One of the most difficult decisions for families often comes when a loved one can no longer live independently in their own home and other options must be considered. Often the need for 24-hour nursing care, assistance with bathing and dressing, and meal preparation require us to consider a long-term care facility.
There are four levels of care provided by these facilities:
Residential Care Facility I - Provides shelter, board and protective oversight and may include dispensing of medication and care during short-term illnesses or recuperation. Residents must be able to "negotiate the path to safety"
Residential Care Facility II - Similar to Residential Care I, but also provides additional services, including supervision of diets and assistance with personal care.
Intermediate Care Facility - Provides board, personal care and basic health and nursing care services under the daily supervision of a licensed nurse and direction of a licensed physician.
Skilled Nursing Facility - Provides board, skilled nursing care and treatment services.

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Resident Rights in Long-Term Care Facilities

When you enter a nursing home, you must comply with reasonable rules of the facility and you must respect the rights of staff and other residents. However, you do not surrender your basic civil rights when you enter a nursing home. While institutional care may place limitations on your privacy and lifestyle, you should expect care that is compassionate, dignified, and high quality.

The federal Nursing Home Reform Amendments of 1987 provides the following rights to residents:

Right to information - Nursing homes must provide:
written information about your rights, including personal funds, the right to file a complaint and how to contact the ombudsman and the state survey agency;
written information about the services included under their basic rate and any extra charges for additional services;
advance notice of any changes in room assignment or roommate;
an explanation of your right to make a health care advance directive and information about their policies on complying with advance directives;
information about eligibility for Medicare and Medicaid and the services covered by those programs.
Upon reasonable request, the facility must provide the results of the most recent survey (inspection) of the facility.

Self-determination rights - Residents have the right to:
choose a personal physician;
be informed in advance about any changes in care and treatment which could affect resident well being;
participate in changes in care and treatment or planning care and treatment;
voice complaints about care without fear of discrimination or reprisal for voicing concerns;
participate in resident and family groups.

Personal and privacy rights - Residents have the right to:
participate in social, religious, and community activities that do not interfere with the right of other residents;
privacy regarding accommodation, medical treatment, written and telephonic communications, visits, and meetings of family and resident groups;
confidentiality regarding medical and personal records.

Visitation rights - Nursing homes must permit immediate access to a resident:
by personal physician and representatives from state and federal agencies, including the ombudsman program;
immediate family or other relatives, if resident consents;
by others with "reasonable" restrictions.

Involuntary transfer and discharge rights - Residents may only be transferred or discharged under the following conditions:
the residents welfare cannot be met in the facility;
the residents health has improved so that nursing care is no longer needed;
the health and safety of individuals in the facility are otherwise endangered;
the resident has failed, after reasonable notice, to pay for care;
the facility ceases to operate.

Protection against Medicaid discrimination - Nursing homes that participate in the Medicaid program must:
have identical policies and practices regarding services to residents regardless of the source of payment;
provide information on how to apply for Medicaid;
not require a third-party guarantee of payment to the facility;
in case of a Medicaid recipient, not charge, solicit, accept, or receive gifts, money, donations or other considerations as a precondition of admission or continued stay in the facility;
not require, request, or encourage residents to waive rights concerning Medicaid.

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20 Suggested Topics To Discuss With Your Health Care Agent

When instructing your health care agent about your wishes in the event you become incapacitated and they need to make health care decisions, we suggest you consider the following questions. We suggest no particular answers. Each person should answer these questions based on their own beliefs and convey those beliefs and wishes to their health care agent. Any other wishes or desires that you feel your heath care agent should know should also be given to them so that they can carry out their responsibilities as you would wish.

1. Do you want to donate parts of your body to someone else at the time of your death? (This is called "organ donation.")

2. Do you think you would want to have any of the following life-sustaining medical treatments performed on you?.

   1. Kidney dialysis (used if your kidneys stop working)

   2. Cardiopulmonary resuscitation, also called CPR (used if your heart stops beating)

   3. Respirator (used if your are unable to breathe on your own)

   4. Artificial nutrition (used if you are unable to eat food)

   5. Artificial hydration (used if you are unable to drink fluids)

3. How would you describe your current health status? If you currently have any medical problems, how would you describe them?

4. If you currently have medical problems, in what ways, if any, do they affect your ability to function?

5. How do you feel about your current health status?

6. If you have a doctor, do you like him or her? Why? Do you think your doctor should make the final decision about any medical treatments you might need?

7. How important is independence and self-sufficiency in your life?

8. If your physical and mental abilities were decreased, how would that affect your attitude toward independence and self-sufficiency?

9. Do you expect that your friends, family and/or others will support your decisions regarding medical treatment you may need now or in the future?

10. What do you think will be important to you when you are dying (e.g. physical comfort, no pain, family members present, etc.)?

11. What is your attitude toward death? Where would you prefer to die?

12. How do you feel about the use of life-sustaining measures in the face of terminal illness?

13. How do you feel about the use of life-sustaining measures in the face of permanent coma?

14. How do you feel about the use of life-sustaining measures in the face of irreversible chronic illness (e.g., Alzheimer's disease)?

15. Do you wish to make any general comments about your attitude toward illness, dying and death?

16. What is your religious background? How do your religious beliefs affect your attitude toward serious or terminal illness?

17. Does your attitude toward death find support in your religion?

18. How does your faith community, church or synagogue view the role of prayer or religious sacraments in an illness?

19. Do you wish to make any general comments about your religious background and beliefs?

20. What else do you feel is important for your agent to know?

If, over time, your beliefs or attitudes in any area change, you should inform your health care agent. It is also wise to inform your health care agent of the status of your health when there are changes such as new diagnoses. In the event you are informed of a terminal illness, this, as well as the ramifications of it should be discussed with your health care agent. How well this individual performs depends on how well you have prepared him or her.

NOTICE

THIS INFORMATION IS NOT OFFERED AS LEGAL ADVICE BUT ONLY AS GENERAL INFORMATION ABOUT TOPICS OF INTEREST TO SENIOR CITIZENS AND THEIR CAREGIVERS. YOU SHOULD NOT RELY ON THE LIMITED INFORMATION PROVIDED HERE, BUT ARE URGED TO CONSULT WITH A QUALIFIED ELDER LAW ATTORNEY FOR LEGAL ADVICE BASED ON YOUR PARTICULAR , INDIVIDUAL CIRCUMSTANCES.

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