Source: https://friedlanderlaw.com/help-your-clients-pick-a-nursing-home/
Timestamp: 2019-04-22 14:24:25+00:00

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You know how to investigate a nursing home case and how to spot evidence of negligence—or worse. Use that experience to show your clients how to steer clear of the wrong homes, and help them make the right decision for their loved ones.
Clearly, there’s more to nursing home evaluation than meets the cautious eye of a professional litigator, much less the worried eye of an elderly person or someone concerned about finding a home for a failing family member. So how do you turn your experience and knowledge into useful advice for your clients and their loved ones?
What you can offer someone looking for a nursing home is a lawyer’s perspective on common financial, administrative, medical, and quality-of-life concerns that arise in nursing home care and some tools for evaluating how well a specific nursing home addresses them.
The first 20 Medicare days are paid in full; after that, the resident pays a daily copay, which may be covered by a client’s Medigap insurance policy, if he or she has one. Nursing home residents whose room and board are not covered by Medicare may still look to Medicare for health coverage for hospital stays, medical care, and medications.
Even if your client’s resources are ample, it’s wise to consider a facility’s Medicaid certification at the start. For one thing, Medicaid-certified facilities are evaluated annually and must meet federal and state certification, licensing, and performance standards.12 Moreover, statistics show that most long-term nursing home residents will deplete their resources enough to meet Medicaid eligibility standards at some time during their stay, and federal law prohibits Medicaid-certified homes from evicting residents or terminating necessary services when residents become Medicaid-eligible.
Whether your client pays privately or with public support, know what services will be covered in a nursing facility’s rate structure. Private-pay residents, in particular, should ascertain which services are included in the facility’s basic daily rate and which—for instance, therapy, medications, lab tests, and physicians’ services—are billed separately.
Quality of care, certainly one of the chief criteria for selecting a nursing home, is at the heart of your experience as a nursing home litigator.
You know how to scrutinize inspection reports, medical records, and staff logs for indicators of deficiencies in staffing, training, supervision, policy development, equipment, assessment, planning, and oversight. But that’s mostly after-the-fact investigation; looking for these red flags before your client signs an admissions agreement is a different matter. Here are some simple suggestions to make the process more manageable.
Look for “culture change” programs or practices. “Culture change” is a term used by nursing home researchers and advocates to describe actions taken to improve quality of care and quality of life by “de-institutionalizing services and individualizing care.”24 It grew out of the 1987 Federal Nursing Home Reform Act, which mandates that each nursing home “care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.”25 Homes that emphasize this protocol use “person-directed practices” that allow residents to make daily life choices on their own, emphasize the continuity of relationships between residents and staff, and make the care environment as homelike, intergenerational, and intimate as possible.
Your experience, knowledge, and the instincts you’ve honed as a nursing home litigator can help you offer a valuable service to your clients. Use your hard-won knowledge to help them make one of the most important decisions for themselves and their loved ones. Learn to use the tools and resources you’ve developed in litigation—along with those available through federal, state, and advocacy organizations—with greater insight and discernment.
You may not be an elder law specialist, but by drawing on your familiarity with nursing home practices and your ability to look past a facility’s outward appearance, you may help clients avoid those ugly stories of nursing home care gone awry.
William S. Friedlander practices law in Ithaca, New York. He can be reached at [email protected].
Ctrs. for Disease Control & Prev., FastStats: Nursing Home Care (Apr. 15, 2010),www.cdc.gov/nchs/fastats/nursingh.htm; Sarah Greene Burger et al., Nurses Involvement in Nursing Home Culture Change:Overcoming Barriers, Advancing Opportunities 7 (Spring 2009), //tinyurl.com/2dpmstp (citing Charlene Harrington et al., NursingFacilities, Staffing, Residents, and Facility Deficiencies, 2000 through2006 (U. Cal., Sept. 2007),www.pascenter.org/documents/OSCAR2006.pdf).
Medicare’s Web site offers state links and home-by-home evaluations, the starting point for any nursing home search, at Ctrs. for Medicare & Medicaid Servs., Nursing Home Compare,www.medicare.gov/nhcompare.
Charlene Harrington et al., Nursing Facilities, Staffing, Residents, andFacility Deficiencies, 2003 through 2008 (U. Cal., Nov. 2009),www.pascenter.org/documents/OSCAR_complete_2009.pdf.
U.S. Govt. Accountability Office, Nursing Homes: CMS’s SpecialFocus Facility Methodology Should Better Target the Most PoorlyPerforming Homes, Which Tended to Be Chain-Affiliated and For-Profit, GAO (Aug. 2009),www.aging.senate.gov/letters/gaosffreport.pdf; Jack Gillum, Analysis:Poor Ratings Persist for 1 in 5 U.S. Nursing Homes, USA Today (Jan. 28, 2010), www.usatoday.com/news/health/2010-01-28-nursing28_ST_N.htm; see also Heather Gillers et al., Crisis of Careamong State Nursing Homes, Indianapolis Star (Mar. 9, 2010),//tinyurl.com/26fnne5.
See Cynthia Rudder & Meghan Shineman, Nursing Home Oversight inNew York State: A Regional Assessment (Long Term Care Community Coalition 2006), //nursing home411.org/documents/NYsoversight reportCRJune12.pdf.
See e.g. U.S. v. NHC Health Care Corp., 163 F. Supp. 2d 1051 (W.D. Mo. 2001).
