A resident council is an independent, organized group of persons living in a nursing facility who meet on a regular basis to discuss concerns, develop suggestions, and plan activities. If the nursing facility does not already have a resident council, it must try to establish one.
From the Nursing Home Reform Act of 1987 (OBRA):
- A nursing facility must protect and promote the rights of each resident, including the right of the resident to organize and participate in resident groups in the nursing facility
- Residents have the right to voice grievances with respect to treatment or care that is furnished without discrimination or reprisals
- Residents have the right to prompt efforts by the nursing facility to resolve grievances the resident may have
|Tasks of the group
Why have a resident council?
The lives of nursing facility residents are heavily controlled by laws, rules, and policies set by the government and the nursing facility. Compromises in life-styles become necessary due to health problems and the close quarters within which residents live. These compromises and controls can make nursing facility residents feel like their opinions and preferences do not matter. Many nursing facility residents are not content to give up control over their lives. They want an active part in life and the chance to influence decisions which affect them. A resident council gives them that chance.
Effective resident councils can:
- Improve communications within their nursing facility; resident councils are known as places to get the facts and can help dispel rumors
- Help identify problems early when it is easier to do something about them; resident councils are an important part of the grievance process and help avoid the necessity of discussing problems with outside sources
- Serve as a sounding board for new ideas; resident councils allow participants to review and comment on proposed nursing facility policies and operational decisions which affect resident life and care
- Help individuals speak out about what is bothering them and help overcome fear of retaliation; when people are dependent on others for their needs, there is fear that they may make others so angry that care will be withheld
- Improve the atmosphere of the homes where they are active; staff members appreciate having residents share in some of the responsibilities of planning activities and events
- Promote friendship; by working in small groups which meet regularly, residents have a chance to get to know each other well
Do residents have a right to meet as a council?
Yes; State and federal laws give residents the right to meet as a council. At the time of admission, nursing facilities are required to inform new residents of their right to establish a council if one does not exist or to participate in the activities of a council which is already operating. The nursing facility must also provide space for meetings and assistance to residents who need the nursing facility’s staff, relatives, friends, or members of community organizations to participate in the meetings. The nursing facility must designate a staff person to serve as liaison to the council, to attend council meetings as requested, and to provide needed support services and assistance such as typing of minutes and correspondence.
How are resident councils organized?
The structure of a resident council can be the key to its success. The structure to choose depends upon the size of the nursing facility and the abilities and needs of the residents.
In small nursing facilities, resident councils are frequently operated as open meetings for all interested residents. There may be a steering committee to help plan meeting agendas and to follow up on decisions made by the council. Larger nursing facilities often have councils made up of representatives either elected or recruited from different sections of the nursing facility. In this style, council representatives are responsible for seeking the concerns and suggestions of residents in their area and for bringing this information to the meetings.
A model resident council
- Residents run the council
- The council receives support, not interference, from nursing facility staff
- Residents feel comfortable speaking freely; raising issues and concerns
- Residents are treated in a dignified manner, and their issues and concerns are taken seriously
- Issues and concerns are promptly addressed by the appropriate departments
- Residents have access to information as needed and as requested by the council
- Different committees address the issues and concerns raised, and then follow up at the next meeting
- The council is a vehicle to bring about positive changes for all residents in the nursing facility
Notes on resident councils
- The nursing facility must provide space, privacy, and staff support
- Normally, only the staff liaison person is present at the meetings; any other staff members come at the invitation of the council; liaison staff is present only if the group requests assistance
- The ombudsman should be present and may serve as facilitator
- The Older Americans Act of 1965: “The ombudsman shall…personally or through representatives of the office, provide technical support for the development of resident councils to protect the well-being and rights of residents.”
- The councils do not have to have officers; of course, they may choose to organize in such a manner
- The nursing facility must provide assistance to residents in writing up requests from the group
- The facility must respond to such requests; requests may be in the minutes
- The ombudsman should review the minutes/records made of council meetings by staff to insure they accurately reflect the council’s actions/desires
- The nursing facility must listen to council views, act upon their recommendations, grievances concerning proposed policy, and operational decisions affecting resident care and life
- The council should focus on suggestions for improvement, not just complaints
- Structure council meetings so that residents experience success; confidence will build on their accomplishments
- Council meetings do not have to be held monthly; the residents decide the frequency; at first, weekly meetings might be good
- Ombudsmen need to insist that the meetings take place as scheduled; absence of the staff liaison is not a reason to cancel
- Residents can meet alone, with the ombudsman, or with a substitute staff liaison
Today I am blogging an answer to a common long-term care question about holiday gifts for residents of long-term care facilities.
