a recent series of articles in the wall street journal have painted a disturbing picture of nursing homes nationwide systematically medicating residents with anti-psychotic drugs in an attempt to manipulate their conduct and conduct. The wall street journal has reported that the use of new anti-psychotic drugs to manipulate conduct of dementia persons who requires medical care has surged, in spite of fda warnings regarding the use of said drugs. The core for medicare and medicaid services has similarly reported that approximately thirty percent of nursing home residents are taking anti-psychotic drugs.

although reports of this nature are not new, they reinforce the want for attorneys, families and friends to know, grasp and effectively advocate nursing home residents’ rights.

the 1987 nursing home reform act (”nhra”), allocation of the omnibus budget reconciliation act of 1987(”obra”), established quality standards for nursing homes nationwide and defined the state survey and certification process to enforce the standards (42 cfr 283. 0). These regulatings represent minimum standards for long term care facilities. They were promulgated to advance the quality of care of their residents. The ordinary goals of obra are to:

(a) promote and enhance the quality of life of the resident;

(b) provide services and activenesses to attain or maintain the most eminent practicable, physical, mental and psycho social well being of every resident in accordance with a written plan of care;

(c) provide that resident and advocate participation is a criteria for evaluating the facilities compliance with administrator necessities; and

(d) assure access to the state’s long term care ombudsman (a 3rd party resident advocate) to the facilities residents, and assure that the ombudsman has access to records, residents and care providers.

the goals are enforced by nhra establishing the resident’s bill of rights:

• the right to freedom from abuse, mistreatment, and neglect;
• the right to freedom from physical restraints;
• the right to privacy;
• the right to accommodation of medical, physical, psychological, and social needs;
• the right to participate in resident and family groups;
• the right to be treated with dignity;
• the right to practice determination of ones own fate or course of action without compulsion;
• the right to commune freely;
• the right to participate in the review of one’s care plan, and to be fully
• informed in advance regarding any changes in care, treatment, or adjust of status in the facility; and
• the right to voice grievances without the discrimination or reprisal.

a copy of the nursing home resident’s bill of rights must be conspicuously posted in the lobby of the facility. While these rights are ordinary in nature, nhra specifically defines the parameters of every right. As an illustration, relative to medication, nhra proscribes that a resident be free of unnecessary physical or chemical restraints, including anti-psychotic drugs and sedatives, except when authorized by a physician for a defined and fixed period of time.

additionally, the nhra specifically provides that:

(a) facilities inform the resident of the name, specialty and means of contacting the physicians responsible for the resident’s care;

(b) facilities must inform the resident, his or her guardian or fascinated family fellow member of any deterioration of the resident’s health or whether or not the physician wishes to adjust treatment;

(c) facilities must provide the resident access to his or her medical records within one business day, and a right to copies of the records at a fair cost;

(d) facilities must provide a written description of a resident’s rights, explaining state laws applicable to living wills, durable powers of attorney, etc. , along with a copy of the facilities policy on carrying out these directives. This becomes exceptionally crucial when a facility refuses to honor the residents advance directive applicable to end-of-life decisions, the use of feeding tubes, ventilators and respirators;

(e) the resident has a right to privacy, which extends to all aspects of care; and

(f) a resident can not be moved to a dissimilar room, dissimilar nursing home, a hospital or back home without progressed observe, and an chance for appeal.

in short, familiarity with obra and nhra will provide the practitioner with a more desirable cognizance of protocols for the next applicable areas:

• abuse, including unnecessary or excessive restraints.
• pressure sores, infections, falls and fractures.
• adverse drug reactions and over-medication.
• nutrition, hydration, and unintended weight loss.
• dining and food service.
• sufficiency of staff, including nursing.
• rehabilitative care, including physical therapy and conversation therapy.

as the baby boomers come of age it’s inevitable that a substantial number of them will spend numerous time in a nursing home. Cognition of their rights are going to be of vital importance for their lawyers, families and friends.