Continuation of the Review of OBRA Regulations: The National Community Practice Standards</h1> <article> <h1>Continuation of the Review of OBRA Regulations: The National Community Practice Standards</h1> <p>2012-06-07T13:24:00.006-04:00</p> <h2 style="color: #0b5394; font-weight: normal; text-align: center;"> </h2> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhya94f2vVezbBewkeWxDBYHPdc3Sg_kf4J7huuHYNloezgoLoyGJB6dGAPWU2bkNzmhTRSe3VRx9AtbaaXzl-yoNGXdzbH135ySKUezuZ5-jmqFowrsXCSn47W7c9jYdePaMiIyIKtOQc/s1600/scales-of-justice-3423.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div> <br /> <span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><b><u>§483.30</u></b> is always associated with nursing services and often used along with another sections of OBRA in the course of litigation. This regulations specifically is used to assert that there were insufficient nursing resources that lead to an adverse outcomes. These types of outcomes can be: </span></span><br /> <ul> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to properly complete a clinical assessment after a unwitnessed fall,</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to properly assess or monitor changes in a resident's condition,</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">inadequate staffing or staff supervision.</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to advocate for the resident in demanding and assuring prompt access to needed medical and hospital care.</span></span></li> </ul> <span style="font-size: small;"><br style="font-family: Verdana,sans-serif;" /><span style="font-family: Verdana,sans-serif;"><u><b>§483.35</b></u> - This OBRA section addresses food service in a nursing facility and would be used in allegations concerning:</span></span><br /> <ul> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to provide snacks or nutritional supplements when associated with weight loss,</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to provide substitute foods of similar nutritional value for residents who have refused the initial food choice, </span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to provide foods of the correct consistency (usually associated with a clinical recommendation that was not followed and an allegation that a resident chocked to death on pieces of solid food),</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">failure to provide adequate food proportions.</span></span></li> </ul> <span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><u><b>§483.40</b></u> - This OBRA section has to do with physician services. The following allegations appear most frequently:</span></span><br /> <ul> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">Physician orders must be followed,</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">Physician must medically assess the resident according to established timetable,</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">The facility must arrange for the provision of physician services on a 24 hour a day basis.</span></span></li> </ul> <span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><u><b>§483.65 </b></u>- The facility must establish and maintain a infection control program that creates a safe, sanitary, and comfortable environment. Examples of this section would include:</span></span><br /> <ul> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">Development of MRSA, an antibiotic bacteria</span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">Development of a infected pressure ulcer </span><span style="font-family: Verdana,sans-serif;">infections caused through substandard application of universal precautions</span></span></li> </ul> <span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><u><b>§483.70 </b></u>- A facility must be designed and maintained to protect the health and safety of the residents. Allegations under this physical environment section could include: </span><br style="font-family: Verdana,sans-serif;" /><span style="font-family: Verdana,sans-serif;">a failure to maintain or or properly use a piece of equipment. Examples could include:</span></span><br /> <ul> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"> a resident lift machine (Hoyer lift) that fails because the safety lock is disengaged or eroded over time.</span></span><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"> </span></span></li> <li><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">The hot water heater is set too high and a resident suffers skin burns.</span></span></li> </ul> </article> <article> <h1>Continuation of Common Alleged Deviations in the Standard of Care</h1> <p>2012-05-03T10:37:00.000-04:00</p> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4j3nmPJYYIxf8neuzzBmSaluFG_X_R4EEUOF_CfTXLTAjJRNJnVNFE344_KjxjRYMB05z4qQC3p6wtjASExpIG0CPGE6WNXALonFz1X3E1Ww_ygHV7DQ_j5PZp-4b-R6G54AGqX8Yd24/s1600/nurse-small.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div> <br /> <div> <br /> <h3 class="post-title entry-title" itemprop="name" style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: small;"><div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px;">As we continue to review the most common allegations in deviations to the standard of care, we come across §483.25 which address nursing home quality of care. Under this regulation, the expert witness is asked to review adherence or deviation to the following sections:</span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(a)</span><span style="letter-spacing: 0px;">- This section would be commonly alleged in cases where a plaintiff attorney perceived that residents were not adequately kept clean, brought to the toilet, ambulated or provided assistance with activities of daily living. These deviations would naturally compromise a resident's ability to attain or maintain their “highest practicable well being".