Consumers

1. Long Term Care Services
2. After Admissions: Answering your Questions about Long Term Care
3. Physical Restraints: Important Information for Residents and Families

AFTER ADMISSIONS:
Answering your Questions about Long Term Care

We realize that making the decision to place someone in a nursing home may have been difficult and stressful. As the family or friend of the resident, you probably have several questions and concerns. Understandably, some people fear the transition from their home to a nursing home. The new resident may demonstrate feelings of anger, loneliness, and periods of confusion, due to new surroundings.

As long term health care providers, we understand these feelings. We are professionals who have been trained to address the needs of the residents, as well as the needs of the family. In situations such as this, problems or concerns may arise. Open communication between the family, the resident and facility can best address these problems and concerns in the nursing home. Because North Carolina nursing homes have a commitment to caring, we have outlined certain realities about everyday life in a nursing home in this brochure. If you have any other questions, feel free to talk with any member of our staff.

Q. Who is the decision maker?
A. When the resident is capable of making decisions, it is his or her right to do so. We welcome your input, but final decisions are up to the resident. When the resident is incompetent to make financial, medical or social decisions, the designated responsible party (a person named during the admissions process) will make the decisions. Questions and concerns regarding the resident are to be directed to the responsible party. Staff in the nursing home will contact the designated responsible party. It will be the obligation of the designated responsible party on record to share information with other family members. During the resident's stay, you may have questions regarding living wills, guardianship, or powers of attorney. If so, contact the facility administrator or your family attorney for more information.

Q. What are residents rights?
A. All residents have rights, a copy of which is available from the admissions counselor, and is posted in the facility. Our main concern is the resident and his or her immediate needs. Family wishes will be considered, but may not be best for all concerned.

Q. What if the resident doesn't like his or her roommate?
A. We will make every effort to have compatible roommates; however, if the resident is unhappy with his or her roommate, he or she should discuss the problem with the facility's staff, and we will attempt to resolve the conflict. Please keep in mind that a room change is not always feasible.

Q. Why do some residents scream and yell?
A. Residents express themselves in different ways and may not have control of their behavior due to a disease process. Screaming and yelling does not necessarily indicate suffering or unmet needs. Staff respond to these behaviors in ways appropriate for the individual. Residents who are disturbed by other residents who are screaming and yelling should discuss this with the facility nursing staff.

Q. Why do some residents wander?
A. Every effort is made to occupy and fulfill each resident's day; however, on occasion, residents affected by memory loss or dementia may wander around the facility. Facility staff are aware of residents who wander and most facilities have methods for monitoring their whereabouts. It is every resident's right to be free from restraints, unless they are required for medical reasons.

Q. How are nursing homes staffed?
A. State and federal regulations require all nursing facilities to be adequately staffed to care for the patients within the facility. Staffing in each facility is based upon the acuity levels of its residents. Subsequently, each facility's staffing needs are different. Staffing levels may fluctuate for many different reasons. If you have questions regarding the facility's staffing levels, facility management will be happy to explain the regulations to you.

Q. Why are some residents restrained?
A. After an evaluation by the professional staff, residents are restrained for their safety and the safety of others. Responsible parties will be consulted when possible and the least restrictive restraints will be used. All restraints must be ordered by a licensed physician.

Q. How often do physicians visit the residents?
A. Physicians do not visit daily or make daily rounds. Residents receive a physician's visit every thirty days during their first three months in the facility. Following the initial three months in the facility, physicians visit the residents every two months. Significant changes in a resident's condition will prompt a call and/or a visit by the doctor. As a point of comparison, rest home residents receive physician visits annually.

Q. Should call bells be responded to immediately?
A. Yes, a timely response by a staff member should be expected. At the time of response, the staff member will assess the resident's needs and prioritize them relative to other residents' needs. If the resident does not receive a timely response, contact the nurses' station and speak with the charge nurse.

Q. What will food be like in a nursing home?
A. Nursing homes offer a variety of well-balanced meals to all of their residents; however, physicians often limit residents' intake of salt, fat, cholesterol or sugar. If a resident does not like a particular food, alternates are available at each meal.

Q. What course of action can I expect the facility staff to take when I report personal items missing?
A. The facility is not responsible for personal items; therefore, you are not encouraged to bring valuable items to the facility. We will conduct an investigation if it is reported, but items may not be found due to: residents throwing items away; accessibility by visitors, staff and other residents; commercial laundry; and misplaced items. Laundry is a major problem due to a large volume of clothes and unmarked clothing. The quicker a missing item is reported, the more likely it is to be located. Often items are found within the facility. It is important to talk with facility management regarding personal property policies before bringing valuables into the facility.

Q. Should I smell an odor when I visit?
A. Because many elderly nursing home residents are incontinent, an occasional odor may be noticeable. Medical conditions such as some forms of cancer, ulcers and infections may also cause persistent odors. Long term lingering odors can be a legitimate concern and should be communicated to the staff.

Q. Is it acceptable for me to find my family members soiled upon visit?
A. Rounds are made by staff on a frequent basis, but occasionally an incontinent episode may have occurred prior to your visit. It is not acceptable if the resident is soiled each visit, or appears to have been soiled for a long period of time.

Q. To whom should I go if I have a problem or concern?
A. When possible, problem resolution should begin at the source of the problem. If you are dissatisfied with results from attempted resolution, or wish to speak to someone not directly involved in the situation, you may speak with the social worker, the appropriate department head, or the nursing home administrator. Be sure to ask about the facility's problem resolution policy. In addition, each facility has a telephone number posted for the state's regional ombudsmen, who will be happy to assist in the problem resolution process.

We hope this information has helped to answer some of your questions. Staff members in NCHCFA facilities are dedicated to providing quality care to our residents. We pledge our willingness to go the extra mile in order to resolve your concerns. We believe this can be accomplished through open discussion and communication within the facility.