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Nursing Home Care
Nursing homes are facilities that are licensed to care for residents who need rehabilitation, health-related services above the level of room and board, or skilled nursing services. Nursing homes must have nurses and other medical staff. Typically, a nursing home resident will need more help and supervision than an assisted living resident.
Read the regulations: Code of Md. Regulations 10.07.02.01
Consider Alternatives - Depending on your needs, there may be alternatives to nursing home care that work better for your situation, including home aide services, medical adult day care centers, meal services, and in-home nursing and therapy services. Contact your local Center for Independent Living for more information about nursing home alternatives.
NOTE: If you choose to hire someone to help with the caregiving tasks, decide whether to hire an individual or an agency. If you hire an individual, you may have to pay Social Security and Medicare taxes and withhold income taxes. The Internal Revenue Service (IRS) Publication 926 – Household Employer’s Tax Guide provides detailed information.
Financial Considerations - Placement in a nursing home facility may become very expensive very quickly. However, you may not have to shoulder this financial burden alone. Publicly funded programs, including Medicare, Medicaid, and Supplemental Security Income, all have different policies regarding long-term care. Check to see what assistance these programs may provide.
Pre-placement Counseling - Deciding to enter a long-term care facility is a major life decision and requires careful planning. Pre-placement counseling is available for seniors and their families. Review and discuss how to select a facility, types of facilities available, current facility surveys by state licensing agencies, and financial considerations. Contact your Department of Aging local area agency for more information.
A nursing home must care for all your personal needs—physical, mental, and social.
Assessment and Care Plan - A comprehensive assessment must be done when you enter a nursing home. Staff should ask you about every part of your life, such as:
- What is your personal history?
- What are your physical and mental conditions?
- What activities and food do you like and dislike?
- What is your preferred schedule for taking a bath, waking up in the morning, eating meals?
- What help do you need with eating, walking, dressing, and using the toilet?
- How well are you able to communicate with staff?
- Do you need to lose or gain weight?
- What medications do you take, and how does that affect your life?
- How can your care at the nursing home be improved?
A nursing home uses the assessment to create a Care Plan with you and any family members that you choose. Your care planning team should include a nurse, nurse aide, activities and dietary staff, and social worker. Staff should review your Care Plan at least every 3 months and when your condition changes. If it’s not working, the staff should update the Care Plan at a new meeting.
Read the regulation: Code of Md. Regulations 10.07.02.60
Residents’ Bill of Rights - Maryland and federal law provide nursing home residents with many special rights. Nursing homes must give you a copy of the Residents’ Bill of Rights upon admission. Nursing homes also must post the rights.
Your basic rights include the right to:
- be treated with consideration, respect, and full recognition of human dignity and individuality;
- receive treatment, care, and services that are adequate, appropriate, and in compliance with relevant State and federal laws, rules, and regulations;
- be free from mental and physical abuse;
- notice, procedural fairness, and humane treatment when being transferred or discharged from a facility;
- participate in decision making regarding transitions in care;
- expect and receive appropriate assessment, management, and treatment of pain;
- be free from physical and chemical restraints, except for restraints that a physician authorizes for a clearly indicated medical need;
- receive respect and privacy in a medical care program; and
- right to manage personal financial affairs.
This is just a short list. Your rights are more detailed and expansive.
Read the law: Md. Code, Health-General § 19-343
Read the regulations: Code of Md. Regulations 10.07.09.*, 42 U.S. Code of Federal Regulations 483.10
Medical Rights - As a nursing home resident, you have the right to:
- be fully informed about your medical condition, in a language that you understand;
- make decisions about your medical treatment;
- refuse treatment if you don’t want it;
- create an advance directive;
- create a Medical Orders for Life-Sustaining Treatment form;
- give yourself your medications if your doctor says that it’s safe;
- choose your own doctor, although it may be difficult to get doctors to visit you in the nursing home;
- be free from chemical restraints, such as a drug that is used for the nursing home convenience, not for medical treatment;
- be free from physical restraints, such as something that prevents you from moving freely, like a bed rail;
- have the nursing home adjust to your individual needs;
- review all your medical records and reports;
- participate in Care Plan meetings so that you can talk about your care with the staff;
- apply to get Medicaid services in your own home or apartment, rather than in a nursing home; and
- complain about your care without retaliation
Read the law: Md. Code, Health-General § 19-343; § 19-344
Involuntary Discharge or Transfer
Nursing homes can only discharge or transfer residents for very limited reasons. If you do not agree to leave, it is called an involuntary transfer or discharge. Federal and state laws have strict rules about involuntary transfers and discharges.
