Nursing Home Laws: Do They Extend To Rehabilitation Hospitals?

Nursing homes and rehabilitation hospitals are both long-term care facilities that provide specialised medical care and services to patients. However, there are key differences between the two. Nursing homes, also known as skilled nursing facilities (SNFs), are typically licensed as long-term care facilities, focusing on providing skilled nursing care and rehabilitation services to elderly patients. On the other hand, rehabilitation hospitals, or acute rehabilitation facilities, offer more intensive and specialised medical care to patients recovering from injuries, illnesses, or disabilities. These facilities are usually licensed as hospitals and have a higher staff-to-patient ratio to provide complex care. While nursing homes are regulated by federal and state laws that protect residents' rights and ensure quality of care, the question remains whether similar laws apply to rehabilitation hospitals. Understanding the legal framework governing rehabilitation hospitals is crucial to ensuring patients' rights and well-being during their recovery journey.

Patient rights in nursing homes

Nursing home residents have many rights, which are guaranteed by the federal 1987 Nursing Home Reform Law. This law requires nursing homes to promote and protect the rights of each resident, emphasising individual dignity and self-determination. Nursing homes must meet federal residents' rights requirements if they participate in Medicare or Medicaid.

Right to Information and Participation:

Nursing home residents have the right to be fully informed about available services, charges, facility rules, and their rights. They can present grievances and complain without fear of reprisal, and their complaints should be promptly addressed by the facility. Residents also have the right to participate in their care, including assessments, care planning, treatment, and discharge decisions. They can refuse medication, treatment, and physical or chemical restraints. Additionally, they have the right to review their medical records and be informed of all changes in their medical condition.

Right to Privacy and Confidentiality:

Patients in nursing homes have the right to privacy and confidentiality. They can communicate privately and unrestricted with anyone they choose. Their personal needs, medical affairs, personal affairs, and financial affairs should be kept confidential.

Rights During Transfers and Discharges:

Nursing home residents have the right to remain in the facility unless a transfer or discharge is necessary for their welfare, their improved health, the protection of others, or due to unpaid facility charges. They should receive adequate notice of any transfer or discharge, including the reason, effective date, and their right to appeal. The nursing home is responsible for ensuring a safe transfer or discharge.

Right to Dignity, Respect, and Freedom:

Residents have the right to be treated with consideration, respect, and dignity. They should be free from mental and physical abuse, corporal punishment, involuntary seclusion, and physical or chemical restraints. They have the right to self-determination, security of their possessions, and to refuse visitors. Residents can also make independent choices, such as personal decisions about their appearance and how they spend their free time. Reasonable accommodations should be made for their needs and preferences, and they can participate in community activities inside and outside the nursing home. They also have the right to manage their financial affairs.

Right to Be Free from Discrimination:

Federal law prohibits skilled nursing facilities from discriminating against protected classes. Nursing homes cannot decide whether individuals can live there based on their race, colour, religion, age, sex, or any other protected characteristic. If discrimination is suspected, it should be reported to the local long-term care ombudsman and the state agency that regulates nursing homes.

Right to Safeguarded Property:

Nursing home residents have the right to safeguard their property. The facility is responsible for ensuring that residents' personal belongings are not lost or stolen.

Right to Choose Visitors:

Residents in nursing homes have the right to receive visitors during reasonable times. They can also choose to forbid certain people from visiting. Family members must be allowed access at any time, unless the resident desires otherwise.

Right to Refuse Services and Treatments:

Patients in nursing homes can refuse the services of resident practitioners or those appointed by the nursing home. They have the right to refuse treatments and medications, similar to outpatients.

Right to Necessary Counselling:

If patients require mental, legal, or financial counselling related to their treatment, the nursing home is responsible for providing these services.

Right to Sue:

Nursing home residents have the right to sue federally-funded nursing home facilities. This right was established in 2016, allowing residents and their families to take legal action against nursing homes that violate their rights or provide substandard care.

