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Considerations for Establishment of a Nursing Home Case - Related Statutes

Posted by attorney Kenneth LaBore

Summary of Federal Nursing Home Regulations

To participate in the Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483).

Under the regulations, the nursing home must have sufficient nursing staff. (42 CFR § 483.30)

Questions regarding Staffing:

· How many nursing aides / Registered Nursing Assistants (RNA) were scheduled to work at time of incident?

· How many nursing aides / RNAs were working on the floor?

· What is your normal staff to patient/resident ratio on a shift?

· Were there any temporary workers at time of incident?

· Were any employees working an extra shift due to “sick leave" of other workers? Were all the sick leaves covered?

· Any employees working a double shift?

· Any special circumstances on the floor which required more staff on the date of the incident?

A nursing home must conduct an initial comprehensive and accurate assessment of each resident's functional capacity. (42 CFR § 483.20). The facility must further develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.(42 CFR § 483.20 (k)) andMinnesota Rule 4658.0405, Subp. 1.

Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that—

(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and

(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. (42 CFR § 483.25(c))

Questions regarding Pressure Ulcers:

· Request Nursing Home Policies regarding Pressure Ulcers

· Was the sore acquired at the facility?

· Has the resident been assessed for Skin Breakdown Risks, what is the Braden scale staging? (Stages I-IV)?

· Does the nursing home have photos of the wound?

· Has the resident’s family and physician been notified that there is an ulcer?

· What was the resident’s treatment plan / care plan for the ulcer. Was there wound care?

· Was the wound care provided by the facility or outsourced?

Urinary Incontinence. Based on the resident's comprehensive assessment, the facility must ensure that—

(1) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary; and

(2) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.(42 CFR § 483.25 (d))

Questions regarding Urinary Incontinence:

· Request the Nursing Home Urinary Incontinence Polices

· Was the resident continent upon admission?

· Had the resident been taking fluids?

· Is the resident’s urine input and output being tracked by the facility?

· Are fluids being given via IV?

· Has the resident been catherized?

Accidents. The facility must ensure that—

(1) The resident environment remains as free of accident hazards as is possible; and

(2) Each resident receives adequate supervision and assistance devices to prevent accidents.(42 CFR § 483.25 (h))

Questions regarding Fall Accidents:

· Request the Nursing Home Fall Prevention Policy

· Has a fall risk assessment been performed?

· Was the resident considered at risk for falling?

· Had the resident fallen in the past? How many times? When was the last fall?

· Was there one-to one monitoring after the fall(s)?

· What was the delay between time of fall and when the resident received medical attention?

· When were the family and resident’s doctor notified of the fall?

· Were vitals and post incident assessments performed?

· What fall precautions were in place before the fall?

o Bedrails, bed alarm, floor mats, lowered bed?

· Were there any post fall assessments made to protect resident’s safety?

· Were there other risks for fall such as dementia or reactions from medications, or blood glucose levels, as well as anticoagulants?

Questions regarding Burn Accidents, from Smoking:

· Request Nursing Home Smoking Policies

· Did the resident require supervision when smoking?

· What were the resident’s risks?

o Dementia, Medications, Oxygen?

· Did the facility have a designated supervised smoking area?

· Was there a facility sign out sheet for cigarettes and lighter?

· How does the facility monitor for return of cigarettes and lighter?

Maintain acceptable parameters of nutritional status. (42 CFR § 483.25 (i))

Nutrition. Based on a resident's comprehensive assessment, the facility must ensure that a resident—

(1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and

(2) Receives a therapeutic diet when there is a nutritional problem.(42 CFR § 483.25 (i))

Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR § 483.25 (j))

Hydration.The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.

Ensure that residents are free of any significant medication errors. (42 CFR § 483.25 (m)) andMinnesota Rule 4658.1320.

42 CFR § 483.25 (m) Medication Errors.The facility must ensure that—

(1) It is free of medication error rates of five percent or greater; and

(2) Residents are free of any significant medication errors.

Questions regarding medication errors:

· How are errors reported in the facility?

· Is the same person making repeat med errors?

· Who tracks and the errors?

· What was indicated on the Medication Administration Records (MAR)?

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