Nursing Home Abuse Advocate : Idaho Nursing Home Abuse Lawyers & Attorneys : Kormanik Hallam & Sneed Law Firm : ID Assisted Living Neglect, Nursing Home Injuries : Boise, Nampa, Caldwell

Let's face it: No one wants to think about the end of their life. Because of this, many of us do not have end of life plans to ensure our affairs are in order. Making sure your wishes are followed as your life nears its end is important; after all, they are your wishes!

Melissa Healy, in a recent Los Angeles Times "booster shots" blog, tackled the difficult subject of "getting your affairs in order."  The post links to a Guide Book for those with a serious illness to help get their affairs in order. The guide book was published by the American Bar Association Commission on Law and Aging for the National Hospice and Palliative Care Organization. Although Ms. Healy's entry is based upon receiving bad news from a health care provider, it contains good information for all of us to consider as the new year approaches.

The Guide Book discusses, in fairly good detail, step-by-step instructions on the following areas: 

• Planning how you will pay for the healthcare you need;
• Making a plan for the management of your health and personal decisions during your illness;
• Making a plan for the management of your money and property;
• Planning for the care of dependents;Knowing your rights as a patient;
• Knowing your rights as an employee; and
• Getting your legal documents in order.

Although all of these areas are important, for nursing home residents, perhaps the most important area is that of making a plan for the management of your health and personal decisions. If you cannot make your wishes known, you want to make certain they have been previously documented or someone who knows your wishes is legally able to make them known for you.

In Idaho, there is a specific law governing "living wills and durable powers of attorney for health care." This is just the document to make sure your desires are known and a the appropriate person is able to legally make decisions about your health care when you cannot. Such decisions include, for example, the level of care desired, including whether a "do not resuscitate" or "DNR" is properly carried out.

End of life decisions are difficult things to think about, let alone put on paper. Carefully considering the care you wish to receive, with input from, among others, family, friends, medical care providers and, perhaps, clergy, is critical. If you do not plan, and put your wishes to paper in a legally enforceable document, your wishes may not be followed. That would be a tragedy.

Take the turning of the year to decide what you want concerning your health care. Make a plan and make your wishes known. There is no better time to do so.

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The Idaho Department of Health and Welfare, Bureau of Facility Standards is the state agency that conducts "surveys" of Idaho's nursing homes to make sure they are in compliance with all applicable federal and state regulations. It may surprise you that in the most recent survey available, for the period of January through June 2009, there were seven (7) citations issued for facilities who hired staff "guilty of abuse." Although this may not seem like a large number of citations, remember two things: (1) This survey was for a six month period; and (2) There were only 64 surveys conducted.

What drives facilities to make such an egregious and potentially harmful hiring decision? First and foremost, facilities often do not conduct appropriate and thorough background checks on applicants. Second, many facilities do not pay for quality staff and, thus, they "scrape the bottom of the barrel" of the employee pool. Third, some facilities simply need to "fill the void" when existing staff leave and may believe that some staff is better than no staff. Of course, none of these "excuses" for hiring staff "guilty of abuse" are "reasons" for substandard hiring practices.

Before choosing a nursing home, make sure you ask the appropriate administrator what type of background checks are conducted on potential employment candidates. Also ask if the facility has received any citations from the Idaho Department of Health and Welfare's Bureau of Facility Standards. If the facility has received any citations, ask to see them and what the facility did to correct its conduct.

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In a prior post, I wrote about the Ombudsman for the Idaho Commision on Aging and his or her duty concerning the care of nursing home residents. If you are concerned about nursing home care, you can also lodge a complaint with the Idaho Department of Health and Welfare (IDHW). Indeed, the IDHW encourages the filing of appropriate complaints: "The opportunity to lodge a complaint provides the public with a mechanism to notify the Bureau of Facility Standards (i.e. State Survey Agency) of a health care providers failure to provide appropriate care within the framework required by regulations."

If you wish to file a complaint, you should contact the Bureau of Facility Standards at (208) 334-6626, or, in writing at: Bureau of Facility Standards, PO Box 83720, Boise ID 83720-0036. If you file a complaint, you should be prepared to provide the following information:

• Provider/Facility Name and City
• Name of Patient/Resident
• Detailed Statement of Care Provided And Any Negative Outcomes
• Names of Witnesses
• Your Name and Contact Information; unless you wish to remain anonymous.

After a complaint is filed, it will be investigated by Bureau of Facility Standards' staff in a confidential manner. If you would like to know the result of any complaint against a facility, you need to request the results through a public records request to the Idaho Department of Health and Welfare.

Although notification of the staff of a facility is one way to ensure your concerns are heard, you should also file a formal complaint with the Bureau of Facility Standards. Such a complaint will ensure your concerns are taken seriously and investigated appropriately.

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In a recent New York Times blog entitled "Easing Tensions In The Nursing Home," author Paula Span addresses the important issue of tension between family members and nursing home staff. As you can imagine, most, if not all, of the issues contributing to this tension is a family's belief their loved one is not being cared for in an appropriate manner against the staff's belief to the contrary.

According to Ms. Span, the tension between family and staff leaves the family concerned that, if they voice their concerns, their family member will suffer because unhappy staff will, in some way, retaliate against the resident for the complaints of the family. To avoid, or at least lessen, the chance for tension between family and staff, Ms. Span provides the suggestions of Karl Pillemer, a gerontologist at Cornell University, and the sociologist J. Jill Suitor of Purdue University:

• Take complaints and requests to the right place. While aides do most of the hands-on care in nursing homes: “They’re almost never the ones who are making decisions about it. You’ve got to go high enough up the chain to make sure the person you talk to has the ability to influence what goes on.” The staff social worker is a starting point.
• When a problem involves an aide’s duties, practice “clear and respectful communication.” “Avoid blaming the other person. As people get angry, there’s a tendency to insult the other party, and it escalates.” A demand or reproach — “How come nobody’s shaved my father?” — puts overworked staffers on the defensive. Try phrasing it this way: “I noticed my father isn’t shaved. This is very important to him. How can we make sure he’s shaved every day?” After the conversation, summarize to clarify the agreement you have reached: “I understand that you were short-staffed today. But he will be shaved every morning — is that what you’re saying?”
• Keep visiting, and monitoring. “The amount of visiting people receive is directly related to the quality of care. Families do need to advocate for their relatives, but they need to do it in the right way.”
• Give positive feedback as often as possible.

In a previous blog post, entitled "The Ombudsman for the Idaho Commission on Aging is on the Side of Idaho Nursing Home Residents," I addressed the role of the Idaho Ombudsman for long term care in addressing concerns regarding teh care of nursing home and assisted living facility residents. Regardless of the involvement of the Ombudsman, it is important you, as a loving and caring family member, are able to effectively communicate your concerns with the proper individual at the facility so your family member does receive the proper care. As Ms. Span and Mr. Pillemer suggest, perhaps the most important contact at any nursing home or assisted living facility is the social worker or, if none is available, the director of the facility.

I suggest not only approaching the appropriate individual with your comment or concern, but also following up with that person in writing. A written summary of your concerns, the discussion which you had with the appropriate upper-level employee and the outcome or change in care you expect are all good things to write down. This way, if the concern is not addressed, you can again voice it or contact the Ombudsman. If the concern is addressed, you will be able to follow up with a "thank you" to the staff of the facility caring for your family member or loved one.

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