patient rights

Adjusting to a new environment can be difficult. Adjusting to an environment that is typically seen as a higher level of care from an independent life can be even more challenging. As older adults are requiring more dependence in self-care, it is important to be mindful of how individuals and families can advocate for needed care. There can be many factors that can affect how care is delivered in skilled nursing facilities. As a telehealth therapist who works more often with rural facilities, I have compiled a list of the top five tips for addressing advocacy concerns.

1. Know your rights: Familiarize yourself with the rights you have as a nursing home resident, such as the right to privacy, to be treated with respect, and to make decisions about your care. This means that staff should be knocking on doors before they enter private rooms. If you are in a meeting (like a therapy session) where you expect privacy, there should be some type of sign on the door making notice of a private conversation taking place. If there is a care plan meeting, sufficient notice of the meeting needs to be given to residents and their guardians/power of attorneys as well as any parties they wish to invite. Skilled nursing facilities are most often privately owned businesses although they still have to adhere to state and federal regulations. There are state ombudsmen who will inform on rights as well as county aging and disability resource centers (ADRC) that can assist with knowing rights.
2. Speak up: If you have concerns about your care, don’t be afraid to speak up and let your caregivers and nursing home staff know. You have the right to have your concerns addressed and to have your needs met. As a therapist, I encourage my patients to speak up, often their voices are the last bit of control they have in their lives. One needs to understand the difference between addressing concerns with CNA’s, LPN’s or aides versus nurses and administrators. If the issue is smaller, then the aides may be able to assist in correcting things quickly. If there are larger concerns, nurses and administrators may be a better option to listen and respond.
3. Keep a record: Keep a journal or log of any issues or concerns you have, including dates, times, and the names of any staff involved. This can be helpful if you need to report a problem or issue to the nursing home administration or to a regulatory agency. What I will say instead of writing things down (people often cannot write due to sight and arthritis or neuropathy) is to keep track of how often a concern is verbalized and to whom it was verbalized. Often, a concern will be lost at the doorway when the staff move on to addressing the immediate needs of another resident. As a therapist, I have found that staff will often listen and respond in a way that keeps the resident calm in the moment and then there is no further action taken. These situations are more difficult when residents have isolated contact with family members or if they require corporate guardians (non-family guardians/POA). In Wisconsin, a guardian is only required to be in communication every three to six months (sooner if needed) and to see individuals once per year face to face.
4. Use the nursing home’s grievance process: If you have a problem or concern that cannot be resolved through casual conversation, use the nursing home’s grievance process to report the issue. The grievance process is probably the most effective way to get issues resolved or to get some accountability and action. Issues or complaints related to direct interactions with staff are usually handled through the grievance process. The facility’s social worker (who sometimes isn’t even a social worker) can assist in explaining the grievance process.
5. Be assertive and keep family or friends informed. It is important to be firm and clear about your needs and concerns, but it is also important to be respectful of the staff and caregivers who are working to meet your needs. Staff have a lot to deal with during their shifts and a lot of different personalities to connect with when assisting residents with their personal needs. Keep your family informed about your care and any concerns. They can be a valuable source of support and can help you advocate. Know where to go for help: If you feel that your rights are being violated or that you are not receiving the care you need, don’t be afraid to seek help from facility management teams, ombudsmen, facility social workers, and county human service departments.