California Elder Abuse Lawyer Blog

Helpful tips when facing the discharge of a loved one from the hospital:

Because all of the rules, regulations and differences in levels of care can be confusing and over-whelming to patients and families, I recommend that almost from the moment of admission, to take the time to seek out the discharge planning personnel in your loved one's hospital. This person can be a nurse, a social worker or a 'discharge planner'. Talk to this individual on a daily basis. Keep abreast of your loved one's physical progress with the physicians and discuss changes with the discharge planner. He or she will also have access to your loved one's medical record and will read the physician's daily notes. Seek input and express your concerns, financial and otherwise. Visit facilities suggested by the discharge planner. Interview home care agencies if appropriate.

Finally, ask your discharge planner whether the facility you contemplate choosing is insured. If they don't know, ask the facility you are contemplating whether they carry liability insurance. This is particularly essential when considering a small, home-like RCFE. Responsible operators of elder care facilities carry liability insurance. This is an important and little known piece of information that will assist you in making the very best and most informed choice for your family member.

Posted by: Denise A. Platt, RN, JD with Law Offices of Jody C. Moore, APC

California 'Levels of Care': A Residential Care Facility for the Elderly As an Alternative to Skilled Nursing Facility Care

If the patient is not receiving any skilled services and requires assistance with positioning, feeding, bathing, grooming, dressing, walking, and/or must be in a secured environment related to cognitive impairment, a 'lower level of care' such as a residential care facility for the elderly ('RCFE') often times known as a 'board and care' may be appropriate. It is very important to thoroughly investigate to ensure that the RCFE is capable of providing for an individual's needs such as secured doors and perimeters if required. It is equally important to be sure that an RCFE does not accept a patient whose level of care is too high and/or has medical conditions that are specifically prohibited such as patients who require skilled nursing care, who have serious bedsores, or who are bedridden. There are also many 'restricted' conditions that require on-going professional care from an outside licensed home health care agency if a patient is admitted to an RCFE.

A factor that heavily influences a family's decision regarding appropriate discharge might be financial. Most 'skilled' services are reimbursed by Medicare or Medicare Advantage plans, but 'custodial' services are not. Also, Medi-Cal might reimburse someone for long term custodial care in a nursing home if they qualify financially, but Medi-Cal does not pay for an RCFE. Many times this factor causes elderly persons who require physical assistance or who are suffering from dementia to be confined to a nursing home because Medi-Cal will not pay for custodial care in the RCFE environment.

Posted by: Denise A. Platt, RN, JD with Law Offices of Jody C. Moore, APC

The Role of Discharge Planning

These entries will discuss in three parts the transition of an elder who normally lives at home, maybe with some assistance or in-home caregivers, but then is hospitalized and needs more extensive care after treatment. Let's say, mom was living at home but had knee surgery, or was hospitalized for treatment of pneumonia which left her weakened, or perhaps she had a fall and broke a bone. In today's world, hospitals tend to discharge these types of patients who clearly require further care pretty quickly. Hence the adage, "discharge begins at admission".

A hospital will assign a discharge planner to the case and assess what type of support the patient has in the home. The discharge planner has an obligation to determine whether a discharge to home would be safe for the patient. An elderly person with a significant injury (broken leg) or who had recent surgery would not likely be a candidate to return home if they live alone unless they can afford round the clock care giving to assist with toileting, grooming, transfer and repositioning and meal preparations.

Even if the patient lives with loved ones, their care needs might be too high to return home. For example, many patients leave the hospital requiring additional services that must be provided by professionals like physical and occupational therapies. Perhaps they need dressing changes for surgical or other types of wounds. Perhaps they need IV antibiotic therapy for infection. These are often referred to as 'skilled' services. Other times patients require less complex 'custodial services' which are more assistive type services with activities of daily living such as eating, bathing, dressing and grooming. This type of service is also called 'unskilled' service.

Continue reading "California Nursing Homes and Assisted Living: How Do You Know Which Level of Care is Right? (Part 1 of 3)" »

A recent study published in the May issue of the American Journal of Infection Control found the correlation between low staffing levels in a nursing home and failure to follow infection control protocols. It has long been argued in nursing home neglect cases that having sufficient numbers of qualified staff is the most important factor in ensuring good patient outcomes. This study provides further proof of that position. Since infections are the leading cause of death in nursing homes, responsible for nearly 400,000 deaths per year according to a news release relating to this publication, the importance of having sufficient staff and nursing home environment cannot be overstated.

Why would nursing homes fail to provide sufficient staff to meet the needs of that its residents? The plain truth is that because staffing is the number one most expensive line item on any nursing home budget. Increasing staffing makes nursing homes less profitable.

How does low staffing cause breach of infection control protocol? The answer is that nurses and nurse's aides who are well-meaning and (hopefully) properly trained simply do not have enough time to meet the needs of all the residents they are assigned to care for and they are more likely to be hurried and skimp on infection control measures. To illustrate, when providing care to too many residents in an environment of chronic short-staffing, the floor nurses and aids are often put in the position of having to make the uncomfortable choice of letting the patients' call bells ring unanswered or taking a few extra minutes to wash their hands between caring for patients.

Continue reading "California Nursing Homes that Skimp on Staffing Risk Infecting Patients" »

Elderly and infirm residents of nursing homes are at an increased risk for malnutrition and dehydration for a myriad of reasons, most significantly because they frequently cannot monitor their own intake of food and water.

A study done in 2000 by the Commonwealth Fund found that at least 1/3 of our nation's nursing home residents suffer from malnutrition and dehydration. The Commonwealth Fund is a private foundation that supports research to promote improvements in health care.

"The extent of malnutrition and dehydration in some American nursing homes is comparable to that found in many poor, developing countries where inadequate food intake in compounded by repeated infection." Jeanie Kayser-Jones, co-author of the study and professor of physiological nursing and medical anthropology in the School of Medicine at the University of California at San Francisco.

Continue reading "CA Nursing Homes: The Problem of Malnutrition and Dehydration " »