New rules for the protection of nursing home residents have been implemented as part of the Affordable Care Act (ACA). Many of these rules provide answers to concerns that have troubled families with loved ones living in skilled nursing facilities (SNFs), generally called nursing homes. I emailed Medicare expert Ginalisa Monterroso for an update on these rules and what they mean for nursing home residents and their families.
Monterroso is the founder and president of Medicare & Medicaid Advisory Group, which is a company that represents families in the world of subsidized care. She has more than 25 years of experience consulting, managing, and processing Medicare and Medicaid eligibility applications for some of the most prestigious nursing homes and medical facilities in the New York and surrounding areas.
You can read our conversation below:
HealthCentral: Ginalisa, abuse and neglect can happen even in a good facility if they mistakenly hire a bad caregiver, but for chronically substandard facilities the threat is much more likely than others. This fear that a vulnerable loved one may be neglected or abused in a care home keeps many families on edge and contributes to family caregiver guilt. Do any of these new protections help families feel more relaxed about these issues?
Ginalisa Monterroso: Patients and families can now sue for neglect under the new rules. In the past, many nursing homes required families to sign away their rights to sue, even if the nursing home was negligent in a death or abuse. Under this section of the rule, which went into effect last November, nursing homes can no longer force families to sign away these rights to litigation.
HC: While the ability to sue is no guarantee against neglect or abuse, it does help in that the nursing home administration knows that they can be sued. It’s at least a start.
My next question is about roommates. My mother-in-law loved her new home in a wonderful SNF; however, she didn’t like her roommate. The home tried to accommodate her the best that they could, but their rooms were full and they didn’t feel that they could force room switches for others. I’ve read that a rule change may help with this problem. Is that true?
GM: Yes, a new rule allows residents to choose their roommates. They also may have visitors "at the time of his or her choosing.” A lot of these new changes were put in place to improve the quality-of-life experiences for seniors at nursing homes. It also loosens the visiting hour policies. It’s a big step towards giving residents more control over their care and making everyone feel closer to home.
HC: I agree, wholeheartedly, with your second point. In my opinion, families should be able to stop in unannounced as long as they don’t disturb other residents.
My next question is another issue that I've struggled with. This was before more homes were offering meal choices, though the home where my mother lived did what they could to accommodate her poor appetite. I also kept a cooler in her room so that I could bring her treats on my daily visits. However, I’d like all nursing home residents to have more choices about what, and even when, they eat. What has changed when it comes to food choices?
GM: Families and caregivers now have more say over what their aging parents, grandparents, and loved ones eat. This is another nice quality-of-life change that I think will do a lot of good for residents. Appetite or hunger can cause stress for nursing home residents and adversely affect the patient. Allowing a family member to get their favorite food, or have a snack when they are hungry, will make everything feel a little more comfortable and close to home.
HC: As a newspaper eldercare columnist, I hear from many people who are stressed over waiting for the change from private pay to Medicaid. Is there help in these new rules on that issue?
GM: It's now harder for nursing homes to discharge patients who are waiting for payment from Medicaid or are in dispute. This is one of the bigger changes to come out of this ruling. These new discharge policies will hopefully end horror stories our social workers hear all the time — and that is getting put on the street with no backup home in place.
HC: Now for the big question. It took years to push these changes through our system. Now that they are in place, the ACA is up for repeal. Will these changes for nursing home residents be reversed, as well?
GM: There is really no way to know what will happen if the ACA is repealed. There are too many unknowns in both Congress and the new administration to know exactly what the new health care system and regulations will cover. That could always change.
HC: Thank you for this update on significant improvement in our nursing home environment and security, Ginalisa. These are good changes that I hope will remain. Whether or not they do stay in place, I’m looking forward to checking back with you for occasional updates.
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Carol Bradley Bursack is a veteran family caregiver having spent over two decades caring for a total of seven elders. She is a longtime newspaper columnist and the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” as well as a contributor to several additional books on caregiving and dementia. Her websites can be accessed at www.mindingourelders.com. Follow Carol on Twitter@mindingourelderand on FacebookMinding Our Elders.