Assisted Living Lawyer Minnesota
Tuesday, February 26th, 2008
When someone moves into a building that offers Assisted Living services they are required to sign a rental agreement or lease which covers the occupancy issues of the apartment or living space. Additionally, the resident is required to sign a Service Agreement which deals with the particular services to be provided from a licensed home care provider. The contracted services can be provided by either outside home care providers or the property owners. An Assisted Living provider must provide basic services, such as on-call 24 hour nursing access with daily checks on each resident and help with services such as laundry, meals, transportation and at least three activities of daily living. There must be a staff person available 24 hours daily who is awake and able to respond quickly. The facility must have a method for residents to contact them if needed for health or safety needs 24 hours a day.

Minnesota Assisted Living providers must also clearly state what services are offered, allowing consumers to compare facilities and choose one with the appropriate level of care. Minnesota’s Assisted Living Bill of Rights creates specific rights for residents of Assisted Living Facilities, including fair and respectful treatment. It further allows the right to choose services and providers. It gives the right to a current Care Plan, to participate in your care and to change medical or other providers if desired. There are safeguards to basic human rights such as: the right to self-determination, to privacy, to safety, to speak out and specifically prohibits harmful treatment.

If you suspect abuse or neglect to any vulnerable adult in an Assisted Living or Nursing Home facility, please contact our firm for information or assistance on how to file a complaint with the Minnesota Department of Health and have the matter investigated.

The American Association of Homes and Services for the Aging are against the rating of nursing homes by Medicare by on the results of surveys of the facility. The goal is to identify nursing homes with a history of failing to meet the federal minimum requirements for quality of care and treatment.

There is no legitimate reason to oppose the rating of the nursing homes, unless you run or profit from a nursing home that is not compliant

According to PRNewswire-USNewswire via COMTEX, in a statement by Larry Minnix, President and CEO of the American Association of Homes and Services for the Aging:

“AAHSA believes there should be two types of nursing homes: the excellent and the non-existent. Quality should be an automatic public expectation. The five-star rating system is a great idea prematurely implemented. We support a consumer-friendly nursing home rating system based on reliable quality information that the public can understand. But what is being launched tomorrow is poorly planned, prematurely implemented and ham-handedly rolled out.”

Mr. Minnix goes on to state “together, government and providers must be responsible, transparent and accountable for taking care of vulnerable seniors. CMS has key responsibility for defining, measuring and overseeing quality. Data provided by the government must be accurate, reliable, timely, and friendly.”

Minnix is apparently against the Five Star Rating System being implemented by CMS today because in part, “Inspection data is inconsistent”.

However, the inspections are the only way short of a complaint after an incident to evaluate the potential problems related to shortcoming in the facility which lead to deficiencies and violations of the bare minimum standards of care set forth as appropriate for the vulnerable adults in their care.

According the the article Minnix believes that What needs to be improved about the Five-Star Rating system is:
• Immediate development of a data collection tool around staffing.
• Coordination of the rating system with the Advancing Excellence in America’s Nursing Homes campaign.
• Overhaul of the survey and certification system with funding provided for a new system.
• Medicaid and Medicare reimbursement that flows through directly for caregiving. The dollars follow the caregiver should be the mantra.
For the entire story see: AAHSA Statement on CMS Five-Star Rating System for Nursing Homes

These suggestions are based upon an entire reform of the system and without such a change leave the consumer without valuable information on the past performance of a nursing home and problems identified by the nursing home surveyor.

The American Association of Homes and Services for the Aging fails to tell the reader that each and every time there is a violation determined by a Medicare surveyor the facility can appeal the decision, or agree. Most violations are resolved by the facility not only agreeing that there was a problem but a new promise made to the United States of American that they will correct the problems that lead to the substandard rating.

There is no valid reason for the government to keep information from consumer that depends on these facilities for support of life. After all the residents of nursing homes are vulnerable adults by definition and are dependent upon their caregivers. The facilities are paid based on the acuity level of each resident and make a promise to provide the care the resident needs. When the nursing home fails in this duty they should not object to the information being included in a rating to warn the public of the risks associated with their facility.

If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to klabore@prslegal.com, or call Ken at 612-767-7503.

According to the Office of Inspector General Report called Trends in Nursing Home Deficiencies and Complaints:

Survey and Certification Process All nursing homes that participate in Medicare and/or Medicaid must be certified as meeting certain Federal requirements. The Centers for Medicare & Medicaid Services (CMS) contracts with States to perform nursing home surveys before nursing homes may be certified. States must conduct these standard surveys at least every 15 months, and the Statewide average interval between surveys must be 12 months or less. Surveys are unannounced and may be conducted at any hour on any day. Surveys assess medical, nursing, and rehabilitative care; dietary and nutrition services; activities and social participation; and sanitation, infection control, and the physical environment.