</span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(c)</span><span style="letter-spacing: 0px;"> - This regulation is used with any allegations regarding pressure ulcers. Central to correctly ascertaining if a facility deviated from the standard of care in the prevention and treatment of pressure ulcers, one must determine whether a resident's pressure sore was clinically unavoidable. </span><span style="letter-spacing: 0px; text-decoration: underline;">To deem an ulcer unavoidable, a facility must demonstrate preventative interventions were applied</span><span style="letter-spacing: 0px;">. Licensed Administrators are governed by the understanding that pressure ulcers cannot be deemed clinically unavoidable without routine preventative care, such as,</span></div> <ul> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Frequent turning and repositioning;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Promptly providing incontinent care;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">The provision of adequate nutrition and hydration;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Providing adequate pressure reduction or pressure relief supplies;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Assuring staff are trained in techniques to avoid friction and shear; </span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Assuring staff follow the resident’s care plan and timely revise it as the resident’s needs dictate;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Assuring staff notify the resident’s physician immediately after significant changes in a resident’s skin condition.</span></li> </ul> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 16px;"> <span style="letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(c)</span><span style="letter-spacing: 0px;"> - This section would typically be used if efforts were not made to restore or maintain continence control through a bowel and bladder maintenance program.</span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(h)</span><span style="letter-spacing: 0px;"> - A nursing facility " must ensure that the resident environment remains as free of accident hazards as possible, and each receives adequate supervision and assistive devices to prevent accidents." This section commonly applies with a resident care practice that results in allegations of:</span></div> <ul> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Falls with injuries;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Patient care equipment not adequately maintained or functioning;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Inadequate supervision of a resident whose actions represent a danger to themselves or to others;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Residents who aspirate based on a failure to provide food consistent with their swallowing ability. </span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Resident elopements;</span></li> <li style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"><span style="letter-spacing: 0px;">Physical restraints that were applied inconsistent with physician orders or inconsistent with prevailing nursing home practices.</span></li> </ul> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 16px;"> <span style="letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(i)</span><span style="letter-spacing: 0px;"> - This section would be cited for deviations to the standard of care regarding weight loss that is clinically avoidable. The federal interpretive guidelines identify associated risk factors and the amount of weight with respective time periods that constitutes "significant" weight loss. Meal consumption sheets and their consistency with nursing staff entries into the medical chart are critical factors in the support of adherence or deviation to avoidable weight loss claims. </span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px 0px 18px;"> <span style="letter-spacing: 0px; text-decoration: underline;">§ 483.25(l)</span><span style="letter-spacing: 0px;"> - This section is used for medications that are deemed to be unnecessary or be of an excessive dose. Working under the resident’s physicians, the facility is required to show systematic efforts to minimize chemical restraints and have practices that demonstrate appropriate dose reduction efforts with the goal that a chemical restraint are minimized or possibly eliminated. </span></div> </span></span></h3> <div> <ul> </ul> </div> </div> </article> <article> <h1>Exploring Federal OBRA: Common Alleged Deviations in the Standard of Care</h1> <p>2012-04-26T15:24:00.002-04:00</p> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtXKNTSg44YyZJ9WBW6-TuDkR_lSGNh93CV1rMbS4lAFwEMADtGugzN3isP3TdceaJ797jfRg85ptPbwTBLUGWhL3mPhrYs12K6H2BIPW0x-GegdFYLMGFf5aVXTgzNDSQAYYiuEzDdM0/s1600/nursing-home-care.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div> <br /> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">While there are a variety of possible allegations that can arise in nursing home negligence cases, there are certain nursing home administration standards that appear more frequently. Using Federal OBRA sections, I will speak to the most common alleged breaches related to the standard of care in today's nursing home.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><u>C.F.R § 483.10</u> deals with resident rights and mandates that each resident is entitled to a dignified existence and self determination. <b>Example:</b> A resident with advanced dementia experiences a significant change in condition and the physician and responsible party are not immediately contacted by the facility.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <br /></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><u> C.F.R § 483.10(d)(3)</u> - The resident has a right to participate in planning their care and treatment or any changes to their care or treatment. If the resident is incapacitated, this right would typically be transferred to the resident's responsible party. <b>Example:</b> The responsible party is not asked to participate in decisions regarding the facility should use a physical or chemical restraint.