Journal of Gerontological Nursing

WASHINGTON DIGEST 

Long-Term Care Requirements

Cheryl Pokalo

Abstract

Long-term care facilities participating in either Medicare or Medicaid programs have a revised set of regulations as of April 1, 1992. The facility must assert, protect, and facilitate the exercise of residents' rights to:

* Exercise their rights as residents of the US and the facility to file complaints and to be free of coercion or reprise from the facility in exercising their rights. If a resident has been deemed incompetent, an individual appointed under state law may exercise these rights.

* Be informed of their rights and all rules governing resident conduct and responsibilities in the facility. This includes the states' notice of rights and obligations.

* Not be required to deposit personal funds with the facility.

* Choose an attending physician, be informed of treatment and care decisions, and participate in the development of their plan of care.

* Refuse the release of personal and clinical records to anyone outside the facility, except when required by law or third party contract.

* Receive treatment or care.

* Examine recent federal and state surveys.

* Perform services for the facility if the desire for work is documented in the care plan.

* Have privacy in written communication, including sending and receiving unopened mail, and using the telephone.

* Receive visits from relatives at any hour and from others at a reasonable hour by arrangement with the facility.

* Retain and use personal possessions if they do not infringe on the rights, health, or safety of others.

* Share a room with a spouse if both spouses consent.

* Self-administer medications.

* Refuse transfer between distinct parts of the facility for purposes of obtaining Medicare/ Medicaid eligibility or without medical justification.

Facilities are specifically prohibited from requiring a third party guarantee of payment as a condition of admission or continued stay; soliciting accepting donations as a condition of admission, expedited admission, or continued stay; requiring residents or potential residents from waiving their rights to Medicare/ Medicaid; or requiring oral or written assurance that residents are ineligible or will not apply for Med icare / Medicaid benefits.

Residents have the right to be free of chemical and physical restraints for purposes of discipline or convenience; abuse; corporal punishment; and involuntary seclusion, mistreatment, and neglect by the staff.

Care must be provided in a manner and a safe and sanitary environment that enhances quality of life without infringing on the rights or safety of any resident. Facilities must conduct initial and periodic assessments of the medical, functional, and psychosocial needs of the residents.

Each resident must receive the nursing, medical, and psychosocial services necessary to achieve and maintain the highest possible mental and physical function. Faculties must supply sufficient staffing unless a waiver is granted.

Residents must have palatable, well-balanced meals, including modified and specially prescribed diets. Residents have the right to physician services, if possible, a personal physician. Physicians must approve in writing a resident's admittance, and each resident must be under a physician's care.

Facilities must provide specialized rehabilitation services. Routine and emergency medications and dental services must also be provided, including transportation.

The new regulations outline requirements for licensure; compliance with federal, state, and local standards and laws; planning and budget; staff qualification and training; disaster and emergency preparedness; and independent medical evaluations and audits.

Facilities must comply with each of the requirements in the regulations to participate in the Medicare and Medicaid programs. All of the requirements will be enforced and penalties assessed.

For more information, contact Bill Ullman, Health Care Financing Administration, 301-9665667.…

Long-term care facilities participating in either Medicare or Medicaid programs have a revised set of regulations as of April 1, 1992. The facility must assert, protect, and facilitate the exercise of residents' rights to:

* Exercise their rights as residents of the US and the facility to file complaints and to be free of coercion or reprise from the facility in exercising their rights. If a resident has been deemed incompetent, an individual appointed under state law may exercise these rights.

* Be informed of their rights and all rules governing resident conduct and responsibilities in the facility. This includes the states' notice of rights and obligations.

* Not be required to deposit personal funds with the facility.

* Choose an attending physician, be informed of treatment and care decisions, and participate in the development of their plan of care.

* Refuse the release of personal and clinical records to anyone outside the facility, except when required by law or third party contract.

* Receive treatment or care.

* Examine recent federal and state surveys.

* Perform services for the facility if the desire for work is documented in the care plan.

* Have privacy in written communication, including sending and receiving unopened mail, and using the telephone.

* Receive visits from relatives at any hour and from others at a reasonable hour by arrangement with the facility.

* Retain and use personal possessions if they do not infringe on the rights, health, or safety of others.

* Share a room with a spouse if both spouses consent.

* Self-administer medications.

* Refuse transfer between distinct parts of the facility for purposes of obtaining Medicare/ Medicaid eligibility or without medical justification.

Facilities are specifically prohibited from requiring a third party guarantee of payment as a condition of admission or continued stay; soliciting accepting donations as a condition of admission, expedited admission, or continued stay; requiring residents or potential residents from waiving their rights to Medicare/ Medicaid; or requiring oral or written assurance that residents are ineligible or will not apply for Med icare / Medicaid benefits.

Residents have the right to be free of chemical and physical restraints for purposes of discipline or convenience; abuse; corporal punishment; and involuntary seclusion, mistreatment, and neglect by the staff.

Care must be provided in a manner and a safe and sanitary environment that enhances quality of life without infringing on the rights or safety of any resident. Facilities must conduct initial and periodic assessments of the medical, functional, and psychosocial needs of the residents.

Each resident must receive the nursing, medical, and psychosocial services necessary to achieve and maintain the highest possible mental and physical function. Faculties must supply sufficient staffing unless a waiver is granted.

Residents must have palatable, well-balanced meals, including modified and specially prescribed diets. Residents have the right to physician services, if possible, a personal physician. Physicians must approve in writing a resident's admittance, and each resident must be under a physician's care.

Facilities must provide specialized rehabilitation services. Routine and emergency medications and dental services must also be provided, including transportation.

The new regulations outline requirements for licensure; compliance with federal, state, and local standards and laws; planning and budget; staff qualification and training; disaster and emergency preparedness; and independent medical evaluations and audits.

Facilities must comply with each of the requirements in the regulations to participate in the Medicare and Medicaid programs. All of the requirements will be enforced and penalties assessed.

For more information, contact Bill Ullman, Health Care Financing Administration, 301-9665667.

10.3928/0098-9134-19920501-11

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