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Overview
Federal and state law require nursing homes to provide
high quality, individualized care for every nursing home resident. The law protects
residents who complain from retaliation by the nursing home and prohibits discrimination
based on the source of payment. When facilities violate these rights, residents can
file complaints with a variety of state and federal agencies. If found in violation
of the law, nursing homes, their owners and administrators can be fined, have their
licenses suspended or revoked, and lose their right to payments by Medicaid or Medicare.
For a excellent summary of residents' rights under
federal law, click here for a two-page Fact Sheet by the
National Citizens' Coalition for Nursing Home Reform (NCCCNHR).
Rights
to Quality Care Generally
A central provision of the law is that every resident is
entitled to individualized, high quality care designed to prevent deterioration whenever
possible.
Patients’ Bill of Rights. Connecticut General Statutes §
19a-550 (b) (8) & (10).
Resident rights. 42 Code of Federal Regulations §
483.10.
Quality of life. 42 Code of Federal Regulations §
483.15 (b), (e) (f), and (h).
Quality of care. 42 Code of Federal Regulations §
483.25 (a), (c), (d), (f) and (g).
Dental services. 42 Code of Federal Regulations §
483.55.
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The Right To Be
Evaluated and Informed as to Your Medical Condition
Patients’ Bill of Rights. Connecticut General
Statutes § 19a-550 (b) (3), (9) & (10).
Resident rights. 42 Code of Federal Regulations §
483.10 (b) (1), (3) and (11) (i) and (ii).
Resident assessment. 42 Code of Federal Regulations
§
483.20 (b) and (d).
The Right to be Free from Abuse and
Restraints
Patients’ Bill of Rights. Connecticut General
Statutes § 19a-550 (b) (5), (8), (10) & (11).
Resident behavior and facility practices. 42 Code
of Federal Regulations §
483.13 (a) and (b).
The Right to Complain without Fear of
Retaliation
Patients’ Bill of Rights. Connecticut General Statutes §
19a-550 (b) (5), (6), (8), (17) & (20).
Resident rights. 42 Code of Federal Regulations §
483.10 (f).
The Right to Refuse Treatment
Patients’ Bill of Rights. Connecticut General Statutes §
19a-550 (b) (3), (5), (8) & (21).
Resident rights. 42 Code of Federal
Regulations §
483.10 (b) (4).
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The Right to Choose Your Own Doctor
Residents may hire and fire doctors as often as they
want to. Residents also have the right to visits by their own doctors.
Patients’ Bill of Rights. Connecticut General Statutes §
19a-550 (b) (3), (12) & (18).
Resident rights. 42 Code of Federal
Regulations §
483.10 (d) & (j)(iii).
The Right
to Privacy
Patients’ Bill of Rights. Connecticut General
Statutes § 19a-550 (b) (9), (12) & (15).
Resident rights. 42 Code of Federal
Regulations §
483.10 (e).
The Right
to Equal Care
All nursing home residents are entitled to receive
the same high quality care, regardless of whether nursing home is paid by Medicaid,
Medicare, insurance or savings.
Patients' Bill of Rights. Connecticut General Statutes § 19a-550 (b) (23).
Admission, transfer and discharge rights. 42 Code of Federal Regulations §
483.12 (c).
The Right to Form and
Participate in Resident and Family Councils
Patients’ Bill of Rights. Connecticut General Statutes §
19a-550 (b) (12), (13) & (17).
Quality of Life. 42 Code of Federal Regulations §
483.15 (c).
Resident rights. 42 Code of Federal
Regulations §
483.10 (e)(1).
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Nursing Home Staffing Requirements
Connecticut law only requires that nursing home staffing
levels result in 1.90 total nurse and nurse's aide hours per resident per day. In
contrast, the U.S. Dept. of Health and Human Services (HHS) recommends 4.10 total hours
per resident day as an optimum level and the National Citizens' Coalition for Nursing Home
Reform (NCCNHR) recommends at least 4.13 total hours per resident per day.
