Many families feel completely overwhelmed and without a voice when a family member is admitted to a nursing home. It sometimes feels that families have little control over critical decisions that are made. Families should be aware that both Florida and Federal law provide that nursing home residents have rights.
Nursing homes cannot limit visiting hours for family members
Federal law prohibits nursing homes from restricting visiting hours for immediate family members or other relatives (483.10(j)(1) of Title 42 of the Code of Federal Regulations. As long as the resident wants the visitor, the facility cannot restrict visits to certain times of the day or night. If a resident lacks mental capacity, decisions regarding visitors can be made by the resident’s representative. Guidelines to the law recommend that late night visits should be made in a location where other residents’ rest is not disturbed, such as a common room.
Medicare days do not end because the patient has reached a plateau
According to law, Medicare therapy should be provided if the therapy improves the resident’s condition, maintains the resident’s condition, or slows the decline of the resident’s condition (Section 483.25(a) of Title 42 of the Code of Federal Regulations. Nursing homes are under pressure from the Medicare program to insure that they do not continue receiving Medicare funds after the usefulness of therapy has stopped. Due to this pressure the facilities sometimes fail to consider whether the therapy is needed to maintain the resident’s condition or slow the decline of the resident’s condition. They seem to focus only on the improvement to the resident’s condition. When the facility issues a notice of non-payment, the patient can force the facility to bill Medicare for the service so that Medicare will have to make a decision about the discontinuation of therapy.
Guidelines regarding readmission to the facility after a hospitalization
Florida law requires that the residents be informed of the facility’s bed hold policy prior to a hospitalization (Section 400.022(u) Florida Statutes). A private pay resident’s bed may be reserved for a period of up to 30 days. A Medicaid resident’s bed will be reserved for up to 15 days by the state. However the state will not reimburse the facility if it is medically determined by the agency that the resident will not need the bed or determines that the facility’s occupancy rate ensures that the bed will be available. If a Medicaid resident’s hospitalization exceeds the time that the state reserved the bed and the facility has no available properly certified beds, the Medicaid recipient is entitled to the next certified Medicaid bed.
Nursing home costs need not impoverish the applicant and family
Planning for benefits allow applicants and their families to use family wealth to augment basic care which can be provided by Medicaid. Married persons should never become impoverished by the cost of nursing home care for the sick spouse.
Jill Burzynski, of Burzynski Elder Law, is the only board certified elder law attorney in Collier County. She can be contacted at firstname.lastname@example.org or 239-434-8557.