Are nursing homes really safe for your loved ones? Many residents face risks that family members can help prevent. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Hannah Garrett to talk about how families can keep nursing home residents safe.
Schenk: How family members can keep their loved ones safe in a nursing home. Stick around.
Hey everybody. Welcome back to the nursing home abuse podcast. My name is Rob. I will be your host for this episode. And today we are talking about what family members can do to help keep their loved ones safe while they are residing In nursing homes, the things that they needed to keep on top of what questions to ask, who to ask them to that type of thing.
And as I mentioned at the top of the show, we’re not doing this alone. We have the absolutely fantastic Hannah Garrett from the Higgins law firm up in Nashville, Tennessee.
Hannah litigates nursing home abuse and neglect cases. She’s absolutely passionate about advocating for her residents and resident families and is continually honored to her that her clients trust her to be their voice when she’s not working. She enjoys reading, baking, knitting. and quilting. And with that, Hannah, welcome to the show.
Garrett:
Thanks for having me.
Schenk:
I absolutely love your law firm’s online presence. Like you have great tick tock, get the Instagram going. And that’s where actually found you guys like you guys give great information. So I’m one of the people out there. I’m also trying to put stuff out there and sometimes you don’t know if it’s sticking or not sticking.
So I just wanted to hats off to you as having a great online presence. And with that being said, one of your posts that you brought up had to do with involvement of the nursing home process. Like in other words, it seemed to me what you were indicating is that the more the family is involved in more of the family involved, the family is involved, the better the potential outcomes for that resident. So that’s what I wanted to have. You want to talk about that so we can start this however you want, Hannah. When you posted that. And when we say that, what do we mean? What? What? What does involvement mean? Just I’m going to pass the mic to you.
You tell me what’s going on with that.
Garrett:
Sure. I’m sure that our social media manager will be very pleased to know that All of the crazy stuff that she convinces us to do is doing something so that’s good. But the idea for that video actually came about because I’m sure you can relate to having clients who have a lot of guilt when they’re on the lawsuit side of having a loved one in a long term care facility.
And that’s, it’s always a, It’s it’s hard to see families go through that and to have that experience of feeling like they should have done more should have done something different because there just isn’t that much knowledge out there before something happens of what you can do to advocate for your loved ones when they’re there.
And there are just so many things that we get to see on our side of it that I wish that people knew. On the beginning side so that they can help a help advocate for their family members better so that they can help avoid some of the situations that we see all the time and also to help mitigate some of those feelings of guilt when really it’s not their fault.
There’s nothing that they did wrong. It’s just there’s a lack of what you can do a knowledge of what you can do out there.
Schenk:
That’s an interesting perspective. I feel like sometimes as an attorney, obviously you have to wear the attorney hat and file lawsuits and take depositions but in terms of the relationship with your client or with typically in our line of work, as we’re not typically dealing with the resident.
A lot of times we’re dealing with the family. And you are having that conversation. Hey, this is not your fault. You’re not the one that is tasked with providing clinical care to somebody like your your only decision was to put them somewhere. And it’s okay to expect that, you’re, they’re going to get the appropriate care.
I can’t tell you how many of those conversations I’ve had of where it’s I can’t tell you what to feel, but. I can’t say not to feel guilty, but you shouldn’t feel guilty. It’s not it’s not justified because these are the people that are you’re entrusting your loved one with.
It’s almost what’s the, what is it? Goodwill hunting. There’s the scene where it’s not your fault. And like they hug and it’s the big, it’s the big. Yeah. That’s what I think about on my mind when I think about that. But yeah okay. You have the, you have family guilt. You, oh we, this shouldn’t have happened or whatever but there, but what do we do want they’re in there?
Like how, what are some of some solid steps that we can take to keep our loved ones safe as a family member?
Garrett:
I think just. Being present so much of the time goes a really long way. And thankfully we’re coming out on the other side of the uncertainty that we had with COVID where family members weren’t allowed to be in there and it was really limited to what you could see through a window or what you could see through an iPad screen.
Now that we’re getting back to some sense of normalcy, especially in the pandemic. In facilities like these that were so cautious at the beginning of everything, rightly I think that there’s so much that families can do. I think knowing how the care planning process works is step one.
