What Are the Options for Dealing with Nursing Home Problems?

Nursing home residents enjoy legal protection from both state and federal laws, in particular the 1987 Nursing Home Reform Law that was incorporated into Medicare and Medicaid regulations. These laws provide broad protection built around the fundamental principle that a nursing home patient must receive the services necessary to allow him or her to function at the highest possible level.

For the most part, skilled nursing facilities and intermediate care facilities provide commendable care to their patients. The careful selection of a nursing home will also usually eliminate those that are substandard. However, problems can crop up despite the best intentions or the most careful research, so it's important to understand what to do in the event there is a problem with your loved one's care.

First, don't assume the worst. The place to start if there's a problem is with the staff member who routinely cares for the patient. In some cases they may not even be aware that a problem exists until you tell them. If talking to the first-line caregiver doesn't help, make your way up the supervisory chain, starting with the charge nurse (shift supervisor) and proceeding to the director of nursing (who has overall responsibility for the nursing staff). Your last stop within the skilled nursing facility itself is the facility administrator.

Second, allow a reasonable amount of time for a solution. What is "reasonable" can vary tremendously from practically none (for example, a request to stop waking the patient up earlier than he or she desires) to significantly more (such as a request to change rooms because of a problem with a roommate, depending on the facility's policies and what open beds are available). Be sure that when you ask for a solution, you also ask how long the solution will take or for a commitment to immediate change. This will give you a clear and equitable timetable for escalating the issue should it not be resolved after your initial request.

At each step, maintain a written record of your actions. This need not be fancy, formal, or complicated; simply use a notebook or even a sheet of paper to make an orderly record of the date and time of your conversation or request, the name and position of the person you spoke to, a summary of what you asked and what they told you, and any applicable commitments they made regarding how long a solution would take. Should it be necessary to escalate your issue, or even go to outside authorities (more on that in a moment), you'll have a concise record of the steps you've taken along the way. This can provide evidence for a supervisor or administrator to take disciplinary action should the situation warrant, and it will reinforce to those you approach for a solution that you are sincere and organized (and thus should be taken very seriously).

Many facilities have a resident council and/or a family council which have the specific function of addressing issues in the facility with the administration. If your initial effort at resolution isn't successful, it may be helpful to talk to members of these councils to see whether similar issues have been raised by others recently or in the past. You may discover that many residents are encountering a similar problem, and approaching the facility administration in numbers rather than alone is likely to provide a speedier resolution.

Also, Medicare- and Medicaid-certified facilities are required to have a formal grievance procedure. If your loved one is in such a facility, you should have received information on this procedure at the time of admission. If your first request for resolution doesn't work, review the grievance procedure and pursue the process as directed.

Should you escalate your issue all the way to the nursing home administrator and still receive no satisfaction, the next step is to involve outside authorities. Most states have a number of agencies involved with the regulation of nursing homes. Though the exact names will vary, there will typically be a licensure and registration office, an adult protective service or protection and advocacy office, and an ombudsman program. Medicare and Medicaid also operate fraud control units.

In cases of particularly gross offenses, such as allegations of abuse, the step-by-step process outlined here will not be appropriate. While you should still notify the administrator of the facility-who should certainly conduct an internal investigation-you will probably wish to simultaneously notify the appropriate state agency of the alleged offense.

A handy reference for finding all of the relevant agencies in your state is available on the National Long-Term Care Ombudsman Resource Center website at http://www.ltcombudsman.org/ombudsman. For detailed information on the legal rights of nursing home patients, review our guide "What Are the Rights of Nursing Home Patients?"