Special Focus: Senior and Long-Term Care
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ong-term care is an eventuality for many Minnesotans. According to the Minnesota Department of Human Services, the number of people living in nursing homes in Minnesota, not including those in a transitional care unit, is approximately 29,000. The number in long-term care settings other than nursing homes, such as assisted living, is significantly higher. Rough estimates are that well over 100,000 individuals reside in an assisted living, group home, or other long-term care setting in Minnesota. Given the vulnerability and volume of residents, staff alone cannot meet all of the social, physical, spiritual, and psychological needs. The support of family members is key to the resident’s overall quality of life. Family involvement Involved family members are a good thing for residents and providers, and should be seen
Family advocates in long-term care Understanding their role By Suzanne M. Scheller, JD as such. For instance, family members generally allow for a substitute decision maker when health care decisions need to be made for a client with diminished capacity. Involved family members may be able to transport their loved one to the doctor, provide input on their care given their extensive knowledge of the resident, and communicate messages back and forth. Family members provide social interaction and facilitate outings that promote overall quality of life and minimize depression, which often accompanies longterm care. In addition, most family members ensure that bills to the provider get paid.
However, providers at times do not embrace the family’s role and if a family member’s voice gets too loud, he or she is labeled as a “detriment” to care; as “interfering” with care; or as a trouble-maker. While there are always outliers who require provider intervention, the vast majority of family members support and speak up appropriately when necessary. As a representative of many vulnerable adults and their families, I label these mainstream family members as “advocates,” and unfortunately providers may bristle at advocates. Advocates need to continue to speak up and providers need to continue to listen, for the good of the elder. Effective family advocacy
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Minnesota Physician December 2015
A family member can effectively advocate for their loved one and work with the provider to ensure quality care. In general, there are a few important themes for family advocates to keep in mind: visit the resident; take the time to read documents prior to signing them, even if the facility says that they must be signed right away; document any concerns; and periodically review medical records to ensure that concerns are incorporated and that the records are accurate and complete. • All providers must make the admission agreements available to the resident or family member for review (see Minn. Stat. §144.6501). Family members are advised to read admission agreements and resist the urge to simply sign under pressure. Family can ask for one or two days to review the language before signing. No signature is actually required for admission.
• Many admission agreements now contain separately signed arbitration agreements. I generally recommend that the family/resident not sign any arbitration agreements since the family does not know what dispute may arise when admitting a loved one. By not signing, the family is not precluding arbitration in the future, if both parties agree. • The resident will be asked to sign one admission agreement for both housing and care when entering a nursing home. However, in a non-nursing home setting the resident will likely be asked to sign two agreements, one as a lease under landlord-tenant law for the physical space and the other for home care services. Family members should read the agreement for home care services carefully (see Minn Stat. §144A.4791, subd. 3) to understand items such as: Valid reasons for discharge; Whether the facility accepts Medical Assistance payments (i.e., Elderly Waiver); Whether the resident is allowed to bring in their own home care services and remain a resident of the facility. • Family advocates can be present during the resident’s initial assessment, which generally happens within 14 days of admission. This allows the advocate to understand the resident’s condition when evaluated by a trained professional. (See Minn. Stat. §144A.4791, subd. 8 regulating home care assessment and 42 CFR §483.20(b)(2) regulating nursing home assessment.) • Family advocates can participate in care conferences to hear what is being said about their loved one’s progress and/or condition.