Surveyors collect data from different sources. They conduct a medical record review based on a case-mix stratified sample of nursing facility residents. They also review plans of care to determine their adequacy, audit residents’ assessments, and review compliance with legal requirements concerning residents’ rights. In addition, surveyors observe facility operations and interview residents, family members, and staff to determine whether facilities are providing appropriate care.

CMS provides guidance on long term care facility survey procedures and protocols through its “State Operations Manual.” The Manual describes the intent of the regulations pertaining to nursing homes as well as the process for determining whether deficiencies have occurred and how to categorize them. Updates to the Manual are issued periodically.

Deficiencies. When a nursing home fails to meet one or more of the Federal requirements, surveyors cite a deficiency. There are 190 possible deficiencies, which fall into the categories listed in the box below.

Deficiency Categories
Resident rights Physician services
Admission, transfer, and discharge rights Rehabilitative services
Resident behavior and facility practices Dental services
Quality of life Pharmacy services
Resident assessment Infection control
Quality of care Physical environment
Nursing services Administration
Dietary services Laboratory and radiology services

Sources: 42 CFR § 483, subpart B; CMS “State Operations Manual,” Appendix PP.

Surveyors also decide the scope and severity of the deficiency based on a matrix that uses the letters “A” through “L.” See Figure 1 on the next page. The scope of the deficiency measures the number of residents potentially or actually affected by the deficiency. The scope rating has three different levels: isolated, pattern, and widespread. Isolated deficiencies occur when one or a very limited number of residents or staff are affected or the situation exists only occasionally. Pattern deficiencies occur when more than a very limited number of residents or staff are affected or the situation occurs repeatedly. Finally, widespread deficiencies occur when the situation is pervasive throughout the facility or potentially affects a large portion of the nursing home’s residents.

The severity rating measures the extent of the health and safety risk to residents. The most serious level, immediate jeopardy, occurs in “a situation in which the provider’s noncompliance with one or more of the requirements of participation has caused, or is likely to cause, serious injury, harm, impairment or death to a resident.” Immediate jeopardy requires the nursing home to take immediate corrective action. The three levels of deficiencies that are not immediate jeopardy are: (1) actual harm that is not immediate jeopardy; (2) no actual harm with a potential for more than minimal harm, but not immediate jeopardy; and (3) no actual harm with a potential for minimal harm.

Letter Grading System:
 Immediate jeopardy to resident health or safety J K L
 Actual harm that is not immediate jeopardy G H I
 No actual harm with a potential for more than minimal harm, but not immediate jeopardy D E F
 No actual harm with potential for minimal harm A B C

For the entire report see: Trends in Nursing Home Deficiences and Complaints
If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to klabore@prslegal.com, or call Ken at 612-767-7503.

According to an article in the Irish Times; older patients discharged from hospital to long-term care in nursing homes live 30 months on average, the first study to examine survival in older patients admitted to nursing homes in the Republic has found.

The survival time of these frail elderly patients is just half that of a corresponding group who live in the community.

Dr Conal Cunningham, consultant geriatrician at St James’s Hospital, Dublin, and colleagues from the Mercer’s Institute for Research in Ageing followed 1,552 patients discharged from St James’s to nursing homes in 1997-2003. A random sample of 210 patients from the seven-year period was then chosen for detailed analysis.

The results, published in the current issue of the Irish Medical Journal, show the patients had an average age of 82 and almost one in three was female. On average, the patients studied lived for a further 30.3 months following transfer to a nursing home. This compares with a life expectancy of 67 months for an Irish man aged 82, with women of the same age expected to live for 85 months.

“As this period of study was associated with increasing privatisation of nursing home care in the Greater Dublin area, it is encouraging to note there was no significant association between survival and the public/private status of nursing homes,” the authors noted.

The proportion of patients discharged to private nursing homes rose from 25 per cent at the beginning of the study to 56 per cent at the end. But the authors said their study was not sufficiently powerful to compare outcomes in private versus public nursing homes.

Data from the US, Canada and the UK has shown that public nursing homes look after people with more complex problems and have higher staffing levels. Patients in public nursing homes are hospitalised less for dehydration and pneumonia, suggesting they may be a more appropriate choice for the long-term care of more frail patients.

The study found that 7 per cent of patients died within one month of admission to a nursing home, but this initial high mortality rate dropped with time spent in long-term care. Some 25 per cent of patients were dead one year post-discharge.