Archives
What's Your Question About Nursing Homes?
By Kathy Gannoe - November, 2008
Question:
What on earth is this HIPAA stuff? I went to look at my brother’s chart at the nursing home and they wouldn’t let me because of HIPAA.
Answer:
HIPAA is a federal law meant to protect personal medical information. HIPAA stands for Health Insurance Portability and Accountability Act. In short, your medical records are only for your eyes, your medical providers’ eyes, and for the eyes of people you choose to see them. The nursing home is being very appropriate if they won’t allow you to view your brother’s chart UNLESS you are your brother’s legal representative (medical power of attorney or his legal guardian) or your brother has given you specific permission to view the chart and has the legal capacity to grant that permission.
Question:
My sister is his power of attorney but she doesn’t really care about him very much. I don’t think the nursing home is doing a good job and I know I can prove it if I see his records. Can you help me get the records?
Answer:
An Ombudsman can interview him (in private) and determine whether or not he wants anyone other than his power of attorney to have access to his charts. If he lacks decisional capacity, then access to his chart is controlled by his power of attorney. However, if you believe that his care is not good, then you can register a concern with the Office of Inspector General (502/564-7963). If you think his care is so poor that it amounts to abuse or neglect, you must report this to the Adult Protective Services (APS) office in your county or use the abuse hotline at 1-800/752-6200. The Inspector General and APS are the two state agencies which look into poor care. So does the Ombudsman. You can relay your concerns to the facility Ombudsman (look for a poster with contact information) or to the state Ombudsman at 1-800/372-2991.
Question:
I just moved back to the state to help with my father. Everything is so new to me! I was told that he would have a “care plan.” Since I’m going to have to take responsibility for his care, can you tell me what I need to know about this?
Answer:
The care plan is the formal plan which tells the facility staff how to care for your father. It builds on his strengths and preferences and addresses the areas where he needs care. It also lays out his rehabilitation goals. Care plans are to be developed within 21 days of admission and reviewed and amended at least quarterly or more often if there is a change in his condition or if there has been a significant event in his life. Prior to a care plan meeting you or your father should ask for a copy of his current care plan (see the HIPAA info in the first two questions). Review it to see if his needs and concerns are accurately reflected. Then observe what is actually happening to see if the current care plan is being followed. This will give you a base of information for discussion at the next meeting. Unless he is unwilling or totally unable to participate, your father should be in that meeting. It is important for everyone to recognize that it’s his life, and his care which are being discussed. He should be encouraged to participate at whatever level he is able. This is the best time for him to make his preferences known. By the way, the meeting should be scheduled so that you can attend. All the staff may not be present, but there must be someone there to hear your (and your father’s) input and to explain the plan to you both.
Question:
Once there is this care plan meeting, what then?
Answer:
The ideal is that everyone will know what the plan says and will work together to see that it happens. Sadly, a reality is that many times it is a paperwork exercise. That’s why it’s important for families to be active and informed. After the care plan meeting, you or your father should request a copy of the new care plan and use it to monitor his progress. (Again, remember that HIPAA stuff.) If he is supposed to be assisted with meals, you should be able to see him getting help. If he is to have specific activities, he should be participating in them. Care planning is one of the most important rights residents have. Be sure to exercise this right as fully as possible.
Question:
Do you think they will let me take him out to eat sometimes? He really likes to do this.
Answer:
Absolutely! The facility is required to encourage residents who are willing and able to participate as fully as they can and want to in community activities. His activities are also to be those he has always enjoyed.
This column is presented as a public service of the Nursing Home Ombudsman Agency of the Bluegrass. If you have a question, send it to:
Kathy Gannoe
Nursing Home Ombudsman Agency
1530 Nicholasville Rd.
Lexington, KY, 40503