Credit freezes are free under a federal law that just went into effect. Learn how to protect your credit.

Reply
Highlighted
Conversationalist
0
Kudos
454
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

454 Views
Message 1 of 9

First, thanks you provided much needed information.

 

Understanding what the law is really saying is what makes this so difficult.  As you wrote:

 

 “ The requirements provide a right of “reasonable” access to any entity or individual that provides health, social, legal, or other services to the resident” 

 

All of the above will in general be paid individuals and I would think qualify as a visitor under the law and the facility would equally not have control over them.  From reading other articles the goal was for the patient to feel like this is their residence and have the same rights as long as it does not interfere with patient care or other residents.

 

Nowhere does it mention an outside paid caregiver.    Has the patient given the caregiver any rights to be involved in her care DECISIONS? :

 

Yes like most laws there are broad terms and it states other services, yet no definition of those other services.  As for involvement in her care decisions, I am not sure what that entails, but she tries to get mom excited and ready for PT but she is not providing any care that the SNF is supposed to provide like bathing, moving the patient or anything of that nature.

 

I looked over the Cornell Law site and 483.10 Resident Rights and again it has the same vague wording, but it did say you are entitled to have a resident representative.  I wonder if when the aid is there we could state she is mom’s representative.

 

“They could ask you to move her to another facility - or to a more home type based one if and when she gets to the point that any therapy can be done on an outpatient basis.”

 

This is the sad fact and the BIG concern.  You make waves and they kick you out.  It is not like there are a lot of choices.  She will move back to her assisted living facilty once her SNF rehab is completed.

 

“I am also assuming that she does not have Medicare/Medicaid paying for her care at this facility.”

Medicare is paying for the facility, but not for the aid.

 

“Good Luck - you should have kept her at "friend" status if that relationship was important.”

 

It was not a friend that became an aide, it was an aide that become a friend over a long period of time.

Report Inappropriate Content
0
Kudos
454
Views
Valued Social Butterfly
0
Kudos
470
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

470 Views
Message 2 of 9

@RobertB724317

 

The aide is not interferring with anyting the SNF is doing.  That is important I agree but that is not th e issue here or I woudl have solved it already.   I have repeatedly askded them to put in writing what rules she is violating and they will not do it and just give us that "Sitter / Companion Rule".

 

As for legal and liability issues, many of the categories the Federal Medicare law covers for visitors would have the same issues.  

 

From the site you provided:

 

"Spend Time with Visitors: You have the following rights: To spend private time with visitors. To have visitors at any time, as long as you wish to see them, as long as the visit does not interfere with the provision of care and privacy rights of other residents To see any person who gives you help with your health, social, legal, or other services may at any time. This includes your doctor, a representative from the health department, and your Long-Term Care Ombudsman, among others."

 

 

Those words, "To see any person who gives you help with your health, social, legal, or other services may at any time" to me mean something.  That is the law and liability or other concerns cannot override the law.

 

Yet how one enforces that law is beyond me.  I bring up the law to SNF and they tell me things like that is Medicare not us.  And I am like you accept Medicare and it is federal law regarding SNF.  It is literally like talking to a wall.

 

And good luck trying to call Mediare and getting a response.

 


@RobertB724317

 

You are trying to over simplify government rules and regulations and that is not so easy for a lay-person.   Laws are always open to interpretation.

 

The whole program of Medicare is managed by CMS (Center for Medicare and Medicaid Services).  CMS writes the proposed rules based on the law or any changes to the law and then the final rules and reg for providers of all sorts covering things like their billing to Medicare, their payment from Medicare, staffing issues, rights of beneficiaries, etc - ALL of it.  Then your state adds more specifics.

 

The federal register with such law interpretation and final rules and regs are long and written many times in legal language.  Of course, you can do the research and the interpretation - I can give you a start but it is not easy to search and interpret for specifics.

CMS - Nursing Homes

 

Clarity on Rights - I have included the Right to Receive Visitors and the Medical Care Rights:

Center for Medicare Advocacy: A Closer Look at the Revised Nursing Facility Regulations - Visitation...