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><u>C.F.R § 483.12(a)</u> - The facility Administrator shall neither admit nor retain a resident whose needs it knows it can not meet. <b>Example:</b> A resident begins showing signs of dementia, including wandering. The resident is repeatedly found outside the nursing home, confused and exposed to the elements. The facility creates a care plan to address the wandering issue, but the care plan proves unsuccessful in defeating these behaviors. The facility must discharge to an appropriate setting, such as a facility with a secured dementia program or provide one to one care if the administrator believes this will successfully reduce the resident's risk.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">C.F.R § 483.13(a) - "The resident has a right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. <i>The regulations do not preclude the use of restraints, but rather require that the interdisciplinary care team, with the approval of the resident or responsible party and approved by the resident's physician, to consider less restrictive, yet equally effective alternatives.</i> The physician order must specify the exact type of restraint, the frequency of use, and under what circumstances it can be used (in the wheelchair, or in the bed or at all times).</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <br /></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">C.F.R § 483.13(b)(c) - The resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion. The facility administrator is statutorily required to investigate all alleged vi<span style="background-color: white;"></span>olations and report the issue with the required time frame. The Administrator must also immediately take action to prevent the possibility of further harm to any residents who can potentially be adversely affected. </span></div> <blockquote class="tr_bq" style="color: black; font-family: Verdana,sans-serif;"> <div> <span style="font-size: small;"> <i><span style="background-color: yellow;"><span style="background-color: white;">It is important for counsel to review the definitions of "abuse" and "neglect" within the interpretive guidelines under § 483.13. The term abuse is more expansive based on a caregiver's deprivation of services in which harm occurs.</span></span></i> </span></div> </blockquote> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><i><span style="background-color: yellow;"> </span></i></span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">C.F.R § 483.15(a) Requires a skilled nursing facility to "provide care for residents in a manner that maintains each resident's dignity and respect in full recognition of his or her individuality". <b>Example: </b> A resident has the physical capability to be continent and the staff make insufficient efforts are made to restore or support this capability.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">C.F.R § 483.20(K)(1) - A facility must develop a comprehensive plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs. <i><u style="background-color: yellow;">This standard of care is the most frequently alleged as breached in nursing home negligence cases. </u><b> </b></i>The Resident Assessment Instrument, both with respect to its accuracy and implementation will affect a wide range of quality of care issues, including resident falls, accident prevention, elopements, transferring, pressure ulcers, safe use of equipment, etc.</span></div> <div style="color: black; font-family: Verdana,sans-serif;"> <br /></div> <div style="color: black; font-family: Verdana,sans-serif;"> <span style="font-size: small;">My next entry will discuss other critical standards of care and I will begin with </span><span style="font-size: small;">C.F.R § 483.25, which also appears frequently in allegations in nursing home negligence cases. It mandates that:</span></div> <blockquote class="tr_bq" style="font-family: Verdana,sans-serif;"> <div> <span style="font-size: small;"><span style="background-color: white; color: black;"> "Each resident receive, and the facility provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care" </span></span></div> </blockquote> <div style="font-family: Verdana,sans-serif;"> <span style="font-size: small;"> </span></div> <div style="font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <div style="font-family: Verdana,sans-serif;"> <span style="font-size: small;"><br /></span></div> <br /> </article> <article> <p>2012-02-29T12:26:00.001-05:00</p> <div class="separator" style="clear: both; text-align: center;"> <a href="http://nusprobono.files.wordpress.com/2011/10/1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span class="Apple-style-span" style="background-color: white;"></span></a></div> <div style="text-align: center;"> <b><span class="Apple-style-span" style="background-color: white; color: blue; font-size: large;">The Administrator and Nursing Home Liability issues</span></b></div> <span class="Apple-style-span" style="font-family: Georgia,'Times New Roman',serif;"></span><br /> <div style="display: inline ! important; font: 12px Verdana,sans-serif; margin: 0px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px; text-decoration: underline;">What Exactly is the the Standard of Care in nursing homes? </span></div> <div style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span"> </span></div> <div style="font: 12px Verdana,sans-serif; margin: 0px; min-height: 14px; text-decoration: underline;"> <span class="Apple-style-span"><span style="font-size: small; letter-spacing: 0px;"></span></span></div> <div style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span"> </span></div> <div style="font: 12px Verdana,sans-serif; margin: 0px;"> <span class="Apple-style-span"><span style="font-size: small; letter-spacing: 0px;">When a licensed skilled nursing facility’s actions come under review, defining the standard of care becomes the threshold to evaluate the actions of the provider. The Nursing Home Reform Act of 1987, where the federal regulations are contained, <b>represent the national community practice standards</b>. </span></span></div> <div style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span"> </span></div> <div style="font: 12px Verdana,sans-serif; margin: 0px; min-height: 14px;"> <span class="Apple-style-span"><span style="font-size: small; letter-spacing: 0px;"></span></span></div> <div style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span"> </span></div> <div