Eric Carlson: On Elder Care—and Elder Law

Tips from the author of "20 Common Nursing Home Problems—and How to Resolve Them."

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If there's a problem with a nursing home, what are your rights?

Many nursing homes follow procedures that are in conflict with the federal Nursing Home Reform Law, which has been in effect since 1990. The nursing homes' admission agreements often have provisions that contradict what the law says. For example, an admission agreement might limit the rights of a Medicaid-eligible resident to be readmitted after a hospital stay. By law, residents are entitled to the nursing home's next available bed. We have a consumer guide that gives step-by-step instructions on how to handle 20 common nursing home problems. Each state has an ombudsman program that provides advocacy for nursing home residents free of charge. Contact information for a particular state's program can be found at the National Long Term Care Ombudsman Resource Center. I know at the time it is a difficult period and people feel unsupported, and it's baffling to them that this possibly could be happening, but nursing homes need more consumer pressure. A lot depends on consumers knowing more about nursing homes and not being intimidated talking to these people.

How do laws governing assisted-living communities differ from nursing homes?

Older persons and their family members need to be particularly careful in selecting an assisted-living facility and, after admission, in demanding adequate, personalized care. Assisted living is regulated state by state—there is essentially no federal law on assisted living. Commonly, "assisted-living facility" is defined in state law as a type of facility that provides room, board, and some sort of health-related services. Which is true, but not specific enough. Under such definitions, an assisted-living facility may have around-the-clock nurse staffing with the capacity to handle a resident with significant health care needs. Or it may be a glorified board and care home, with few services beyond meals and housekeeping. Some states' regulations set virtually no standards for the training provided to direct-care workers, and in still other states, the regulations set trivial standards such as 10 hours of initial training. Information on each state's direct-care training requirements can be found in NSCLC's Critical Issues in Assisted Living: Who's In, Who's Out, and Who's Providing the Care, available at State regulations often are vague as to what type of needs an assisted-living facility is required to accommodate. Regulations commonly say that a resident can be evicted when a facility can no longer meet her needs but with little specificity of what, if anything, the facility is required to do to try to meet those needs. The Assisted Living Consumer Alliance provides information to consumers and policymakers and is developing recommendations to guide the development of assisted-living law on both the state and federal levels. The ALCA website includes explanations of each state's assisted-living law.

senior health
senior citizens
nursing homes