 

Rights to Receive Visitors
The resident representative is added to the list of people and government representatives who have immediate and unrestricted access to the resident. However, visits from non-family visitors are now subject to “reasonable clinical and safety restrictions,” which is a change from “reasonable restrictions.”
 
. . . . Unchanged in the revised regulations, the requirements provide a right of “reasonable” access to any entity or individual that provides health, social, legal, or other services to the resident, also subject to the resident’s right to deny or withdraw consent at any time.
 
The interpretation of “reasonable” access is similar to the understanding of “reasonable restrictions”: CMS states that the only reasons for denying reasonable access would be based on clinical or safety reasons. If clinical or safety concerns do not exist, then visitors are to be provided access to the resident, as long as the resident consents. . . . .
 
Written Policies and Procedures, and Other Facility Requirements
The revised regulations include new requirements for facilities to have written policies and procedures regarding residents’ visitation rights.
 
These written policies must indicate what the facility considers to be reasonable health or safety restrictions that may be placed on visitation rights. The facility policies must also include the rationale for such restrictions.
 
. . . . . Visitation rights are discussed in section 483.10(f ) of Title 42 of the Code of Federal Regulations.
 
But now that is for a "visitor" IMO, not a visitor if she is being paid for care - she is a caregiver, personal care aide - whatever her title.
 
This is much more specific than what was covered on the Medicare.gov site.
      Get Proper Medical Care:
You have the following rights regarding your medical care:
  • To be fully informed about your total health status in a language you understand.
  • To be fully informed about your medical condition, prescription and over-the-counter drugs, vitamins, and supplements.
  • To be involved in the choice of your doctor.
  • To participate in the decisions that affects your care.
  • To take part in developing your care plan. By law, nursing homes must develop a care plan for each resident.
  • You have the right to take part in this process. Family members can also help with your care plan with your permission
  • To access all your records and reports, including clinical records (medical records and reports) promptly (on weekdays).
  • Your legal guardian has the right to look at all your medical records and make important decisions on your behalf.
  • To express any complaints (sometimes called “grievances”) you have about your care or treatment.
  • To create advance directives (a health care proxy or power of attorney, a living will, after-death wishes) in accordance with State law.
  • To refuse to participate in experimental treatment

Nowhere does it mention an outside paid caregiver.    Has the patient given the caregiver any rights to be involved in her care DECISIONS? 

You can file a complant with the Ombudsman.

 

Here is the law and guidance part on QUALITY OF CARE - your state probably has more specific rules too -

HIT the PREVIOUS Button on the page to see the complete list

notice the details -  many of the things covered here are in areas where the outside personal (paid) caregiver is working.  States would add hiring qualifiers on the person, which have to updated ever so often - background checks, medical exam, requirement for flu shot and other immunizations.

 

IMO, you are introducing a person into the "care" aspect of the resident and this is controlled by the facility and the medical professionals under the auspices of quality rules imposed by Medicare and your state - the problem is simply that the facility has no control over the person you are paying directly or  for these services and it is their facility.

 

Can this be overcome?   ????? 

They could ask you to move her to another facility - or to a more home type based one if and when she gets to the point that any therapy can be done on an outpatient basis.

 

Now I am under the impression here that your mother is only recooperating at this facility and is not there for Long Term Residential type care.  I am also assuming that she does not have Medicare/Medicaid paying for her care at this facility.

 

To your questions

Solicite help from the state agency that oversees SNF or nursing homes.

Solicite help from the Ombudsman

Solicite help from maybe your Congressperson - if it turns out to be a CMS rule.

 

Something "medical" is also illusive because personal daily living care is not normally though of as being actual medical care -

 

Good Luck - you should have kept her at "friend" status if that relationship was important.

 

 

Report Inappropriate Content
0
Kudos
470
Views
Conversationalist
0
Kudos
494
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

494 Views
Message 3 of 9
Actually the aide has the TB and criminal BG, but that was not good enough for them. I just wish to find someone that truly knows and understand the law in this area and how one can enforce that law without spending thousands hiring an attorney.

I have calls into the local ombudsman. They are all on vacation for the holidays
Report Inappropriate Content
0
Kudos
494
Views
Conversationalist
0
Kudos
498
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

498 Views
Message 4 of 9

"Your answer is not cut and dried ".  

