An Ounce of Prevention

   

Fast Times at Sunny Vale

Before agreeing to place yourself or any patient in a residential care facility, there are important questions to ask. It is not always obvious or easy to ask the right questions, because marketing personnel are extremely skillful at 'selling' you on a facility, its amenities and standards of care. A decision maker must focus on facts, not fiction. Is the corporate mission posted? Are there community standards posted? If so, don't take them at face value. The name, Sunny Vale Assisted Care and a lovely motto, such as "A Restorative Community," are meaningless. Was there a cute day care facility, where pre-school children were abused in your community? Didn't it have a sweet name, like Button Tree Farm?  We're always so polite in speaking with sales people and managers; remember, this is not a social occasion, any more than it was a social occasion, when we chose our children's day care facilities.

     Consult consumer ratings and publications, local, as well as national. Know the staff-to-patient and the supervisor-to-staff ratios for a specific facility. How does the outside of the building (not the landscaping or building facade) look? Is trash, garbage and bio-hazardous waste properly contained? Does it appear to be removed on an appropriate schedule, or is it overflowing -- is the containment area clean? Walking the premises inside, how does the facility look and smell. There should be no lingering or pervasive smell of urine, feces, or other unpleasant smells in hallways, rooms or waiting areas. Is the facility well lighted, night and day? Is it attractive and well-maintained in appearance? Is there video surveillance? Where, and are the cameras both maintained and used? Who manages and dispenses medications, and is the dispensary well-staffed and secure? 

     Ask management for the facts of recruitment, training standards and vetting of staff. Do staff members rely on a day of orientation, or are training workshops and demonstrations substantive. Are they ongoing and how often is continuing education offered? What about emergency preparedness for management, supervisors and other staff? What are the benchmarks for quality of care in the facility, and how well are they being met. How are benchmarks measured? -How often and by whom? Ask to speak with other residents or their family members concerning the quality of care, meals, recreational opportunities -- don't hesitate to be nosy.

      Here is a patient bill of rights. If you are going into long-term care, have a close friend or family member entering care, know the following: 

1. No patient may be denied appropriate care on the basis of race, religion, national origin, sex, age, handicap, marital status, sexual preference, or source of payment. 
2. Any patient may inspect and obtain a copy of his or her medical records, upon demand. No third party may receive a a copy of the patient's medical records without the patient's express authorization, except as required by law or third party contract.
3. Every patient or resident is entitled to privacy, to any extent feasible, in treatment and caring for personal needs. Care for personal needs will be delivered with consideration, respect, and full recognition of the patient's individuality and dignity. 
4. A patient or resident is is entitled to adequate, appropriate, care. The patient has the right to full information about his/her medical condition, proposed treatment and prospects for recovery, unless medically contraindicated by the physician in the medical record. 
5. A patient or resident is entitled to examine and receive an explanation of his/her bill. Also, he/she is entitled to know who is responsible for, and who is providing, his/her care.
6. A patient or resident has the right to associate and have private communication with his/her physician, attorney or any other person. A patient has the right to send and receive personal mail unopened, unless medically contraindicated.
7. No patient's or resident's civil and religious liberties shall be infringed. The facility shall encourage and assist in the exercise of patients' civil and religious rights.
8. Every patient or resident is entitled to be free from mental and physical abuse. Every patient shall be free from physical and chemical restraints, unless authorized by his/her physician, or necessitated by emergency to protect the patient.
9. A patient or resident has the right to retain and use personal clothing and possessions, space permitting. At the request of a patient, a nursing home shall provide for safekeeping of personal property and funds. However, the nursing home shall not be required to provide for the safekeeping of property which would impose an unreasonable burden on the nursing home.
10. The nursing home must provide the patient with meals which meet the recommended dietary allowances for the patient's age and sex. The menu may be modified according to special dietary needs.
11. A nursing home, its owner, administrator, employee, or representative shall not discharge, harass, retaliate or discriminate against a patient because a patient has exercised rights protected by law. (Reporting violations of the above rights or quality of care issues is protected by law.)

     Whether you are helping a loved one enter independent living, assisted living or nursing care, you are his or her best hope in ensuring these rights are protected. It is important to know your own rights and those of others. 

     Be vigilant on behalf of your loved one. Be present. Be in touch frequently. Even people in independent settings are vulnerable.In the next post, we'll make a distinction between unacceptable conditions and criminal negligence or abuse in long-term care. Meanwhile prevention begins with each of us.