Family Member Guide to Nursing Homes

Clients frequently tell us they trusted the nursing home or assisted living facility to take care of their loved one. We also hear clients say 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 your presence in the room or down the hall is not enough.

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

Be Organized:

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

- Date / time of visit.
- Location - where your loved one was upon arrival.
- Complaints - stained clothes, sheets, food problems, no water? Write the complaints down.
- Notify staff - make a written and verbal complaint to the charge nurse. Write down her name, and what she said would be done about the problem.
- Follow up – next time you are there and ask the nurse what has been done. Ask to see the chart where the corrected action should have been documented.

Document Your Complaints:

If the problem continues take photographs; send a letter to the nursing home administrator requesting a conference. Ask that staff receive further 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 is required by the facility’s policies and procedures.

Complain to State/Local Authorities:

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

How to Work with Attending Physicians:

Many attending physicians also serve as Medical Directors to the facility. They are only obligated to review a resident’s chart and or examine them, pursuant to Medicare requirements, and when a change in condition occurs. Ask to speak to the attending physician after each visit to determine whether there has been a change in condition. If it is a routine visit, contact the physician to find out what was examined. If medications are changed, ask why? Be curious, and write down the answers you receive. We have discovered in our cases where some nurses actually will draft the physician’s orders and then call the physician after the fact, just to get their “ok”.

What to do if a Fall Occurs:

If a fall occurs immediately go the facility. Ask for the name of individual who found your loved one. Where was the fall? What was he wearing? Was there medical equipment involved? Write all of this down. Who examined your family member to assess their status 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 Fall Committee’s next conference when your family member is being discussed.

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

What if Your Resident Stops Eating:

We hear staff say all the time – “we tried to get her to eat, but she refused.” Is that true? What is the facility policy? I am certain the policy doesn’t say, “if resident refuses to eat discontinue attempts.” It likely requires staff to provide an alternative or supplement until the resident gets needed calories. Malnutrition can lead to the development of decubitus ulcers and prevents existing decubitus ulcers from healing.

Review the chart. Can your loved one see to eat? Can he or she feed themself? What about the food – will he eat what you bring? If so – tell the nurse and ask them to chart it. Patient refusal is a big excuse given by facilities when problems occur.

Discuss supplements, intravenous nutrition, energy bars – there are ways to get needed calories in. Is the physician aware? Make him aware.

Conclusion:

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