In most cases, there are only five reasons a nursing home can involuntarily transfer or discharge you:
- A transfer or discharge is necessary for your welfare and your needs cannot be met by the nursing home.
- The transfer or discharge is appropriate because your health has improved sufficiently so that you no longer need the services provided by the facility.
- You are endangering the health or safety of an individual in the nursing home.
- You failed to pay or have others pay the nursing home for your stay. The facility must have given you reasonable and appropriate notice of the amount you owe.
- The facility has stopped operating or, if you are a Medicare or Medicaid recipient, the facility has been decertified or withdrawn from the program.
Read the Law: Md. Code, Health-General § 19-345
Notice - The nursing home must give you a written notice at least 30 days before the proposed transfer or discharge date. This notice must be provided to you; your next of kin, guardian, or any other individual known to have acted as your representative, if any; the Long-Term Care Ombudsman; and the Department of Health.
The notice must have:
- the proposed date of the discharge or transfer;
- each reason for the proposed involuntary discharge or transfer;
- the location to which you will be discharged or transferred;
- the name of the social worker or other professional staff member who is designated to provide social services and discharge planning services and will be responsible for the development of the post-discharge plan;
- a proposed date, within 10 days after the notice date, for a meeting between you, your representative, and the facility, to develop the post-discharge plan,
- your right to request a hearing;
- your right to consult with any lawyer of their choosing;
- the availability of services from the Legal Aid Bureau, the Older American Act Senior Legal Assistance Program, and other agencies that may be able to assist individuals who need legal counsel;
- the availability of the Long-Term Care Ombudsman Program; and
- the provisions of the applicable Maryland statutes.
If the notice does not contain all the information above, or if it is not sent properly to everyone who should get the notice, you can challenge the discharge because the notice was not valid.
Exceptions - The nursing home does not have to provide you with 30 days’ notice and an opportunity for a hearing if:
- there is an emergency, and the health and safety of you or other residents is in immediate and serious danger, or
- you have been at the nursing home less than 30 days.
Read the Law: Md. Code, Health-General § 19-345.1
Stopping the Discharge/Transfer - There are several ways that you can try to stop the transfer or discharge. As soon as you get the notice of discharge:
- Request mediation and a hearing. You have 30 days from the date you received the notice of discharge or transfer to ask for mediation and a hearing. This is also called filing an appeal. Your Notice of Discharge tells you how to file the appeal with the Office of Administrative Hearings. If you file an appeal within 30 days, the nursing home cannot transfer or discharge you until an Administrative Law Judge makes a final decision at your hearing.
- Contact the Long-Term Care Ombudsman for assistance.
- File a complaint with the Maryland Office of Health Care Quality.
- File a lawsuit in the circuit court against the nursing home requesting an injunction if you believe that a transfer or discharge violates the law. An injunction is a court order telling the nursing home not to transfer or discharge you. Your agent, your attorney, or the Attorney General, on your behalf, can also ask for this court order. This is a difficult thing to do by yourself. If you want to file a lawsuit, talk to a lawyer as soon as possible.
If you are discharged or transferred, you must be transferred or discharged to a safe and secure place that can meet your needs. It doesn’t matter what the reason is for the transfer or discharge. It doesn’t matter how long you were in the nursing home. It doesn’t matter if it is an emergency. Your transfer or discharge must be safe and secure.
The nursing home must provide:
- a comprehensive medical assessment;
- post-discharge plan of care;
- written confirmation from your attending physician that the transfer or discharge complies with the post-discharge plan and that it will not harm your medical condition;
- statement of medical evaluation;
- list of current medications;
- at least a 3-day supply of your current medications;
- the information necessary to assist you in getting additional prescriptions for necessary medication; and
- a written statement of the date and time you will be discharged, how you will be discharged, and where you will be sent.
If you don’t get something on this list, you can challenge the transfer or discharge.
Read the Law: Md. Code, Health-General § 19-345.2