 

Your are not kidding.  No one there seems to even be familiar with the law and mom's visitation rights.  And it is not practical to pay a lawyer to sue them. 

 

 

 

The aide is not interferring with anyting the SNF is doing.  That is important I agree but that is not th e issue here or I woudl have solved it already.   I have repeatedly askded them to put in writing what rules she is violating and they will not do it and just give us that "Sitter / Companion Rule".

 

As for legal and liability issues, many of the categories the Federal Medicare law covers for visitors would have the same issues.  

 

From the site you provided:

 

"Spend Time with Visitors: You have the following rights: To spend private time with visitors. To have visitors at any time, as long as you wish to see them, as long as the visit does not interfere with the provision of care and privacy rights of other residents To see any person who gives you help with your health, social, legal, or other services may at any time. This includes your doctor, a representative from the health department, and your Long-Term Care Ombudsman, among others."

 

 

Those words, "To see any person who gives you help with your health, social, legal, or other services may at any time" to me mean something.  That is the law and liability or other concerns cannot override the law.

 

Yet how one enforces that law is beyond me.  I bring up the law to SNF and they tell me things like that is Medicare not us.  And I am like you accept Medicare and it is federal law regarding SNF.  It is literally like talking to a wall.

 

And good luck trying to call Mediare and getting a response.

 

Report Inappropriate Content
0
Kudos
498
Views
Valued Social Butterfly
0
Kudos
507
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

507 Views
Message 5 of 9

@RobertB724317

 

Your answer is not cut and dried because it does involve the relationship and authority which the aide has been given by either the patient, the approved family representative, the patient's doctor -

In a SNF, the staff should all work as a team under a treatment plan - from the aides to the therapist to the medical staff or doctor, keeping informed the patient and/or the legal family representative- this person is outside that realm, it seems. 

 

I am assuming that the aide does not do anything medically oriented and the lines are clear here and the aide knows what the doctor has ordered as far as things go under which she can/cannot do in this type of involvement.  Example:  feeding tube or other dietary or feeding restrictions, mobility issues, etc.  Hopefully this person isn't doing anything that is against the SNF's rules - some are legally based like mechanical or chemical restraints, others more medical..

 

The other poster was correct about the legal issues but not just for the SNF benefit; although liability issues are part of it.  Does this paid aide have her own professional or liability coverage, is she covered under the patient's coverage - perhaps a rider on her homeowners policy - check with the insurance agency, if that might be the case and find out if it can be extended to the SNF in some way..  Of course, nobody wants a lawsuit - and insurance protection is there for that protection in case something does happen.  Liability protection is a big concern in any facility that cares for seniors.

 

To be in a SNF under Medicare, there has to be medical necessity because Medicare is picking up their part of the bill under that medically necessary umbrella  - The patient must receive a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered "skilled," nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis.   That's a little different than a "nursing home" which is more for residential care differing from more medical/residential care (SNF).  

 

Mentioning this only because, again, the roll of this paid caregiver has to be defined with the facility since they are a SNF - if this person is gonna be part of the team at the SNF, then that is what the aide should be but under the (whatever) determinations of the SNF - liability-wise, responsibility-wise, legal-wise - and in that regard, there could be a conflict in your expectations and the SNF's expectations. 

 

Read more here:

Elder Law FAQ: 05/24/2016 - Medicare's Limited Nursing Home Coverage

 

Here is the CMS (Center for Medicare and Medicaid Services) pdf page on those Medicare Rights and Protections.  It may have some more detailed information for you on those Rights and Protections.

CMS.gov - Your Rights and Protections as a Nursing Home Resident

 

Perhaps you should consult with the Ombudsman, the states' regulatory agency or even an eldercare attorney with all the details.  Perhaps, it is just a matter of fully defining the rolls of this person - legally - right now that seems a little murky.  Friends aren't paid.  That puts a totally different perspective on the whole thing. 

 

If she is being hired as an independent paid caregiver- she has to be treated as such and have her authority roll defined, her responsibilities defined, her credentials defined and her liability coverage in place, because she is not working within the patients home and there is more than one "boss" so to speak.