Nursing home laws and rehabilitation hospitals

Nursing homes and rehabilitation hospitals are both dedicated to patient care, but they serve different purposes and patient populations. Nursing homes, also known as long-term care facilities, cater to the elderly and focus on providing skilled nursing care for chronically ill and disabled persons. On the other hand, rehabilitation hospitals offer specialized medical care and rehabilitation services to individuals recovering from injuries, illnesses, or disabilities. These facilities aim to help patients regain their independence and improve their quality of life.

Nursing homes are regulated by federal and state laws designed to protect residents' rights and ensure quality care. These laws cover various aspects, including residents' financial and medical affairs, freedom from abuse, privacy, and visitation rights. Federal laws also prohibit discrimination against protected classes, ensuring equal access regardless of race, colour, religion, age, or sex. Additionally, nursing homes must adhere to safety standards, such as fire safety and sanitation.

Rehabilitation hospitals, including acute rehabilitation facilities, are regulated and certified by federal, state, and local laws. They are held to specific standards to maintain their licensing as hospitals. These facilities provide intensive therapy, with patients receiving a minimum of 15 hours of therapy per week to build strength, endurance, mobility, and balance. The interdisciplinary team in rehabilitation hospitals consists of physicians, nurses, therapists, and case managers, who work collaboratively with patients and their families.

While there are distinct differences between nursing homes and rehabilitation hospitals in terms of their focus and patient populations, both types of facilities are committed to providing quality care and improving patients' well-being. The regulations and standards governing each type of facility aim to protect patients' rights, ensure safety, and promote positive outcomes.

It is important to note that the specific laws and regulations applicable to nursing homes and rehabilitation hospitals may vary based on location and the governing bodies in place. Therefore, it is advisable to refer to the relevant local and national authorities for detailed information on the laws pertaining to these facilities.

Nursing home discharge

Legitimate Reasons for Discharge

Nursing homes can only discharge residents for specific legally valid reasons. These reasons typically include:

• The facility is unable to meet the resident's needs.
• The resident's health has improved, and they no longer require the facility's services.
• The resident's presence endangers the safety or health of other individuals in the facility.
• Non-payment of fees after reasonable and appropriate notices, although there are exceptions if the resident is transitioning to Medicaid coverage.
• The facility ceases its operations.

Discharge Planning Requirements

Before discharging a resident, nursing homes must follow certain protocols to ensure the resident's safety and proper arrangements for their continuing care:

• Provide written notice to the resident and their authorised representative at least 30 days in advance of the discharge, unless it is an emergency situation.
• Prepare a summary of the resident's mental and physical health status.
• Develop a comprehensive post-discharge plan that includes alternative care arrangements, required medications, therapies, services, and any necessary medical equipment.
• Allow the resident and their representative to participate in all aspects of discharge planning.
• Arrange for the safe and orderly discharge of the resident, including the return of their belongings and personal funds.

Appealing a Nursing Home Discharge

Residents have the right to appeal a discharge decision if they believe it is unfair or unjustified. The written discharge notice should include information on how to file an appeal and contact details for relevant resources, such as a long-term care ombudsman program or an advocacy organisation. The appeal must be filed before the discharge date, and the resident has the right to remain in the facility until a determination is made.

Next Steps Following Discharge

Finding placement in a new nursing facility after an involuntary discharge can be challenging. It is recommended to consult with an elder law attorney to navigate the complex rules and regulations and ensure the resident's rights are respected.

Understanding Rehabilitation Hospitals

Rehabilitation hospitals provide specialised medical care and services to individuals recovering from injuries, illnesses, or disabilities. These facilities offer short-term or long-term care, depending on the patient's needs. Rehabilitation hospitals are regulated and certified by federal, state, and local laws. Medicare may cover a stay in a rehabilitation hospital for a limited period, after which private payment or Medicaid coverage may be required.

