or part of the day are susceptible to bedsores, also called pressure sores or decubitus ulcers. Prevention requires attention to relief of pressure through turning schedules and pressure-reducing devices. Maintaining clear, dry skin, adequate hydration, and supplemental nutrition for the malnourished is equally critical to prevent pressure sores. Federal law states that if a resident enters a nursing home without bedsores, than the nursing home must ensure that they do not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable.
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