Question: My sister is in a nursing home and I’m not sure what would be a good gift for her during the holiday season. Any suggestions?
Answer: Ask her what she wants. There may be something she’d enjoy or something which would make her life more pleasant. Some residents need and want clothing, including undergarments. She might like a nice outfit for the holidays or a coat and gloves. Does she like to watch television, read, or listen to music? Does she need a television? You might get her books, a CD player and CDs, or an MP3 player loaded with audio books and music files. Don’t forget to write her name on anything you give her, either by using permanent marker or engraving the item(s). Wireless earphones are a great gift for someone who has trouble hearing the television or likes to watch without disturbing anyone else. Many residents cannot afford cable television or telephone since most residents only have a $40 allowance for incidentals each month. What about a prepaid cell phone or cable television for a year? Additional gift ideas: personal items such as toiletries of the resident’s brand of choice, a trip to the beauty shop, magazine subscriptions, digital photo frames, or soft and plush blankets. If she uses a walker, you might consider a walker-tote, which attaches to a walker using Velcro®. These are perfect for the person on the go. You can find them at drug stores and medical supply stores. Another option is art, especially if it is created by an artist or children she cares about. You could create a photo album or scrapbook that would bring back fond memories. Be sure to ask the facility social worker or other facility staff to update the resident’s personal belongings inventory list so that new items are on the list. This might help recover misplaced, lost or stolen items. Note that some residents just want to be remembered throughout the year with regular visits, some fresh home-cooked food, and opportunities to be involved in family outings whenever possible.
Question: My brother lives in a nursing home and he would like to come home for the holidays. Will the nursing home let him?
Answer: Your brother can come and go as he is able. If he uses the Medicaid program, he is allowed to be away from the facility a total of ten days each year for purely social reasons. The Medicaid program calls this “therapeutic leave.” If he is currently using Medicare to pay for his stay in a skilled nursing facility, the facility can bill Medicare for the day’s stay if he returns to the facility by midnight. With advanced preparation, going home can be the best gift your brother could have this season. You should talk with the nursing staff at least two to three days in advance of the outing so they can prepare for it. The staff should package needed medication, bag up incontinence supplies, write down special food preparation instructions, and anything else you might need to do. Ask the staff to give their instructions to you in writing. If you run into trouble, you can always call the nursing home and ask questions. If there is a medical emergency while he’s home, call 911 as you would for anyone else and then alert the nursing staff at the facility. If he tires and wants to return to the facility earlier than expected, respect his wishes. With a little planning and a lot of love, it should go just great.
If you have questions about long-term care, call the Nursing Home Ombudsman Agency (NHOA) at 859-277-9215 or email us at firstname.lastname@example.org.
Today I am blogging an answer to a common long-term care question about getting along with other residents in nursing homes.
Question: My uncle isn’t getting along in the nursing home. He likes to be alone and listen to music. It upsets him if other people are around. When the other residents “bother” him, he gets angry. I’ve been told that there have been some fights between him and other residents. I think the nursing home wants him to leave. What should I do?
Answer: This is a really tough situation. Unfortunately, a nursing home is very busy and there are always fellow residents around all of the time. Living in one calls for major adjustments by residents, adjustments made more difficult by age and illness. The first thing you need to do is talk with the Director of Nursing. Your uncle is entitled to privacy and care that meets his needs; the facility is obliged to accommodate his preferences as much as possible; and, both he and the other residents are entitled to a safe environment. A care plan is a meeting where all of the people who work with your uncle, as well as your uncle if he wishes, sit down together and develop a strategy to provide the highest possible quality of life for him. Before the care plan meeting be sure to gather information about when your uncle and others do not get along. It is very important to determine when these fights occur and exactly what is said or done. For example does your uncle get upset when residents wander into his room and touch his belongings? If so, what does he say or do? Does he yell? If so what does he yell? Does he hit the other resident? If so, does he hit with him hand or cane or throw something? What is the reaction from the other resident? Is you’re your uncle subjected to the unmonitored wandering of residents with Alzheimer’s or other memory loss? If so, does this occur during a certain time of day? For example, does a confused resident wander into his room at 7pm? Be sure to share details so the problem can be addressed.
