Nursing homes, assisted living and care at home

The notice names the office that takes appeal requests and says how to appeal (42 CFR 483.15(c)(5)). The state sets the deadline to ask for a hearing, in some states as few as 10 days after the notice. If no written notice came, you can ask the home for one. While an appeal is pending, the home may not move the resident unless staying would endanger health or safety (483.15(c)(1)(ii)).

A nursing home must give written notice at least 30 days before a discharge or transfer (483.15(c)(4)). The notice gives the reason, the date, where the resident would go and how to appeal. Less notice is allowed for safety or health reasons, for urgent medical needs, or after a stay of under 30 days. It is also allowed when the resident's health has improved enough to move sooner.

Send it to the state hearing office named on the notice, with copies to the administrator and the Long-Term Care Ombudsman.

Before a resident goes to the hospital, the nursing home must give written information on its bed-hold and return policies (42 CFR 483.15(d)). That includes the state's bed-hold policy, if there is one.

If the stay outlasts the bed-hold period, the home must still take the resident back (483.15(e)). That means the old room if it is free, or the first semi-private bed that opens. This applies when the resident needs its care and is eligible for Medicare skilled nursing or Medicaid nursing home services. A refusal is treated as a discharge, so the notice and the appeal described above apply.

Send it to the administrator, with copies to the Long-Term Care Ombudsman and the hospital case manager.

A nursing home must help each resident with daily care such as eating, washing and using the toilet (42 CFR 483.24(a)). It must also guard against accidents, prevent pressure sores where it can, and keep up food and fluids (483.25).

After an injury in an accident, a major change in condition or a big change in treatment, the home must act right away (483.10(g)(14)). It must tell the resident, consult the doctor and notify the resident's representative. The resident or the representative can see the records within 24 hours on working days (483.10(g)(2)). Copies must be ready within 2 working days of asking.

Send it to the administrator and the director of nursing, with a copy to the Long-Term Care Ombudsman. The state health office takes complaints about nursing homes too.

A nursing home may not use a physical or chemical restraint for discipline or staff convenience (42 CFR 483.10(e)(1) and 483.12(a)(2)). It may use one only when needed to treat a medical symptom. When one is needed, it must be the least restrictive option, for the least time. A pharmacist reviews each resident's drugs every month (483.45(c)).

Drugs that change mood or behavior may start only for a specific condition recorded in the chart (483.45(e)). The home must then try gradual dose reductions, unless the prescriber records a medical reason not to. An as-needed order for one lasts 14 days unless the prescriber records a reason to continue it. An as-needed antipsychotic is renewed only after the prescriber evaluates the resident. Bed rails need informed consent before they are used (483.25(n)).

Send it to the director of nursing and the attending doctor, with a copy to the Long-Term Care Ombudsman.

Each state licenses assisted living, so the rules on notice before a move, staffing and medicines come from state law and the residency agreement. The state agency that licenses assisted living takes complaints, and the Long-Term Care Ombudsman helps residents for free.

Some residences are owned or run by the provider and paid for by Medicaid home and community services. There the resident has at least a tenant's protections against eviction (42 CFR 441.301(c)(4)(vi)). Visitors are allowed at any time, unless the care plan records a need to limit them.

Send it to the administrator, with a copy to the Long-Term Care Ombudsman.

A home health agency must give the care in the plan of care (42 CFR 484.50(c)). It must also look into complaints and write down what it found (484.50(e)). It may stop care only for reasons the rules list, and must give advance written notice first (484.50(c)(8) and (d)).

Before stopping care for cause, the agency must warn the patient, try to resolve the problem and offer other agencies. When Medicare home health care is ending, the fast appeal applies.

Send it to the agency's administrator or clinical manager, with a copy to the doctor who orders the care.

A hospice must manage pain and other symptoms (42 CFR 418.52(c)(1)). It may end hospice care only for three reasons: the patient is no longer terminally ill, moves away or transfers, or for cause (418.26). Before a discharge for cause, the hospice must warn the patient and try to resolve the problem.

The patient may stop hospice at any time (418.28) and may change hospice once in each benefit period (418.30). When Medicare hospice care is ending, the fast appeal applies.

Send it to the hospice administrator, with a copy to the hospice doctor.

A dialysis center may discharge a patient for behavior only after a 30-day notice (42 CFR 494.180(f)). The notice goes to the patient and to the ESRD Network. The order must be written and signed by the medical director and the patient's doctor. The center must also try to place the patient elsewhere and notify the state health office. A shorter process applies only to an immediate, severe threat.

Patients have the right to hear about every treatment option, including a transplant and dialysis at home (494.70(a)(7)). The ESRD Network for your state takes grievances.

Send it to the center's administrator, with a copy to the ESRD Network for your state.