Tcl - Advocating for Quality Nursing Home Care and Sufficient Staffing in Colorado - October 2005 - Articles
| Jurisdiction | Colorado,United States |
| Citation | Vol. 34 No. 10 Pg. 31 |
| Pages | 31 |
| Publication year | 2005 |
2005, October, Pg. 31. TCL - Advocating for Quality Nursing Home Care and Sufficient Staffing in Colorado - October 2005 - Articles
October 2005
Vol. 34, No. 10 [Page 31]
Advocating for Quality Nursing Home Care and Sufficient Staffing in Colorado
by Valerie L. Corzine
Valerie L. Corzine, Denver, is with The Legal Center for People with Disabilities and Older People, Colorado Legal Assistance Developer for the Elderly, and staff attorney for The Legal Center - (303) 722-0300; toll free, (800) 288-1376; TDD for Hearing Impaired; www.thelegalcenter.org. The Legal Center is Colorado's federally mandated protection and advocacy system for people with disabilities.
Imagine that you are a Director of Nursing in a Colorado nursing home. The parent corporation of the nursing facility you work for refuses to allocate necessary funds to hire sufficient staff. Frail and vulnerable residents depend on you to ensure quality care throughout the facility. Just having enough staff to get everyone fed, bathed, and turned to prevent pressure sores is a daily struggle. If a complaint is made to the health department, a plan of correction may require staff training on pressure sore prevention or additional documentation, such as that patients are being bathed on a regular schedule.
Unfortunately, it is unlikely that there will be any requirement that addresses the underlying problem - insufficient staffing. Nursing staff are morally implicated, their licenses are on the line, and their options are limited. The most reasonable course of action in their view may be to quit. This is what Directors of Nursing across this state are doing at an alarming rate. The average tenure of a Director of Nursing in a Colorado nursing home is only nine months.1
Colorado attorneys who become aware of this situation may be morally implicated, but do not work for the nursing home corporation and do not have to worry about finding work in the industry. However, there are some legal tools available that Colorado attorneys might be able to use to address the underlying problem of insufficient staffing. Two legal and regulatory sources that could assist attorneys in improving quality of care in Colorado nursing homes include: (1) the Colorado Nursing Home Grievance Procedure ("Grievance Procedure") (see the Appendix to this article, entitled "Colorado Nursing Home Grievance Procedure");2 and (2) the Federal Guidance for Insufficient Staffing - F-353,3 both of which are discussed below. First, some background is in order on the issue of quality of care in nursing homes.
Quality of Care and Abuse Problems in Nursing Homes
Government Accountability Office ("GAO") reports have continued to document the persistence of quality of care and abuse problems, even several years after the passage of the federal Nursing Home Reform Law, amendments to the Omnibus Budget Reconciliation Act ("OBRA") - technically, the 1987 nursing home reform amendments to the Medicare and Medicaid Acts: 42 U.S.C. § 1395i-3 (Medicare) and 42 U.S.C. § 1396r (Medicaid).
The nursing home reform amendments provide, among other things, significant federal requirements on nursing facilities relating to resident rights; admission, transfer, and discharge; prohibitions on abuse and employment of abusers; maintenance and enhancement of quality of life; resident assessments and comprehensive care plans; and a high standard of quality of care requiring that the facility ensure that the resident attains or maintains his or her highest practicable level of physical, mental, and psychosocial well being.4
Despite these impressive federal requirements, GAO reports conclude that nursing homes continue to have serious problems, such as malnutrition, abuse, pressure sores, and over-medication.5 After a survey of ten sample states, one GAO study reports inadequate staffing levels remain one of the major problems, which most officials believe lead to chronic quality of care problems.6 In another report,7it was found that allegations of physical and sexual abuse of nursing home residents were not reported promptly and that local law enforcement officials were seldom summoned to nursing homes to immediately investigate such allegations. When they are summoned, evidence of this type of abuse has been compromised. Abuse allegations are supposed to be reported to state survey agencies immediately, but often are not.8
Moreover, the GAO found that as many as one in five nursing homes nationwide (about 3,500 homes) had deficiencies so serious that caused residents actual harm or placed them in immediate jeopardy.9 Along with this, the GAO discovered there was significant understatement of care problems that should have been classified as actual harm or worse. These included such problems as serious avoidable pressure sores, severe weight loss, and multiple falls resulting in broken bones and other injuries.10
In Arkansas, a state survey agency investigated coroner referrals that identified weaknesses in nursing home quality, mirroring the GAO's nationwide findings.11 These weaknesses included: (1) understatement of the seriousness of complaints and a failure to investigate serious complaints promptly; (2) predictable timing of state surveys, which could enable a nursing home to cover up deficiencies; (3) weaknesses in survey methodology that resulted in care problems that were overlooked; and (4) lack of accountability for neglect associated with a resident's death.12
Experts, long-term care ombudsmen, and health survey agencies continually find that inadequate staffing is a primary cause of persistent quality of care problems in nursing homes.13
Colorado Nursing Home Grievance Procedure
The Colorado Nursing Home Grievance Procedure provides a mechanism for residents and their legal representatives, as well as family members and resident councils, to submit grievances regarding nursing home care and challenge not only findings, but also remedies (see Appendix).16 The Grievance Procedure is more than a mechanism to complain to facility management and the Colorado Department of Public Health and Environment ("CDPHE"). It is an administrative appeals process that begins at the facility staff designee level, but ultimately provides for an administrative hearing and the right to judicial review.17 However, the Grievance Procedure is not a substitute for private nursing home tort litigation; Colorado courts have ruled that litigants are not required to exhaust administrative remedies.18
To continue reading
Request your trial