If You Are Afraid

FEAR IS NATURAL

Most of us who have placed a loved one in a nursing home or who visit nursing homes have been afraid.  Many of the people who call TANHR are typically afraid of:

  • Making the wrong decision about placement
  • Poor or inadequate care of the resident
  • Loss of love or approval of our loved one
  • Staff who might retaliate in some manner if we confront them about something with which we are dissatisfied
  • Our loved one’s death

FEAR IS A FEELING

It is important to recognize and accept the feeling or it will haunt us.  It is okay to be afraid, but we can decide to act and make positive decisions in the face of fear.  The opposite of fear is love and love is a decision .

GUILT AND FRUSTRATION

Other feelings that loved ones and friends of residents frequently have are guilt and frustration.  We are sometimes unwilling to face two realities: the declining abilities and health of our loved one or friend and our own inability to care for the loved one due to reasons such as finances, work or family responsibilities, lack of resources or emotional limitations.  These are all valid reasons for placement of a loved one in a nursing home.  One result of denial is guilt.  In this case, the guilt is not helpful, because it can immobilize us - not good for the residents who depend on us to act in their behalf.  We also frequently get frustrated and beat down by problems associated with the resident or nursing home staff or facilities.  This can lead to apathy.  Frustration and its partner apathy are the enemy.  Do something , even if it is a small gesture to make the resident’s stay a bit more comfortable or light.  Even a smile and a hello help.  It is not necessary to stay long.  Brief visits are often preferred and appreciated by residents.


SOLUTIONS

Remember these three things:

You are not alone

  • TANHR is available for support during difficult times or to help you get the resources and responses you need.  Call us toll free at (888) TANHR4U (888-826-4748) or locally at (972) 572-6330.  TANHR is working for residents by accompanying them or their loved ones to nursing home offices, by calling agencies and by going to the legislature to try to improve laws regulating nursing homes.
  • Reach out to other loved ones or friends for support and encouragement.  If you see regular visitors to other residents, they can be valuable allies and support.
  • Look at the other pages on this website for additional help: About Us , Resources , What You Can Do , and News .

Legal remedies are available

  • Legal remedies are available for your friend or loved one who is not getting good care.  TRUST YOUR GUT!  You know intuitively when someone is being harmed or neglected.  Listen to your feelings.  If something happens that really scares you, ACT!  If you have attempted to deal with a situation with staff and administration of the nursing home and have not gotten results, TANHR has a list of attorneys who handle these kinds of cases.  Feel free to call us even if you are not sure if there is a legal care or enough evidence, etc.  The attorneys can determine these things.

You must be strong!

  • Residents very often cannot stand up for themselves and they depend on you to use your eyes and ears in the nursing home.  If you see any resident receiving abuse, you should call 911.  In case of inadequate care, first notify the nursing authorities and, if nothing is done, call TANHR at (972) 572-6330 or toll free at (888) TANHR4U (888-826-4748).

THE GOOD STUFF

One way to deal with fear and frustration is to do something positive.  The opposite of fear is love.

  • If you see staff who are doing an excellent job, please let the administrationi know.  There are many nursing home staff who truly are overworked and underpaid, but they still care.  They need support and encouragement.
  • If you know of a lonely resident besides your loved one, stop by and say hello.
  • Volunteer or get involved with TANHR.  Start a Family Council at the nursing home where your loved one or friend resides.  The State of Texas requires nursing home facilities to provide space for and listen to the residents and their families and to act on their recommendations.  Family Councils are the perfect forum. Contact us for help organizing a Family Council.  See our web page What You Can Do for the regulations and TANHR guidelines for organizing a TANHR unit.

RESIDENTS’ RIGHTS

Under the federal law titled Omnibus Budget Reconciliation Act of 1987 (OBRA ‘87) you, as a nursing home resident, can exercise your rights as a citizen or resident of the United States without fear of discrimination, restraint, interference, coercion or reprisal.

Your Rights as a Nursing Home Resident

  • To be informed of your rights and all rules and regulations governing resident conduct and responsibilities, both orally and in writing
  • To inspect and purchase photocopies of your records
  • To be fully informed of your total health status
  • To be informed of facility services and charges
  • To be informed of your physician and ways of contacting him or her
  • To be consulted and your physician and interested family member notified of any significant change in your condition or treatment
  • To refuse room changes requested by the facility
  • To be notified, along with an interested family member, of changes in your rights as a resident
  • To manage your own financial affairs and not deposit personal funds with the facility
  • To have any funds you choose to deposit handled with your best interests in mind and not commingled with facility funds
  • To choose your own personal physician and to be informed and participate in your care and treatment
  • To keep private your personal and clinical records
  • To include as privacy rights: 1. personal care, 2. medical treatments, 3. telephone use, 4. visits, 5. letters, 6. meetings of family and resident groups
  • To approve or refuse the release of your records except in the event of a transfer or legal situation
  • To voice grievances concerning your care without fear of discrimination or reprisal
  • To expect prompt efforts for grievance resolution
  • To examine survey results and the plan of correction
  • To contact client advocate agencies
  • To receive or deny visitors
  • To visit with any relevant agency of the state or any entity providing health, social, legal or other services
  • To be treated with dignity and respect in full recognition of your individuality
  • To choose your own activities, schedules and care
  • To organize or participate in groups of choice
  • To have families visit with other families
  • To have group meeting space provided by the facility
  • To invite or deny staff or visitors’ attendance
  • To have a staff person assist and follow up with the group’s requests
  • To have requests and concerns of the group listened to and acted upon by the facility
  • To be provided activities that meet your needs and interests
  • To be provided social services that will maintain your highest level of well-being
  • To be provided a safe, clean and comfortable environment
  • To be provided 1. housekeeping and maintenance services, 2. clean bath and bed linens in good repair, 3. private closet space as space permits, 4. adequate and comfortable lighting, sound and temperature levels