Nursing home admission requirements

Nursing home services are ideal for seniors with serious or debilitating conditions that require frequent medical supervision and round-the-clock care. Before admission, a physician will assess the health care needs of the individual to verify that they meet the state requirements for nursing home care. This process can be lengthy and tedious, so it is beneficial to be aware of the necessary documents and procedures beforehand.

Documents Required for Nursing Home Admission

The following documents are typically required for nursing home admission and are usually completed by hospital staff or the individual's primary care doctor:

• Physician's order for admission to a nursing home
• Physician's order for medications and treatment
• Medical history and physical examination
• State-required form for nursing home admittance
• Health care tests, such as flu shots, pneumonia vaccines, and tuberculosis (TB) tests
• Completed admissions paperwork, including consent to be treated, and information about Medicare or Medicaid coverage

Financial Assessment

Nursing homes require a financial assessment to ensure that the patient has the means to pay for their care. This process involves disclosing financial information and completing paperwork to determine eligibility for state or federal funding. Questions may include:

• Is the patient enrolled in Medicare or Medicaid, or do they plan to apply?
• Does the patient have supplemental insurance?
• Does the patient receive any government benefits or pensions?
• What are the patient's assets, including cash, stocks, real estate holdings, and insurance policies?
• Has the patient transferred assets in the last 3-5 years?

Emergency Nursing Home Admittance

In cases of unexpected or emergency nursing home placements due to sudden illness, injury, or caregiver illness, most nursing homes are equipped to handle these situations. While nursing homes typically have waitlists, emergency placements are given priority and wait times are reduced. Contacting the local Area Agency on Aging (AAA) is a recommended first step to gather information on available resources.

Nursing home safety

Legal Protections and Resident Rights:

Nursing homes are governed by federal and state laws designed to protect the rights of residents. These laws cover areas such as freedom from abuse, the right to privacy, and the right to manage one's financial affairs. Residents also have the right to report any issues without fear of retribution. Federal law prohibits discrimination based on race, color, religion, age, sex, or any other protected characteristic.

Health and Safety Practices:

Common safety issues in nursing homes include medication errors, falls, and the inappropriate use of restraints. To address these issues, nursing homes must implement measures to ensure residents' safety. This includes proper medication management, fall prevention programs, and the appropriate use of restraints only when necessary.

Staffing and Training:

Nursing homes rely on a mix of licensed nurses and non-licensed personnel to provide care. However, there is a need for improved training and management of staff to enhance safety. This includes ensuring that staff are knowledgeable about residents' medical conditions and providing them with the necessary tools and resources to deliver timely and appropriate care.

Care Omissions and Documentation:

Omissions in care, such as delays or failures to provide necessary assistance with daily activities, can have serious consequences for residents' health and well-being. Proper documentation and direct observation of care delivery are essential to identify and address these issues.

Person-Centered Care:

Person-centered care, which focuses on respecting residents' preferences and choices, is an important aspect of nursing home safety. While this approach may have clinical and quality-of-life benefits, more rigorous evaluations are needed to understand its impact on safety and how it can be optimally implemented.

Polypharmacy and Medication Management:

Polypharmacy, or the use of multiple medications, is a common issue in nursing homes. It is essential to evaluate interventions and technology-based approaches to safely reduce the number of prescribed medications, especially for older adults with complex medical conditions.

Rehabilitation and Discharge Planning:

Rehabilitation facilities and skilled nursing facilities play a crucial role in resident safety. These facilities provide specialized care and services to help individuals recover from illnesses, injuries, or disabilities. Discharge planning is also essential, ensuring that residents and their families are prepared for the transition back to their homes or other permanent residences.

In conclusion, ensuring nursing home safety requires a multifaceted approach that addresses legal protections, health and safety practices, staffing, care omissions, person-centered care, medication management, and effective rehabilitation and discharge planning. By addressing these aspects, nursing homes can provide a safe and dignified environment for their residents.

Frequently asked questions