 

 

 

 

 

 

 

 

Report Inappropriate Content
0
Kudos
507
Views
AARP Expert
2
Kudos
520
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

520 Views
Message 6 of 9

When i was a geriatric care manager, i recall that any privately hired aide had to 'register' with the director of nursing, some process that made sure this aide didn't have a criminal history and had some basic training.

 

What i would do first is call the local ombudsman (or ombudswoman) for the area that this skilled facility is in and check.  The other posts give good information. We also have an attorney who chimes in on posts. So glad you wrote. We'd all like your mother to be comfortable with the person who's helping her. I'm glad you all can afford the extra help.

 

Please let us know how this turned out, okay? We all benefit from what each of us learns in this tangle called 'long term care'!!

 

Jane

Report Inappropriate Content
2
Kudos
520
Views
Conversationalist
0
Kudos
557
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

557 Views
Message 7 of 9

Many individuals under the federal visitors reguations would be assisting you.  This comes down to what the Federal Law Regualting SNF means, as most laws it is a bit fuzzy and gives broad terms but does not define them, yet it says or other services which is pretty broad.

 

 “An individual or representative of an agency that provides health, social, legal, or other services to the resident has the right of "reasonable access" to the resident”"

Report Inappropriate Content
0
Kudos
557
Views
Info Seeker +
1
Kudos
580
Views

Re: Skilled Nursing Facility & Caregiver Visitation Rules

580 Views
Message 8 of 9

It all comes down to insurance and liability. Visiting is one thing, Assisting is another. They’d be in a pickle if your mom got hurt by an outsider or unauthorized helper. I’m sure you and your mom trust her, but the SNF is ultimately responsible. 

TC Daniel
Report Inappropriate Content
1
Kudos
580
Views
Conversationalist
2
Kudos
595
Views
8
Replies

Skilled Nursing Facility & Caregiver Visitation Rules

595 Views
Message 9 of 9

I am hoping someone knows the Laws Regarding Skilled Nursing Center.  I would really appreciate only answers to the question asked and if you now the laws in this area.

 

My Mom is currently in Skilled Nursing and we hired an aide to help mom.  This person has worked with mom for years and knows her health history.  The aide is a long term friend and aide.  The aide was told she could no longer visit my mom at skilled nursing and we could only use someone from an approved agency.  My mom is not interested in having someone from an agency she does not know helping her.

 

When I asked why the aide could not visit I was given different reasons each time.  When I point out the law they seem to have no clue that there is a federal law that regulates SNF and visitation rights. 

 

When I look at the Medicare website the federal law clearly states:

 

“You have the right to spend private time with visitors at any reasonable hour. Any person who gives you help with your health or legal services may see you at any reasonable time. This includes your doctor, representative from the health department, and your Long-Term Care Ombudsman, among others.

 

https://www.medicare.gov/what-medicare-covers/part-a/rights-in-snf.html

 

Also the Aspen Federal Regulation Set: F 15.00 LONG TERM CARE FACILITIES states, “An individual or representative of an agency that provides health, social, legal, or other services to the resident has the right of "reasonable access" to the resident”

 

https://ahca.myflorida.com/mchq/Current_Reg_Files/Long_Term_Care_FED_F.pdf

 

I would think the aid would follow under the health, social or other services categories as a visitor, but the law never clearly defines these terms.   

 

The only documentation I can find from the skilled nursing center regarding this issue is titled, “Sitter / Companion”.  That document talks about rules an agency must comply with and then outlines specific approved agencies, yet my mom is directly paying the aide and no agency is being used. 

 

This seems to be in violation of the Medicare Rules for Visitors and my mom’s rights.

 

So I am confused and not sure what the proper response should be.  I want to email the executive administrator about this issue, but want to make sure I am using the right words to justify mom’s aide is a visitor that follows under the Federal Medicare Regulations, though I must admit I am confused regarding this issue.

 

Advice from anyone with expertise and experience with this very issue would be appreciated.   

 

Thanks in advance,

 

Robert B.

 

Report Inappropriate Content
2
Kudos
595
Views
8
Replies