Admission, Transfer and Discharge Rights

You may be discharged only if your needs cannot be met, safety is endangered, services are no longer required or payment has not been made.  Notice of and reason(s) for transfer or discharge must be provided to you in an understandable manner.  Notice of transfer or discharge must be given 30 days prior, except in cases of health and safety needs.  The transfer or discharge motice must include the name, address and telephone number of the appropriate, responsible protective agency.  Individuals who receive a discharge notice from a facility have 10 days to appeal.  You and a family member must receive written notice of state and facility bed-hold policies before and at the time of transfer.  The facility must follow a written policy for re-admittance if the bed-hold period is exceeded.  The facility must not require a third party guarantee of payment or accept any gifts as a condition of admission or continued stay.  The facility cannot require you to waive your right to receive or apply for Medicare or Medicaid benefits.

Resident Behavior and Facility Practices

The facility may not use physical restraints or psychoactive drugs for discipline or convenience, or when they are not required to treat medical symptoms.  You have the right to be free from verbal, sexual, physical or mental abuse, neglect or mistreatment, and misappropriation of your property.  IN the event of an alleged violation involving your treatment, the facility is required to report it to the appropriate officials.  All alleged violations must be thoroughly investigated and the results reported.

Quality of Care

Each resident must receive necessary care and services in the following areas:

  • Activities of daily living: cleanliness and grooming, eating and communicating
  • Vision and hearing: the facility must, if necessary, provide access to examinations and treatment
  • Prevention and, if necessary, treatment of pressure sores
  • Treatment and services, if necessary, for incontinence and urinary tract infections
  • Prevention of reduction in range of motion
  • Mental and psychosocial functioning
  • Use of naso-gastric tube only if unavoidable
  • Freedom from accident hazards
  • Good nutrition, and a therapeutic diet when necessary
  • Sufficient fluid to maintain proper hydration and health
  • Proper treatment and care for special needs such as injections, certain fluids, -ostomy care, tracheal auctioning, respiratory care, foot care and prostheses
  • Resident’s drug regimen must be free of unnecessary drugs with emphasis on special care and documentation of anti-psychotic drugs
  • The facility must be free of medication error rates of 5% or greater; residents must be free of significant medication errors.

§ 19-901 Quality of Care. Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being as defined by, and in accordance with, the comprehensive assessment and plan of care.  If children are admitted to the facility, care and services must be provided to meet their unique medical and developmental needs.

Source - Texas Department of Human Services, NFR/LMC 95-0

Quality of Life

A facility must care for its residents in a manner that promotes maintenance or enhancement of each resident’s quality of life.

Each resident has the right to be treated with dignity, to choose activities, schedules and health care consistent with his or her interests, and to participate in resident council and other group meetings.  They must also receive notice before their room or roommate in the facility is changed.

A resident assessment must be done within 14 days after the admission of the resident.  The assessment will determine the physical and mental conditions, impairments, functional status, dislikes and interests of the resident, and will identify needs for a care plan.  Residents are monitored and a new assessment and care plan must be made if there is a change in their physical or mental condition.

  • The facility must examine each resident and review the data at least once every three months, and more often as appropriate.
  • The results of the assessment are to be used to develop, review and revise the resident’s comprehensive plan of care as necessary.
  • The comprehensive care plan must be developed within seven days after the completion of the comprehensive assessment by the physician and the registered nurse that is responsible for the resident’s care.  The resident’s family or legal representative has a right to participate in reviewing and revising the comprehensive care plan.

The facility must provide for an ongoing program of activities designed to conform with the comprehensive assessment.  The assessment must meet the interests and the physical, mental and psychosocial well-being of each resident.

A facility with more than 120 beds must employ a qualified social worker on a full-time basis; a facility with less than 120 beds must have a contract with a certified social worker to provide social services to meet the needs of the residents as necessary.

The facility must provide a safe, clean, comfortable and homelike environment for each resident.

Excerpts from Texas Department of Human Services (NFR/LMC, Sec §19.701, 95-0)