Maybe your uncle gets into fights with others only when he goes into crowded areas like a communal dining room or crowded activity even. Having your uncle at the meeting encourages him to express solutions to the fighting. He may share that he doesn’t want to eat a certain meal in the busy dining room or maybe he wants to arrive first at the activity room so he can secure a spot away from others or heavy foot traffic. When people work together with a good will, satisfactory plans can be worked out. A care plan should result in some improvements. Take your facility Ombudsman along with you to the care plan meeting.
You can call the Nursing Home Ombudsman Agency (NHOA) at 859-277-9215. Or email us at email@example.com
Today I am blogging an answer to a common long-term care question about the mattresses in nursing homes.
Question: While visiting my mom recently I noticed the mattress on her bed at the nursing home appeared to be in terrible shape. Mom pointed out several cracks and tears in the mattress cover. Is that sanitary? Doesn’t the facility have an obligation to replace old torn mattresses?
Answer: Yes, you should notify the Facility Administrator or Director of Nursing that the mattress cover and/ or mattress appears worn. You want to make sure to show the cracks and tears to an employee of the facility with authority to obtain or order a new cover and/or mattress.
During the past few years the Federal Drug Administration (FDA) reported receiving hundreds of reports regarding medical mattress covers failing to prevent blood and bodily fluids from leaking into the mattress. The report also mentioned concerns that fluid leaking into worn or damaged medical bed mattress covers may be widespread and largely under-recognized by health care facility staff, and caregivers. Some reports indicate that if bodily fluids from one resident penetrates a mattress, they can later leak out from the mattress when another resident is placed on the bed. Residents are at risk for infection if they come into contact with blood and bodily fluids from other residents. Medical literature shows that damaged and soiled mattresses can be a source of contamination during infection outbreaks. You are justified in being concerned about your mother’s mattress condition for these reasons and for her comfort.
The FDA has recommended that facilities regularly check each mattress cover for signs of damage or wear such as cuts, tears, cracks, pinholes, snags or stains and immediately replace any medical bed mattress cover with visible signs of damage or wear to reduce the risk of infection to patients. You may ask the Facility Administrator when staff regularly check for damage and wear. You may want to make notes for yourself about the date when you noticed the mattress damage, the date that you reported the damage to the facility, the name of the person you spoke to about it, how they said they would fix the problem, when they said it would be fixed, and whether or not the mattress was replaced. A facility should promptly replace damaged mattresses and covers. Nursing facilities must provide each resident with a clean, comfortable mattress with bedding, appropriate to the weather and climate. If you and your mother are uncomfortable talking with facility staff about your mattress concerns we can work on the problem for you. We are here to help you resolve concerns. You can call the Nursing Home Ombudsman Agency (NHOA) at 859-277-9215. Or email us at firstname.lastname@example.org
Today I am blogging answers to some common long-term care questions about the federal Five Star Rating System
Question: Someone told me that the nursing home I live in has a one star rating. What does that mean?
Answer: It means the nursing home has been assigned the lowest rating by the federal government’s Five Star Quality Rating system. The person who told you about the one star rating was probably referring to the overall rating for the facility. The overall rating is based on health inspections, complaint investigations, staffing levels, and quality measures. Five stars are the most a nursing home can get and represent much above average. One star is the fewest and represents much below average. The nursing home you live in was listed as having twice as many health citations or deficiencies as the average nursing home in Kentucky. The home also reports less staff time per resident per day than other facilities in your area. The Five Star Quality Rating system was created to help people compare nursing homes.
Question: I am helping my brother select a nursing home and I want to look at the ratings of all nursing homes in my area. Where can I find the information?
Answer: Anyone can view nursing home ratings by visiting http://www.medicare.gov/nursinghomecompare/search.html If you don’t use the internet or you need help selecting a nursing home you can call the Nursing Home Ombudsman Agency (NHOA) at 859-277-9215. Or email us at email@example.com Remember that the Five Star Quality Rating system is a tool to help you compare facilities. The system isn’t perfect, but it does give you some guidance as you try to make a good choice. You and your brother should visit the nursing home and check it out before moving.