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CARE REQUIREMENTS IN NURSING HOMES

2000 Nursing Home Ombudsman Agency of the Bluegrass, Inc.

Most nursing home residents require some help with basic needs such as bathing, dressing, feeding, and toileting. The nursing home must identify each resident's needs and establish a care plan to meet these needs. This Info Sheet describes some of the requirements nursing homes must meet in helping residents with daily care. Another Info Sheet describes how a care plan is developed and your right to participate in its development. Contact our office for a copy.

The federal and Kentucky Nursing Home Reform acts and regulations set daily care requirements for nursing homes. Kentucky law applies to all Kentucky nursing homes. Federal law only applies to Medicare- or Medicaid-approved nursing homes. Almost all Kentucky nursing homes are Medicare- or Medicaid-approved.

Federal law contains four key standards for nursing home care:

  • •The nursing home must provide services to help each resident attain or maintain the highest practicable physical, mental and psycho-social well-being.
  • •A resident's ability to bathe, dress, groom, transfer, walk, toilet, eat and communicate must not decline unless it is medically unavoidable.
  • •If a resident is unable to carry out activities of daily living, he or she must receive help to maintain good nutrition, grooming, and personal and oral hygiene.
  • •Each resident has the right to make choices about his/her care.

Besides these general principles, Kentucky and federal law set minimum requirements for daily care. Some of these requirements are described below:

CLEANLINESS -- Each resident must receive help, as needed, with care of skin, mouth, teeth, hands and feet. Residents should receive help to take a full bath or shower, including a shampoo, as often as needed but at least once a week. Bedfast residents should be given a full bath at least twice a week and a daily bed bath. Whenever a resident becomes wet or soiled, the clothing and linens should be changed and washed, and the affected body areas cleaned. Each resident should have an opportunity to shave daily with assistance as needed. Hair should be brushed or combed daily. Before breakfast, residents should receive needed help with personal care, including toileting, oral hygiene and washing of hands and face.

SKIN CARE -- Each resident should receive needed skin care to prevent or treat dryness, irritation, itching or pressure sores. People who lay or sit in one position for long periods of time often develop pressure sores. Pressure sores are also known as bedsores or decubitus ulcers. Pressure on the skin prevents blood vessels from carrying nutrients to the affected area. This causes skin breakdown which can lead to large sores, infections and severe pain if not treated. Poor nutrition and certain medical conditions may also lead to development of pressure sores.

Nursing homes must make sure that residents entering the facility do not develop pressure sores and that residents who have them are given treatment to promote healing and prevent infection. Residents confined to bed or a chair should be checked and their position changed (turned) every two hours - more often if the resident is uncomfortable. If needed, supportive devices, special mattresses, pads and pillows should be used to maintain normal body posture and to relieve pressure. Residents should receive daily help with walking and exercise to help maintain or improve their circulation, strength and use of their body.

DRESSING -- Residents should be dressed in their own clean, comfortable clothing each day. Residents who walk should wear appropriate footwear and non-ambulatory residents should have suitable foot coverings on when out of bed.

TOILETING -- Residents who have control of their bowel and bladder should receive help using the toilet as often as needed. Many nursing home residents are incontinent, meaning they have lost control of their bowel or bladder. Residents who become wet or soiled should be cleaned and changed quickly. Incontinent residents should receive care to help restore as much normal bowel and bladder functioning as possible. This care often involves increasing fluid intake and helping residents toilet on a regular schedule. Catheters should only be used for medical reasons. Those residents who do have a catheter, as well as those residents who are incontinent, should receive care which minimizes the development or urinary tract infection.

EATING -- Residents who need help with eating should receive timely assistance. For example, if needed, packages should be opened, special spoons, forks and plates provided, and staff available to feed residents. Food normally eaten hot should be served hot and food normally eaten cold should be served cold. Feeding tubes and other mechanical devices should not be used unless medically necessary. Another Info Sheet gives more information on meals and nutritional issues. Contact us for a copy.

FLUID INTAKE -- The nursing home must ensure that each resident receives sufficient fluids to maintain good health and prevent dehydration. Fresh water and drinking cups must be available on each bedside table. Extra effort to maintain adequate hydration should be taken during warm weather.

VITAL SIGNS -- Residents must be weighed, and their blood pressure, temperature, respiration rate, and pulse taken at admission and at least monthly, or more often if orderd by the physician.

SPECIAL NEEDS -- Nursing homes must arrange for special services residents may need such as physical, speech and occupational therapy, dental services, mental health evaluation and treatment, podiatry services, respiratory care, and vision and hearing services.

This Info Sheet only summarizes some of the daily care requirements nursing homes must meet. Many other requirements also exist. If you have specific questions about care requirements in Kentucky nursing homes, please contact our office.

Resident Care Issues

FODR 8/93

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