Operations at the Nursing Home
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Every certified nursing home has outlined modes of operation of the entire facility. As a nursing home provides residential long-term medical care, the operational policies for a resident are unique and differ significantly from those for other health facilities. In the United States, Medicaid and Medicare do certification centrally to ensure people requiring long-term medical care and short-term rehabilitation are given sufficient care. There are also facilities that operate only under the laws and regulations of their states because they do not accept Medicare and Medicaid payments. However, the regulations establishing the standard a nursing home should attain and what it has to do serve as the operational policies of that nursing home.
Admission, transfer, or discharge policies are similar across all nursing homes. With respect to admissions policy, a nursing facility does not require a guarantee of payment from a third party to the facility as a condition to admit, expedite admission, or allow continued residence in the facility. Prospective residents applying for admission or those residing in the facility must not have their rights to benefits of medical assistance programs waived. They are also obliged to have written or oral assurance that they are eligible for such benefits. In the facility walls, information about application and use of such benefits is written and prominently displayed. States such as Illinois, Massachusetts, and Indiana require every potential nursing home resident to undergo a compulsory pre admission screening. The aim is to determine whether placement in a nursing home is indeed the most appropriate option for the person. Admission policies may also concern times of day when admissions are prohibited or must be allowed. Additionally, some states mandate counseling the family on options as an effort to curb diversion of deserving residents from entering a certain facility.
Transfer agreements are usually between the nursing home and a similar facility or hospital. Resident transfers must be timely and exchange of relevant medical information is mandatory. The agreement should also designate responsibility to ensure adequate care during the transfer, security of the resident’s belongings, as well as prompt readmission to the receiving nursing home. Staff should also take steps to reduce unnecessary anxiety or depression, which may often accompany a transfer or discharge. Such a phenomenon is referred to as ‘transfer trauma,' and it usually occurs when the resident has no control or choice over the discharge. The notice of all involuntary transfers must be mailed to the relevant authorities and provided to the resident simultaneously. It is also required that one copy of involuntary transfer/discharge notice is sent to the ombudsman program as well as to the agency responsible for the placement in the nursing home. Policies regarding the timing for involuntary transfer and discharge notification vary. The notice has to be given a month in advance of the transfer or discharge (Giacalone, 2006).
Bed-hold policies require a nursing home to reserve a bed for an acutely hospitalized nursing home resident. That service has to be paid for because beds in such facilities are in high demand. The profit associated with bed holding is always greater compared to that associated with continually caring for the resident in the nursing home. It is considered not only unfair but also inhuman to attempt to evict a resident the facility staff deems difficult when the former is under acute hospitalization. Nonetheless, it is tempting to do so because the demand for beds often outstrips the supply. Breach of a bed-hold agreement is, however, genuine at times. When a resident fails to pay for the bed, eviction is justifiable. In some instances, the resident may be unwilling to return to a particular nursing home after discharge from hospital or may have grown out of the need for nursing home care. A resident may also feel their needs can no longer be met in a nursing home. Other reasons that often justify a breach of bed-hold policies include a resident’s dangerousness to themselves and to other members of society. Lastly, it is obvious a bed-hold policy cannot be applicable any longer in situations where a nursing home is going out of business. Nevertheless, the nursing home must notify proposed breach of contract to the resident usually within 4 weeks of the discharge, and a list of facts supporting the breach has to accompany the notice. In addition, to include in such a notice is the phone numbers of the facility licensing and inspection authorities, as well as instructions on how to appeal (Giacalone, 2006).
The policies governing the management of personal funds are elaborate. The facility accounts for the personal funds of a resident deposited with them upon written authorization of the resident. Operational policies pertaining to deposit are as follows: it is mandatory for the nursing home to deposit any monies in excess of 100 U.S. dollars. Such a deposit is made with respect to a particular resident in accounts that are separate from the facility's accounts or interest bearing account. All interest earned on a separate account, as this ought to be deposited to the residents’ personal account. About other fund types, the nursing home is required to maintain such monies in a petty cash fund or non-interest bearing account. About accounting and records, it is mandatory for the home to assure a comprehensive separate accounting of any resident's personal funds, while maintaining a written record of all transactions involving the funds the resident has deposited with the facility. In addition, the facility should afford either the resident or their legal representative reasonable access to the record. Upon the death of the resident, the facility has to convey promptly his or her personal funds, as well as a proper accounting of the funds to the person administering the estate of the deceased. It is a requirement for a nursing home to buy a surety bond, failure to which there is an option of providing assurance satisfactory to all parties. The aim of that part of the policy is to assure all of a resident’s personal funds deposited with the nursing home are secure. Finally, a nursing home may not impose charges against personal funds for any service for which payment is completed (Giacalone, 2006).
The level of care can vary, but provision of 24-hour nursing service sufficient to meet the resident’s nursing needs is mandatory. During the stay in the facility, restraining the resident is justifiable only if it is for the interest of his/her health. A resident who is on occupational therapy may be free to do housekeeping duties; he or she can cook and regulate her own diet as long as her safety is guaranteed in the course of these activities. The meals have to meet the nutritional needs of the resident and a professional-directed program of physical activities designed to meet a resident’s physical and psychosocial well-being is mandatory. A pet that does not pose a threat to the resident and others may also be allowed, if it increases the patients comfort and enhances self-image. The schedule for a resident who is insignificantly incapacitated can be flexible and subject to changes by the individual as long as it serves their well-being. The purpose should be to make the resident feel comfortable and lead a happy life because such persons are often those who are unfit to be either at home or in a hospital. The number of residents that require medications is often able to self-administer medications, but assistance should always be readily available when necessary. Services such as beauty and barbershop facilities are also part of quality care and must be easily accessible. A nursing home may install phone and mail services in every room, or may have booths for mobile patients at strategic corners. Overall, appropriate care must comprise medical as well as social facilities meant to make the resident’s stay at the facility enjoyable.
Visitation policies do not dictate visitation hours but govern access of the resident to his/her relatives or other parties. There is guaranteed immediate access of a representative of the Secretary to any resident. Any state representative, ombudsman, or the residents’ personal physician enjoys similar privileges. The family members of the resident reserve the right to deny other parties from accessing a resident. They may also withdraw, at will, consent of access to their relative. A resident fully capable of consenting may refuse visitation by any parties, including immediate family members, subject to reasonable reasons. During a visit, inspection of the medical records of a resident is only permissible to an individual or entity that provides health, legal, or social services to the resident, and is subject to the consent of the resident, which he or she can withdraw at, will. As for the visiting hours, the nursing home may stipulate the schedule, but the timing must be reasonable (Giacalone, 2006).
The process of registering complaints must be easy and confidential. The nursing home is required to post notices of the availability of such a process in places of the facility that are not only accessible, but also prominent to the public. It is obligatory that the facility never makes available any information that might make identification of complainants possible. The complainant resident must also not be intimidated in any way.
The mode with which a particular nursing home operates may be different from others, but there exist universal operational policies that every nursing home has to meet. A nursing home under Medicaid/Medicare has its operational policies defined by the respective institution. State laws set the policies for those facilities, not under Medicaid/Medicare. Nevertheless, all these policies are more or less the same and ultimately serve to provide any resident with nursing care and related services. Special services may exist for a resident requiring medical care due to injury, disability, chronic somatic disease, or mental incapacity. Such services require to be guided by a distinct set of policies, all of which have been described in the above details.