July 10, 2022 Uncategorized
In the 1980s, Congress found the level of care provided in nursing homes was insufficient to keep residents healthy. To address these concerns, Congress enacted the Federal Nursing Home Reform Act as part of the 1987 federal Omnibus Budget Reconciliation Act (OBRA 1987). Nursing homes seeking federal aid — Medicare and Medicaid —must comply with this law and others to prevent nursing home abuse.
Requirements Under OBRA 1987
OBRA 1987 states that each individual living within a nursing home must receive an individualized personal care plan that includes care from all necessary medical professionals. The act also requires:
- Access to a high quality of life and care
- Freedom from unnecessary restraints, either physical or chemical
- Maintained levels of daily activities, including walking and bathing
These regulations require a sufficient level of staffing all day, every day. Many nursing homes still prefer to remain understaffed so they can increase profits. Other facilities refuse to pay their staff sufficiently, which leads to disgruntled employees and high rates of turnover. Ultimately, poor staffing results in resident injuries or even wrongful death.
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Nursing Home Standards and Expectations
Unlike a straight contract between a customer and a business, which is only as good as the terms of the agreement being followed by the parties involved, duties of care and licensing impose a higher level of expectation and standard to be delivered by nursing homes regardless of their business account status.
When choosing nursing home care, it is critical to know that they comply with and follow the regulatory laws at the federal and state levels to operate. Having this verified, residents are guaranteed to receive the care they need.
In Illinois, the Illinois Nursing Home Care Act sets standards for nursing home care facilities, which means that if you live in Illinois and are looking for nursing home care, the state will ensure that residents are treated with the best standards possible. Most importantly, it ensures that residents maintain their right to autonomy as much as possible.
General Care for Government Insurance Eligibility
Nursing homes are primary operations that tap into government health insurance programs like Medicare and state low-income assistance programs. As a result, to be eligible to participate, nursing homes that participate agree to provide a standard of care defined by the government. That includes mental, physical, and psychosocial care where needed, with involved residents.
The government enforces this baseline standard criterion set through audits and investigations, and violations are penalized financially or even criminally where necessary, and the law allows.
Families need to understand, however, that government standards for home care services are performance bars the nursing home should be meeting prospectively. The government agencies involved typically don’t know of a violation or a problem until they receive reports after the fact or find a problem in an inspection. Alternatively, home care accreditation standards exist, but they are usually industry-determined standards, not government requirements.
State Medical Accommodation of Needs
Where a resident has been accepted into a nursing home, state laws then apply concerning the type of care provided and the minimum standards that should be met. These are often tied to licensure and the ability to keep in good standing. If not, and violations mount up, the licensing can be revoked for the facility or staff, shutting down operations.
As a business, that’s the last place a nursing home wants to be, so there is an incentive from a regulatory perspective to meet such standards proactively. Again, violations are found after the fact through case reviews, audits, and investigations – something nursing home neglect lawyers in Illinois see often.
Operational Requirements
Nursing homes are affected by state-level laws and municipal codes. Both dictate the level and amount of resources that should generally be provided in a nursing home regarding staffing levels, expertise, and capabilities, especially if operating as a 24/7 care facility.
Typically, these standards are spelled out as the number of people on site per patient per day. When staffing levels dip, the facility must bring in additional staff to cover the operating deficit.
Care Plan Per Patient
An additional approach to care requirements that nursing homes must meet tends to be an individualized plan of how each resident will be addressed. That includes a comprehensive view and direction on the medical and physical needs of the patient as well as mental care.
Without this, nursing home staff don’t have a reference for how they are expected to operate with one resident versus another, aside from general procedures, which can turn into big mistakes. Administrative and medical staff on site are expected to be familiar with these care plans per resident and comply with them.
Basic Physical Care Assistance
Nursing homes are expected to have the staff, equipment, and means to help elderly patients with daily needs, particularly with problems of incontinence and bowel control. Many times, residents need assisted-care living help because of ongoing health conditions that require trained staff to be available to provide such services. Neglecting these issues can result in serious problems ranging from lack of hygiene and rashes to infections to psychological damage.
In advanced cases, feeding tube technology and related medical equipment will be applied, and nursing homes must have procedures, training, and sufficient staffing to maintain such requirements. Operational challenges with planning and scheduling are insufficient arguments for not maintaining regular feeding and supporting assisted patients. In this regard, hydration, necessary fluids, and chronic pharmaceutical management fall under the same responsibility.
All of the above is in addition to the “reasonable person” standard of care understood when taking on the housing and support of an elderly person in a nursing home who needs personal care, nutritional standards, regular exercise, social interaction, and support from the community.
Poor Staffing Leads to Poor Resident Care
Personalized care plans depend on having enough staff to meet each resident’s needs. In an understaffed nursing home, this standard falls apart, often leading families to seek legal solutions for elder abuse cases. Indeed, improper staffing or understaffing often leads to many harmful situations, including:
- Wandering
- Elopement
- Falls
- Missed medication
- Inadequate food or fluid intake
- Pressure sores from lack of movement
- The use of physical or chemical restraints
- Physical or sexual abuse
Any of these incidents or actions can cause severe or life-threatening injuries, including infection, malnutrition or dehydration. In severe cases, it may even lead to wrongful death.
Certain Elderly Populations Are at Greater Risk
In addition to improving the standards of care in nursing homes, OBRA 1987 also changed how inspections are conducted. Inspectors now speak directly with residents to learn about the quality of care from their own experiences, and an Illinois nursing home abuse lawyer can help address concerns if those standards are not met.
Despite the requirements of OBRA 1987, facility owners and staff have found ways to hide neglect or abuse. This is especially true for abused residents who are unable to clearly communicate, such as individuals with dementia or those who do not speak English. The best way we can all protect this vulnerable population is to ensure we know the signs of nursing home abuse and neglect and speak up whenever we have concerns.
