Upon admission to a long term nursing home, the person being admitted is handed an admission packet of well over twenty pages. In that is an explanation of the patient’s “Bill of Rights,” established in federal and Connecticut law. This law applies to nursing homes, residential care homes, and chronic disease hospitals. That packet lets residents and their families know the limits of what such facilities can or cannot do.
The facility is required to fully inform the resident, of the services available, and the charges for the services, including charges that are not covered by Title 19. This is usually printed very clearly in the admission packet. In addition, the patient has the right to choose his or her own physician, and to take part in the planning of her or her own medical care. As a practical matter, many residents choose to use the facilities’ physician.
One issue is what room the resident will get. A resident cannot be transferred from one room to another without a medical reason, or for the resident’s welfare, or the welfare of other residents. The transfer must be done with the least disruption to the resident. The resident’s records must document the reasons for the transfer and the actions taken to minimize any disruptive effects of the transfer. The exception to the no transfer rule is that a resident going on Medicaid can be transferred from a private room to a double or triple room, because Medicaid does not pay for private rooms. No one can be transferred to another room if it is “medically established” that such a move could subject the person to a “reasonable likelihood” of serious physical injury, harm, or because of psychiatric problems, when those psychiatric problems would be exacerbated by the move for a long period of time. The resident must be given at least thirty days’ notice, unless of course the health, safety, or welfare of other residents is endangered.
The nursing home is also required to inform the patient of state or federally funded advocacy programs such as the Connecticut Ombudsman program. These can help resolve grievances, and nursing homes are required to make efforts to resolve grievances. A case comes to mind of a person whose behavior was so terrible toward any roommate that the nursing home kept him in a private room, even though he was on Medicaid.
A key provision is that a patient be free from mental and physical abuse, and from physical or chemical restraints for the purpose of discipline or convenience. Drugs cannot be used just for the convenience of keeping someone easy to manage. Physical or chemical constraints can be used to ensure the physical safety of the patient or others and then only on the orders of a doctor or advanced practice registered nurse.
The rules require that psychopharmacologic drugs can only be administered on the orders of a physician or advanced practice registered nurse as part of a written plan of care. A case of a very psychologically troubled resident who refused such medications resulted in a probate court hearing at the hospital. Before the judge could say a word, the patient lunged across the table shouting and threatening one and all, including the judge. You can guess the outcome. But even if such drugs are approved, an independent external consultant must annually review the appropriateness of the plan.
Another right is to associate and communicate privately with persons of the patient’s choice and get mail unopened and make and receive telephone calls.
The law also states that a third party, which includes a spouse or children, cannot be required to give a guarantee of payment to the facility as a condition of admission or continued stay at the facility.
This rough outline of the patient rights does not go into the details the law provides for consultation on how to resolve disagreements with the nursing home. Most cases are resolved with the families through discussion, but the law gives specific guidelines and timelines on how to resolve differences.
If a resident suffers injury because of the facility negligently depriving the patient of any rights or benefit created under the patients’ bill of rights, a court could assess damages.
The patients’ bill of rights goes a long way to protect the health, dignity and well-being of nursing home residents. Knowing these rights can often help resolve misunderstandings or disagreements on how your loved one is being cared for.