The Golden Rule & Key Federal Protections Against Elder Abuse in Nursing Homes
Some elder abuse lawyers refer to ‘the Golden Rule’ principle of nursing home caregiving:
“Each resident is entitled to the care that enables them to maintain their best possible physical, mental, and psychosocial well-being.”
The Golden Rule is a standard of care enshrined in federal regulations governing nursing homes, violations of which can result in fines and termination of Medicaid and Medicare payments.
Title 42 of the Code of Federal Regulations (CFR) contains the key components of the protections and rights afforded to residents of nursing homes. Many of these cover similar ground to the California regulations discussed in last week’s blog, such as requirements for facilities to prevent bedsores and infections, and to properly administer medication.
Let’s look at some of the key federal regulations governing nursing homes and what they mean for residents.
Residents Rights. According to federal law, nursing home residents have a right to ‘a dignified existence [and] self-determination.’ Individual needs should be reasonably accommodated, such as allowing residents to bathe or shower according to personal preference. If there is a language barrier between staff and resident, the facility is required to provide interpreters or otherwise facilitate communication. Residents also have the right to participate in their own care planning.
Resident Assessments. Facilities must conduct comprehensive assessments for each resident, with a view to creating an individualized care plan. Initial assessments must take place within 14 days of admission, within 14 days of any determination of a ‘significant change’ in the resident’s condition, and no less frequently than once every 12 months. A list of the health, demographic and other data to be collected can be found here.
Staffing. Despite being one of the most important components of quality care, inadequate staffing is the locus of far too many elder abuse complaints, in California and across the country.
New federal regulations require nursing homes to provide minimum staffing levels of 3.48 hours per resident day, including, but not limited to:
(i) A minimum of 0.55 hours per resident day for registered nurses, and
(ii) A minimum of 2.45 hours per resident day for nurse aides
The law also requires nursing staff to be furnished with the ‘appropriate competencies and skills’ to deliver on the Golden Rule, and to go above and beyond the minimum requirements. Staffing levels should therefore be determined by the acuity and needs of residents, not mere compliance with minimum hour stipulations.
Another key, federally-enforced component of caregiving is the requirement for facilities to provide adequate staff training and retraining. Facilities ‘must ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.’
Quality of Care. Nursing homes are required to develop person-centered care plans based on comprehensive resident assessments. Individualized care plans should ensure residents have ongoing support for aspects of their health and wellbeing including, but not limited to: sight, hearing, skin integrity, foot care, mobility, incontinence, nutrition, hydration, respiratory care, pain management, and accident prevention.
Quality of Life. The precepts of the Golden Rule are addressed directly in Title 42 of the CFR, which establishes ‘quality of life’ as a ‘fundamental principle’ applicable to nursing homes. Facilities must make provisions to maintain or enhance each resident’s quality of life, and ensure it does not ‘diminish unless circumstances of the individual’s clinical condition demonstrate that such diminution was unavoidable.’
To achieve this standard, nursing homes must provide or facilitate a number of ‘activities of daily living’ set down by the CFR, including personal hygiene, mobility, dining, communication, and both group and individual activity programs run by qualified professionals.
(It’s important to note that federal regulations apply regardless of the Medicare status of an individual resident — any nursing home that participates in Medicare is required to comply with federal law.)
Anyone with an older loved one residing in a healthcare facility understands how imperative it is to do more than just keep them alive and provided with basic necessities. Facilities that fail to meet Golden Rule care standards are, quite simply, failing their residents.
If you’re concerned that your loved one has been the victim of elder abuse in a nursing home and would like a free consultation from an elder abuse lawyer in Los Angeles, San Francisco or Sacramento, contact us here.
For Clients