style="font: 12px Verdana,sans-serif; margin: 0px;"> <span class="Apple-style-span"><span style="font-size: small; letter-spacing: 0px;">Along with the federal regulations, there exists federal interpretive guidelines which offer clarification about a federal regulation. These clarifications both crystallize and articulate the standard. </span></span></div> <div style="font-family: Verdana,sans-serif;"> <span class="Apple-style-span"> </span></div> <div style="font: 12px Verdana,sans-serif; margin: 0px; min-height: 14px;"> <span class="Apple-style-span"><span style="font-size: small; letter-spacing: 0px;"></span></span></div> <span class="Apple-style-span" style="font-family: Georgia,'Times New Roman',serif;"> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"> <span style="font-size: small; letter-spacing: 0px;">Finally, all nursing homes are required to be state licensed and comply with regulations as set forth by their respective state government. Therefore the standard of care leaves for little ambiguity; it is composed of the federal regulations, the federal interpretive guidelines, and the state regulations. </span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px; text-decoration: underline;">What happens if there is a inconsistency between the federal and state regulation?</span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"> <span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;">Typically, there are not "conflicts" between federal and state regulations. </span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span><span style="letter-spacing: 0px;">The minimum standards of care require that the most rigorous standard apply when considering between the federal regulations, the state licensure standards or the facility's own policy. </span></span><br /> <br /> <span class="Apple-style-span"><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;">Generally, the federal regulations will generally provide a <i>minimum</i> standard of care for a certified nursing facility and states may choose to provide greater specificity. For example, the federal regulations regarding staffing requirements are located under Chapter 42 CFR </span><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: 0px; line-height: normal;">§</span><span style="letter-spacing: 0px;">483.30 and are broadly defined as requiring the skilled nursing facility to offer “sufficient nursing staff to provide nursing and related services”. Yet, an individual state will often require a minimum staffing requirement and speak to how it is calculated and whether resident acuity is considered.</span></span></span></span><br /> <span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"><br /></span></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px; text-decoration: underline;">What are the obligations of a facility accepting Medicare and Medicaid funds?</span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px; text-decoration: underline;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px;"> <span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;">In state's that have less intensive regulations, there may appear to be a expectation to provide "reasonable" or "adequate" care. The inference from Federal regulations offers </span><span style="letter-spacing: 0px;"><b>each</b></span><span style="letter-spacing: 0px;"> resident a much higher guarantee about expectations--regardless of what state the nursing home is located. Under title 42, CFR §483.25, the expectation is unambiguous in terms of the care that should be afforded to all residents in every nursing home:</span></span></div> <div style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 0px; min-height: 14px;"> <span style="font-size: small; letter-spacing: 0px;"></span></div> <blockquote class="tr_bq"> <span style="letter-spacing: 0px;">"Each resident shall receive , and the facility shall provide, care and services to enable the resident to attain or maintain his or her highest practicable, physical, mental and psychosocial well-being, in accordance with the individuals assessment and comprehensive plan of care."</span></blockquote> </span> </article> <article> <p>2012-02-17T10:53:00.004-05:00</p> <h2> <a href="http://www.nursinghomeexpertwitnessservices.com/" rel="bookmark" title="Permanent Link to Welcome to my Blog!"><span style="font-size: x-large;">Welcome to my Blog!</span></a><span style="color: #777777;"><br /></span></h2> <div class="entry"> <div> <strong><span style="font-family: Verdana;"><em>Welcome to Nursing Home Expert Witness Services – Blog</em></span></strong></div> <div> <a href="http://www.nursinghomeexpertwitnessservices.com/"></a></div> <div> <span style="font-family: Verdana;"><em>“I offer clients fact-based and insightful case reviews and analysis, typically for cases associated with abuse/neglect in nursing homes, assisted living and retirement housing. My ongoing consultative work enables me to stay current on prevailing industry practices and speak with confidence on reasonable expectations of care”.</em></span></div> <div> </div> <div> <div id="text3"> <div> <div> <span style="color: maroon; font-family: Bookman Old Style;"><span style="text-decoration: underline;">Profile</span></span></div> </div> </div> <div id="text4"> <div> <ul> <li><span style="font-family: Verdana;">Recent hands-on experience managing nationally recognized nursing homes and/or multi-level senior </span><span style="font-family: Verdana;">care campuses. Administrator of facility to earn the Governor’s Gold Seal for Excellence.</span></li> </ul> </div> </div> <div id="text5"> <div> <ul> <li><span style="font-family: Verdana;">Cornell University, Masters in Health Care Administration.</span></li> </ul> </div> </div> <div id="text11"> <ul> <li><span style="font-family: Verdana;">Court appointed Patient-Care Ombudsman. Participated in and/or managed several “compliance” </span><span style="font-family: Verdana;">initiatives, including back to Federal re-certifications, Special Facility Focus, as well as two initial </span><span style="font-family: Verdana;">facility certifications.</span></li> </ul> </div> </div> </div> </article> </main></body></html>