See Ctrs. for Medicare & Medicaid Servs., Guide to Choosing aNursing Home 11–16 (Nov. 2008),www.medicare.gov/Publications/Pubs/pdf/02174.pdf [hereinafter CMSGuide]; Dept. Health & Hum. Servs. Admin. on Aging, EldercareLocator, www.eldercare.gov/Eldercare.NET/Public/Home.aspx; Dept. Health & Hum. Servs., National Clearinghouse for Long-Term CareInformation (Oct. 19, 2008),www.longtermcare.gov/LTC/Main_Site/index.aspx.
Medicare benefits may be discontinued if assessment reveals that the patient needs simple custodial care rather than skilled nursing care.See Chamberlain v. Leavitt, 2009 WL 385401 at *5 (N.D.N.Y. 2009).
For brief overviews of the Medicare and Medicaid programs offered, see CMS Guide, supra n. 7, at 40–42, 43–45.
See CMS Guide, supra n. 7, at 40.
For a summary of Medicaid rights and a useful index of state Medicaid agencies and ombudsman services, see generally CMS Guide, supran. 7.
For footnoted leads to federal Medicaid nursing home standards, seeCal. Advocs. for Nursing Home Reform, Nursing Home CareStandards (Nov. 12, 2008),www.canhr.org/factsheets/nh_fs/html/fs_CareStandards.html.
See Cal. Advocs. for Nursing Home Reform, Nursing Home Guide,www.nursinghome guide.org/NHG/nhg_txt_home.lasso; N.Y. Dept. Health, Selecting a Nursing Home in New York State 3 (Dec. 2006),www.health.state.ny.us/facilities/nursing/select_nh/docs/select_ nh.pdf.
See N.Y. Dept. Health, supra n. 13, at 30.
See Addison v. Lochearn Nursing Home, LLC, 983 A.2d 138 (Md. 2009); see also Oesterle v. Atria Mgmt. Co., 2009 WL 2043492 (D. Kan. July 14, 2009); see also Moffett v. Life Care Ctrs. Am., 219 P.3d 1068 (Colo. 2009).
See Cal. Advocs. for Nursing Home Reform, Nursing Home AdmissionAgreements (Feb. 16, 2010),//canhr.org/factsheets/nh_fs/html/fs_admissionagreement.htm(noting California’s efforts to develop a standard admissions agreement and describing the common problems such an agreement was intended to address).
See Ctrs. for Medicare & Medicaid Servs., supra n. 2.
See Gillum, supra n. 4; Gillers, supra n. 4; see Capriotti v. BeverlyEnters. Pa., Inc., 2004 WL 3584850 (Pa. Com. Pl. June 30, 2004); seealso Dooley ex rel. Estate of Pannell v. Cap-Care of Ark., Inc., 338 F. Supp. 2d 962 (E.D. Ark. 2004); but see Howard v. Estate of Harper exrel. Harper, 947 So. 2d 854 (Miss. 2006).
See Cal. Advocs. for Nursing Home Reform, Nursing Home EvaluationChecklist (Oct. 15, 2008),//canhr.org/factsheets/nh_fs/html/fs_evalchecklist.htm; see alsoCal. Advocs. for Nursing Home Reform, supra n. 12. For a case involving inadequate respiratory services, see Morisette v. TerenceCardinal Cooke Health Care Ctr., 797 N.Y.S.2d 856 (N.Y., N.Y. Co. Sup. 2005).
See e.g. Wagner by Wagner v. Fair Acres Geriatric Ctr., 49 F.3d 1002 (3d Cir. 1995).
Ctrs. for Medicare & Medicaid Servs., Understanding Nursing HomeQuality Measures,www.medicare.gov/NHCompare/static/tabHelp.asp?active Tab=4. For an example of repeated violations in a dementia-certified facility, seeWoodstock Care Ctr. v. Thompson, 363 F.3d 583 (6th Cir. 2003); for a pattern of persisting violations relating to pressure sores, see U.S. v.NHC Health Care Corp., 163 F. Supp. 2d 1051 (W.D. Mo. 2001).
For an easily printed, comprehensive checklist, see Cal. Advocs. for Nursing Home Reform, supra n. 19 (including pointed questions for use during nursing home visits); CMS Guide, supra n. 7, at 32–35; see alsoNCCNHR, A Consumer Guide to Choosing a Nursing Home,Consumer Fact Sheet (Aug. 2009), //tinyurl.com/2ew4yah; N.Y. Dept. Health, supra n. 13, at 12–18.
For patterns of resident decline involving pressure sores, diet, dehydration, and other wasting conditions, see Dooley, 338 F.Supp.2d 962; Scott v. Central Ark. Nursing Ctrs., Inc., 278 S.W.3d 587 (Ark. App. 2008), Iannotti v. Milford N. Health Care Ctr., 2008 WL 4853613 (Conn. Super. Oct. 23, 2008). Regarding staffing, see Soderstrom v.Beaumont Nursing Home, Inc., 2008 WL 5216865 (Mass. Super. Nov. 4, 2008).
NCCNHR, Culture Change in Nursing Homes, Consumer Fact Sheet No. 19 (Aug. 2006),www.allhealth.org/BriefingMaterials/NCCNHRCultureChange06-909.pdf.
Carmen S. Bowman & Karen Schoeneman, Ctrs. for Medicare & Medicaid Servs., Development of the Artifacts of Culture Change Tool(Apr. 21, 2006), www.culturechangenow.com/pdf/artifacts.pdf; see alsoNCCNHR, supra n. 24.

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