In addition to record-high numbers of complaint investigations, volunteer and staff ombudsmen also completed 100 percent of the program’s prescribed facility assessments. Ombudsmen visit every long-term care facility in the state, including all nursing homes, at least once each year to listen to residents’ concerns in an effort to fix problems to the residents’ satisfaction.

The only organization of its kind in the state, the Ombudsman Program trains volunteers to advocate for people living in nursing homes, assisted living facilities and adult family care homes.

The annual report, released in December, also draws attention to the decline in volunteers from more than 400 the previous year to 380 this year. The slow economy was partially to blame.

“We certainly need more volunteers to advocate for residents, to make sure they’re getting the quality of care and life they deserve,” said Brian Lee, the Ombudsman program’s director, in a state department press release.

To get a free copy of this annual report or to find out more about becoming a volunteer, go to http://ombudsman.myflorida.com.

Find our more information in this Dangers of Nursing Homes video by Daytona Beach nursing home injury lawyer or check out the Frequently Asked Questions from this Daytona Beach Nursing Home and Medical Malpractice lawyer.

The agreements provide that the resident gives up the right to file a lawsuit in court and ask for a jury trial. Instead if the nursing home abuses the resident the case goes to an arbitrator who may be less likely to be sympathetic to the resident.

We usually find that these complex agreements were misrepresented as for the benefit of our clients. Businesses sometimes tell our clients that the agreements are good for them because disputes can be resolved quickly. What they don’t say is that the nursing home’s lawyers have carefully drafted the agreements to get people to give up important and valuable legal rights.

For example, one nursing home chain asks its residents to sign an arbitration agreement that places a limit on the amount of money that can be awarded the resident in a lawsuit regardless of the severity of injury that the nursing home caused.   Florida courts have ruled that this limitation is against public policy, but the nursing home chain keeps trying to enforce it.

Therefore, we recommend that nursing home residents refuse to sign arbitration agreements. Be careful to review the nursing home admission agreement to make sure that it does not have an arbitration clause. If there is an arbitration clause, just draw lines through it so it is clear you do not intend to agree to it.

In some circumstances with the appropriate safeguards, arbitration can be fair to both sides. However we recommend that you make that type of decision only after consulting a lawyer experienced in nursing home litigation.  Any decision to arbitrate is best made in the context of a lawsuit with advice of an attorney.

Despite the fact that nursing homes employ people who are more than two years old, the federal government has to tell them to play nice. In fact the Centers for Medicare and Medicaid Services have to publish new rules about how to play nice all the time.  The government creates these rules in response to observations that nursing home employees are not treating residents respectfully. In June of this year the government again had to publish some new rules about playing nice.  Here are some examples of the rules.  They are just like your mom’s rules although they are phrased in more grown-up language:

1. Each resident has the right to be free from mistreatment, neglect and misappropriation of property.

2. Staff [should not] interact/converse only with each other rather than with residents while assisting residents.

3. [Staff should] respect residents’ private space and property (e.g., not changing radio or television station without resident’s permission.

4. [Staff should] respect residents by speaking respectfully, addressing the resident with a name of the resident’s choice, [and]  avoid use of labels for residents such as “feeders.”

 5. [Staff should] maintain resident privacy of body including keeping residents sufficiently covered, such as with a robe, while      being taken to areas outside their room.

That last rule means that nursing homes should not leave a resident in a public area in a wheelchair uncovered without any clothes. Even when you were two years old, you didn’t do that.  Unfortunately in our nursing home abuse practice in Daytona Beach we see just this type of thing happening. The law does allow the resident or family to sue the nursing home for violation of resident rights, but our clients would rather be treated with dignity and respect than go to court.

So what we have to say to some nursing home employees is, “Play nice and grow up!”

For more information about nursing home abuse see the nursing home section of our website zqlawyers.com

The problem is that because these programs taken together do not pay well they make it difficult for nursing homes to both make a profit and to provide quality care. Thus, many nursing homes choose to limit staffing in order to make a profit. Inadequate staffing in turn results in abuse and neglect of nursing home residents.

Medicare taken alone reimburses nursing homes at a profitable rate. However, Medicaid can pay at a rate that causes a loss for the nursing home.  Nursing homes try to offset losses from Medicaid patients with profits from Medicare patients.

Medicare, however, pays for only a limited time and only for those who meet specific guidelines.   Medicare does not pay for “custodial care,” including help with your activities of daily living such as getting dressed, feeding yourself and bathing. If you do not need  “skilled nursing care” Medicare will not pay. “Skilled nursing” includes care such as intravenous injections and physical therapy and requires staff such as registered nurses and physical therapists.

Medicare pays “full cost” for only 20 days. After that the patient pays a large copayment up to 100 days and then Medicare pays nothing. Once the 20 days is up, nursing homes know their profit margins will go down.

Tragically we have seen many cases in our Daytona Beach-based nursing home neglect practice where the nursing home discharges a patient home on the 20th day even if the patient is terribly sick. Sometimes the patient dies because of the discharge.

Therefore, one of the most important conversations you will have with nursing home staff will be with the discharge planner. We recommend that you make it clear to the planner that the choice of healthcare providers after 20 days should be based on the patient’s condition rather than Medicare’s ending reimbursement.

For example nursing home residents who have had strokes or some other extremely debilitating medical condition sometimes cannot swallow. The resident and family must then decide whether to use a feeding tube. The feeding tube provides nutrition and hydration and extends life for people who cannot take in their own nutrition and hydration by swallowing.

Feeding tubes, however, are not without difficulties. The most common type of feeding tube utilized long-term is the percutaneous endoscopic gastrostomy tube or PEG tube. The Peg tube is surgically inserted through the abdomen into the stomach. The surgeon uses a camera inserted through the mouth down into the stomach to perform the surgery. The feeding tube rests in the stomach and exits through the skin. The nurses must carefully clean the surgical site for the remainder of the resident’s life in order to avoid infection.

The tube, of course, interferes with a resident’s mobility. While it provides sufficient nutrition and hydration for the resident to stay alive, it also has side effects and does not do as good a job providing nutrition as normal chewing and swallowing. Side effects include bloating and diarrhea. People on PEG tubes are at risk for poor nutrition and digestive problems. Because of the potential for poor nutrition and decreased mobility, they are also a risk for bedsores. For more information about this feeding tube, see the entry in Wikipedia through this link. http://en.wikipedia.org/wiki/Feeding_tube.

Any decisions about health care in a nursing home or hospital require balancing the goal of extending life with the goal of living a quality life. We recommend that family members talk about end-of-life planning in a very frank and nonjudgmental way well before decisions must be made in a nursing home or hospital. The best way to do this is to consider a thorough living will and designation of health care surrogate as allowed by Florida law.