A patient in a North Carolina nursing home was allowed to fall by a nurse aide. The aide and her friends/coworkers covered it up and for two weeks the patient was untreated for a hip fracture. She was eventually taken to a hospital and there it was found she had a broken hip. Shocked by the news, the family eventually was able to find out what happened. The resident’s family learned what happened only by reviewing follow-up reports from state inspectors.

As we know, rules and regulations get through “channels” and many times they do so without anyone noticing. That has happened again. A recent change in federal rules on nursing home inspections makes it nearly impossible for families to get the information they need to protect their loved ones.

According to the associated press, the changes were put into effect in October 2008 with little notice and without a public comment period. The change is getting sharp criticism for closing off critically important information. Under the new rules, the state inspector follow-up reports can’t be released without specific approval from the chief of CMS.

“It’s an extremely troubling development – it puts a lot of information related to nursing-home inspections off-limits,” said Eric Carlson, director of the Long-Term Care Project of the National Senior Citizens Law Center, a California-based nonprofit group funded in part by the federal Administration on Aging. “I think it’s certainly bad for consumers and the folks who represent them.”

The change bars nursing home surveyors from releasing privileged information to the public without approval from the Director of the Centers for Medicare and Medicaid Services. State employees (the nursing home and hospital surveyors) who perform inspections for the federal government have been reclassified as federal employees as part of the revision. This reclassification is only for this purpose, and not for wages/benefits or other purposes. The surveyors are still state employees. They contract to the Federal government to perform the surey and certification work and as such are required to follow federal standards and procedures, and in this case, are required to follow the federal procedures for the release or non-release of privileged resident/patient information.

Officials at the Department of Health and Human Services said employees have been too burdened by requests for information. Under the rule change, state employees who inspect nursing homes for the federal government are reclassified as federal employees who aren’t allowed to provide “privileged” information or documents to the public without approval from the head of the Centers for Medicare and Medicaid Services.

Requests were diverting employees from certification responsibilities, Michael Leavitt, secretary of the Department of Health and Human Services, said in announcing the change.

Lawyers are now finding out that the new rule has already slowed efforts to represent their clients. It is slowing down the process to get the information they need.

How does this affect you, the consumer? – You can see, it is putting a wall in your path to ensuring your loved ones are getting safe care.

What about those of you who are administrators and staff of nursing homes – now is it affecting you? You might think at first, that it is a good thing, but really, getting information out to the public about both GOOD and BAD state inspections is beneficial to the facility and to those who are wanting to look at where to place their loved ones.  I would think even those who administer nursing homes find the change in rules, without a public comment period, to be a poor decision.

Then look at who has to give the permission – the head of CMS – the head of a federal agency is going to review and provide permission for the hundreds of requests in every state? That sounds like an impossible task, the permission is either going to be given or withheld willy-nilly. What determines who gets permission to see the documents and who doesn’t? Will there be criteria? Who is developing that criteria? What patient rights are being stepped on here?



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So let’s say you have a problem with a facility. Perhaps you saw staff yelling at a nursing home resident. Maybe you are a nursing home resident and the staff are ignoring your requests for assistance. Perhaps you are a patient in a hospital and the staff are not doing your care right. Maybe it is your managed care insurance company who is not approving treatment you need. What do you do? You are sick, you aren’t feeling well, they (meaning the doctors and nurses) are smarter than you aren’t they? They should know what they are doing, right? So you accept it without question.. until now! You do have rights as a patient or resident of a facility. When those rights are violated, you have the right to make a complaint, to have someone look at it and see if the facility violated your rights and/or any regulations.

Every state has one or more agencies to which you can report issues and complaints for any type of facility. Since every state has its own agencies, the agency you contact in one state might not be the agency you contact in another. You can search on the Internet and you might find a phone number to call, or you might find many phone numbers to call, and none of them are the right one to help you. What can you do?

There are several resources on the Internet that can help you. They will have information to lead you to the right agency for your state.

  • One of these is The National Center on Elder Abuse (NCEA). The NCEA has a directory of all state and regional ombudsmen, state offices on aging, state licensure and certification agencies, state adult protection agencies, nursing home quality review boards, Medicaid agencies and Medicare Fraud Control Units nationwide.

  • Another source for making a complaint or reporting a hospital problem is This site, which is administered by a hospital administrator, walks you through steps you should take prior to contact any outside agencies. Many times a complaint can be handled “in house”.

  • You can also contact the Joint Commission to make a complaint against a hospital. There is a box & link towards the bottom right of the page that will lead you to the appropriate place for submitting a complaint.

Stand up, get help and watch out for yourself!


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