While most of Connecticut nursing homes staff above the very low
required levels, the state's average nursing-staff-hours-to-resident-day (3.16) still
ranks 33rd out of the 50 states, is the second lowest in New England, and falls below both
the HHS optimum and NCCNHR
recommended minimum levels.
Federal law does require nursing homes to post in a clearly
visible place the number of nursing staff (RN's, LPN's, and CNA's) on duty each shift.
Unfortunately, the law does not require spearate postings for each unit and it does
not require facilities to post how many residents there are. As a result, advocates
will have to ask for a resident census to conclude if the staffing levels meet the NCCNHR
standards.
Nursing Home Staffing Reports
National
In April of 2004, a scholarly article concluded that
nursing homes with higher direct care nursing staffing levels provided better care than
those homes with lower levels. Click here for a summary.
Also in 2004, HHS admitted that the nursing home staffing
levels is not accurate that is posted on Medicare's Nursing Home Compare
web site. While CMS has attempted to correct this problem, it is still not recommended
that one rely on this staffing information.
In May of 2003, HHS released a
report that reviewed the literature on minimum nurse staffing ratios in nursing facilities.
Then, in November of the same year, HHS released a
lengthy case study covering eight states and their experiences on minimum nursing
staff ratios.
The Kaiser Family Foundation published two reports in
June 2002:
"Nursing Home Staffing
Standards"
This issue paper describes the current federal staffing requirements and how states
separately regulate staffing levels in nursing homes. It also presents data showing
that actual staffing levels in over half of this country's nursing homes exceed the levels
that states and the federal government require.
"Nursing Home Quality:
State Agency Survey Funding and Performance"
This issue paper describes the resources, staffing, and performance of state licensing and
certification agencies based on findings from a survey of state survey agency officials.
In 2002, HHS released Phase II of a Congressionally mandated study
entitled "Appropriateness of Minimum
Nurse Staffing Ratios in Nursing Homes".
Sadly, the study found that 9 out of 10 of the nation's nursing homes lack adequate staff
to take proper care of their residents. The HHS study recommended minimum staffing
levels of 4.10 total direct care hours per resident per day in the nation's nursing homes
because staffing below this level may compromise the quality of care, causing costly,
dangerous outcomes such as pressure sores, infections, and avoidable hospitalizations.
Click here for the Executive
Summary. To view all of the volumes of Phase II of this federal study one can
visit the National Clearinghouse on the Direct Care Workforce web site.
Connecticut
In late 2000, the Connecticut General Assembly's Legislative
Program Review and Investigations Committee published a report entitled "Staffing in
Nursing Homes".
Read the Digest of Findings and
Recommendations of the Final Report.
Read the Keypoints of the Final
Report.
Read the entire "Staffing in Nursing
Homes" Final Report.
Nursing Home Staffing Legislation
In the 2008 Connecticut General Assembly legislative session, House Bill 5794 seeks to increase requirements for direct care
staffing levels to the NCCNHR standards.
In Congress, The Nursing
Home Staffing Act of 2005 (H.R. 4293) was introduced. The purpose of the bill
was to increase nursing home staffing levels to equal the recommended HHS optimum level of
4.10 hours per resident per day. It did not become law.
Nursing Home Staffing Laws
Chronic and convalescent nursing homes and rest homes
with nursing supervision. Regulations of Connecticut State Agencies §
19-13-D8t (m).
Resident behavior and facility practices. 42 Code
of Federal Regulations §
483.13 (a) and (b).
Quality of life. 42 Code of Federal Regulations §
483.15 (h).
Nursing services. 42 Code of Federal Regulations §
483.30.
Specialized rehabilitative services. 42 Code of
Federal Regulations §
483.45.
Posting of Information on Nursing Facility Staffing.
42 United States Code §
1395i-3 (b)(8) & 42 United States Code 1396r (b)(8); 42 Code of
Federal Regulations §
483.30(e).
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