Articles Posted in Residential Care Facilities

Residential care facilities for the elderly (RCFE), or assisted living facilities, are typically board and care homes for individuals age 60 or older who can no longer live by themselves, but do not need 24-hour nursing care. Typically, a RCFE will provide a bed, all meals, and assistance with certain daily activities such as bathing, dressing, meals, and with medication distribution. The residents, however, must be able to take their own medications.

RCFEs and assisted living facilities are licensed by the State of California, and are limited under the code of regulations to the type of care they can provide. In addition, each facility must undergo periodic inspections by the Department of Social Services.

It is important to point out that RCFEs are not permitted to provide medical care. As a result, individuals with certain medical conditions may not be admitted or retained by a residential care facility. A few of those conditions include, but are not limited to, bed sores of a Stage III or larger, or people who require tube feedings. Other conditions are restricted and may not be permitted, such as individuals who require catheters or colostomies. RCFEs may admit people who suffer from dementia, but only after meeting certain regulatory requirements. Always check for the facility’s written plan for caring for individuals with memory impairment.

About four years ago I had a very interesting case involving the death of a developmentally disabled adult in a San Bernardino care facility. In my case, the thirty-year old severely disabled man was found barely breathing on the floor next to his bed just after midnight. Medics were called, and tried to sustain his life, but sadly the man died. Staff and the family presumed it was a heart attack, since the decedent was very obese and had a history of some heart problems.

An autopsy, however, showed a different case of death. The medical examiner ruled the death a homicide, finding that the man died from blunt force trauma to his abdomen. The next question for use was Who did it?

Through the discovery process in a lawsuit we filed against the facility, we believed the death was caused by either a disgruntled employee, who was tired and angry at the resident for the demands he made on staff time, or an autistic room mate (who could not speak), who accidentally kicked the decedent in an act of self-defense. The case settled before trial, so those questions were never fully answered.

Dehydration in the nursing home can lead to significant complications, including death. If the human body is deprived of necessary fluids, several symptoms may appear, including an increased heart rate, decreased sweating, decreased urination, extreme fatigue, headaches, cramps, and tingling of the limbs.

The causes of dehydration are several. The most common is vomiting, diarrhea, malnutrition, or the simple failure to replenish the body with the liquids that are lost from sweating and urinating. Sadly, this is the most common cause of the dehydration in the nursing home.

Nursing homes have a legal duty to provide adequate hydration to their residents, and to provide the proper training to their employees to recognize the signs and symptoms of dehydration. The aging process itself will often cause a decrease in appetite, but this is never an excuse for dehydration in a patient (even though it’s an excuse frequently used by nursing homes). For patients at risk, nursing homes are required to monitor the food intake and urine output of its residents, and keep the medical doctor informed of the resident’s condition. The failure to do this may be a violation of the standard of care.

Living in a nursing home or assisted living facility continues to get more and more expensive. For a fifth consecutive year, the average annual cost for a private room in a nursing facility rose to $76,460. The costs varied dramatically state by state.

The costs for living in an assisted living facility also rose dramatically. Nationally, the average annual costs of living in an assisted living or residential care facility averaged $36,000, up 25% since 2004.

Experts believe that the costs of living in a nursing or residential facility will continue to rise if a shortage of long-term care workers is not resolved. As baby-boomers approach retirement, most have not adequately addressed the prospect of needing long-term nursing care in old age. The average person spends approximately 2.5 years in a nursing home, at a cost of over $190,000. Just a year or two in a nursing home can wipe out a persons lifetime of savings.

Since a significant part of my law practice involves cases of abused and neglected seniors in nursing home, I get asked frequently if I can recommend a good nursing home, or at least point out the bad ones. That is, of course, impossible because of the sheer number of nursing homes in California and the simple fact that every nursing facility, even ones with generally good reputations, have the potential for neglectful care.

When I am asked to recommend a home I typically refer people to the Nursing Home Guide. A web resource published by the California Advocates for Nursing Home Reform (CANHR) that provides detailed information about every licensed nursing home in the State of California, including information about prior complaints, citations, ownership, and the services provided. At the site you will also find a nursing home evaluation checklist, which provides a list of things to think about when looking for a nursing facility.

In addition, CANHR also now has a Residential Care Facility Guide which provides information about all licensed residential facilities in the state. The information there is limited, simply because public information about those facilities is not as available.

Last week President Bush signed into law the Safety of Seniors Act, a bill dedicated to preventing injuries of the elderly inside the home. According to the CDC, one in every three Americans over 65 will suffer a fall their home, and nearly a third of those will require medical treatment. In addition, 80% of elderly Americans who suffer a serious fall will suffer an additional fall within a year.

The bipartisan legislation seeks to develop educational strategies to increase the awareness of falls, support research to identify populations at risk for falling, and encourage projects that promote fall prevention. In California, health officials say they will make fall prevention a major priority starting this summer.

According to the CDC, almost $20 billion dollars is annually on medical costs related to elderly falls, most of which is paid for the Medicare and Medicaid. Because of the aging baby boomers, that figure is expected to rise to $43 billion by the year 2020.

People frequently ask for a recommendation to a “good” nursing or residential care facility. It’s a question that is difficult to answer, other than to state that the style of the building or the cost of the care is rarely a good indicator of quality of care. I have sued nursing and residential facilities that look like the Ritz Carleton, and I know that smaller, “mom and pop” facilities are capable of providing excellent care.

The first step is to find a facility that suits your needs. In may be its location in relation to family or friends, or one that offers a specific service such as dementia care. Once you have narrowed it down to a few, visit the facilities and speak with the administrator or the admissions director, and ask for a tour. While on the tour introduce yourself to other residents and ask them about the facility, the things they like and don’t like, and ask if you can speak with the privately. Frequently your first impression is the most accurate, so trust your instincts.

After the tour, return unannounced to the facilities you like best a few days after your tour, and visit at various times of the day so you can see the program it runs throughout the day. It’s important that these visits are unannounced so you can see the “real” facility and not the one portrayed on the official tour (hopefully they are the same).

Budget cuts proposed by Governor Schwarzenegger could cripple California’s oversight of Residential Care Facilities for the Elderly. Further damage to the already struggling oversight program could put thousands of RCFE residents at risk.

According the California Advocates for Nursing Home Reform (CANHR), the proposed cuts come at a time when assisted living care is growing at a rapid rate. There are more than 7,000 assisted living facilities in the state, an increase of more than 25% over the last decade. Current law requires an inspection of RCFEs only once every five years, a dramatic decline from the 1980s when such facilities were subject to inspections twice a year.

Inspecting RCFEs once every five years or less is a recipe for neglect and abuse,” said Patricia McGinnis, CANHR’s executive director. “Care standards and residents’ rights become virtually meaningless when inspections are so rare. Issuing a license under these conditions deceives consumers who assume the state is conducting regular inspections or offering oversight and protection to residents.

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