Nursing Home Guide for Family Members

Clients often tell us that they trusted the nursing home or assisted living facility to care for their loved one. We also heard clients say that they assumed their regular visits to the nursing home or assisted living facility would encourage staff to provide better care for their family member. Well that may be true, but their presence in the room or down the hall is not enough.

Frustrated family members concerned about the level of care their loved one frequently receives. Most of the time, your complaints cannot and should not be addressed by filing a lawsuit, so we provide more general advice. That advice is as follows:

Organize:

Keep a journal or log of each visit to the nursing home or assisted living facility and include the following information:

• Date / time of the visit.
• Location: where your loved one was when you arrived.
• Complaints: stained clothes, sheets, problems with food, no water? Write down the complaints.
• Notify Staff: Submit a written and verbal complaint to the charge nurse. Write your name and what you said would be done about the problem.
• Follow-up: Next time you are there, ask the nurse what has been done. Ask to see the table where the corrected action should have been documented.

Document your complaints:

If the problem continues, take photos; send a letter to the nursing home administrator requesting a conference. Ask staff for more training. Ask to see the facility’s policies and procedures (you have this right under the Virginia Administrative Code) and compare what the staff is doing with what the facility’s policies and procedures require.

Complain to state / local authorities:

If problems get worse or a single accident causes harm, call your local Department of Social Services (every county has one) and ask to speak to Adult Protective Services. File a complaint. You can also call the Virginia Department of Health (1-800-955-1919) and file a complaint with them.

How to work with treating physicians:

Many treating physicians also serve as medical directors for the facility. They are only required to review or examine a resident’s chart, in accordance with Medicare requirements, and when there is a change in condition. Ask to speak with the treating physician after each visit to determine if there has been a change in the condition. If it is a routine visit, contact the doctor to find out what was examined. If medications are changed, ask why. Be curious and write down the responses you receive. We have found in our cases where some nurses write the doctor’s orders and then call the doctor after the fact, just to get his “approval.”

What to do if a fall occurs:

If a fall occurs, go immediately to the facility. Ask for the name of the person who found your loved one. Where was the fall? What was he wearing? Was there a medical team involved? Write all this down. Who examined your relative to assess his condition after the fall? Who determined that no injury occurred? Did a roommate witness the fall?

Follow up with the charge nurse – ask what is being done to prevent another fall. Ask to attend the next Fall Committee conference when your family member is discussed.

Also, consider the context of the fall: what time of day? Where they were going? Had they asked for help? Do they have the ability to ask for help? Is your family member taking any new medications that may cause dizziness?

What happens if your resident stops eating?:

We heard the staff say all the time: “We tried to get him to eat, but he refused.” That’s right? What is the facility policy? I’m sure the policy doesn’t say “if the resident refuses to eat, stop trying.” It will likely require staff to provide an alternative or supplement until the resident gets the necessary calories. Malnutrition can lead to the development of bed sores and prevents existing bed sores from healing.

Check the table. Can your loved one see to eat? Can it feed itself? What about the food? Will he eat what you bring him? If so, tell the nurse and ask her to record it. The refusal of the patient is a great excuse that the facilities give when problems arise.

Talk about supplements, IV nutrition, energy bars – there are ways to get the calories you need. Is the doctor conscious? Let him know.

Conclution:

There are too many possible problems in a nursing home setting to anticipate or address here. However, it is important to be a diligent family member who takes notes and knows about the care provided, including who provides it. Also, VISIT, VISIT OFTEN – bring other family members, ministers, anyone who is going. A supportive family can mean the difference between good care and poor care.