Understanding that The key to keeping people safe is assessing them regularly of everybody in the nursing home, knowing what their risks are, what their limitations are, because knowing what the problems could be is the first step to advocating for how to keep those things from happening. So being involved with making sure that the administration and that the care planning team knows, no, my mom is at risk for falling.
I know that it doesn’t seem like she is, but she really is and this is why and really being vocal about those things that don’t come across on an MDS, those things that don’t come across in a care area assessment worksheet. Those things that, that the facility uses, their job is a little bit more removed from.
What first hand knowledge of this person is. So being able to add that human component back into it that’s more than just an assessment instrument and saying, no, these are the risks. And then also letting. That opens the door for the facility to then say, okay, this is what we can do about it.
Schenk:
I hear you say, be present as part of the care planning process. And it seemed that you indicated that there is a care plan and there’s some MDS assessments. And these are documents essentially that are prepared at the end of a line of assessments.
So to the family members out there that like they’re hearing the word care plan for the first time, or, and they think MDS is I don’t know, like a government acronym for a Tennessee Valley authority or something. What tell them like, okay, is, are there meetings? Like how, what are some ways that we can be present and be involved in that other than I’ve been handed a document, are there meetings?
How often are they, who’s involved?
Garrett:
Yeah. Okay. Good point. Sorry.
Schenk:
No, you’re good.
Garrett:
The way it’s supposed to work in a perfect world is so MDS stands for minimum benefit and that’s just a document that every nursing home who accepts Medicare money has to submit to the federal government that says, these are the things that we are doing.
For this resident, there are a couple of reasons why they do that. The first is so that Medicare can keep track of statistics and know what’s going on in these facilities because there’s a level of oversight that’s required. But another thing is money. That’s how Medicare determines what amount of money to give to a facility for a resident each day.
And that is determined based on what. Types of things that resident needs. Do they need two people to help them get to the bathroom? Do they need someone to help them eat? What type of assistance do they need for that? Do they need to set up assistance only or do they need someone to actually feed them?
It’s a very detailed document or supposed to be a very detailed document that looks at every facet of that resident’s stay and care and what they’re capable of and what they aren’t capable of. It’s supposed to be repeated quarterly or every time that there is a change in a resident status. So If for some reason between one quarterly assessment and another, a resident experiences some level of change that affects how they are able to do things day to day.
There should be a new MDS that’s done. And one thing that family members can do is to say, Hey, my mom’s acting different. She’s different than she was two months ago. Are we making sure that all of her stuff is updated? So that’s the first step, is making sure that MDS is being completed when it should be completed.
Because A, that makes sure that the facility is getting the resources that they need to provide. The care that resident needs. And also the MDS triggers what are called care area assessments. So if you’re plugging all of these metrics into an MDS, and those metrics indicate that there is a risk for skin breakdown, or there’s a risk for falls, what it does is it triggers the nursing home to fill out to look into those areas a little bit more and to say, okay, you need to, Look at this particular risk, and you need to determine whether or not this needs to be addressed by a care plan.
And a care plan is just a, it’s a written document that lets everybody in the nursing home know what’s going on with a resident. Most nursing homes do what’s called an interdisciplinary team approach to resident care, which means that there’s like dietary team associated with caring for a resident.
There’s direct clinical care there’s, nursing care and then there’s like social services or social work activities physical therapy, occupational therapy, speech therapy, all of those things. And the only way that every department in a nursing home can know what’s going on or what a resident needs is through this one document.
It’s very important that this document is accurate and up to date and it’s a living document and not just static. It needs to change with the resident because depending on what a resident’s condition is, if they have Alzheimer’s, for example, that can escalate really quickly and they can change really quickly from what they can do one month to, three months later that was wildly different.
As a family member, making sure that you’re at least being a voice and saying, Hey, are we doing this? Are we staying on top of this? I’m noticing that something is different. And we have a meeting with everybody to make sure that everybody knows that something is different. And then what that does, those meetings, theoretically, they are supposed to be where everybody, the leaders of each of these different teams or a representative from each of these different teams meets together with a family member.
And says, okay, this is what the problem area is. Here’s what we can do to mitigate this problem. And here’s what we’re going to do to mitigate this problem. And it’s where they record the plan to keep this resident safe for the next care planning period. The nursing home in a perfect world should be.
Coordinating these meetings, but we don’t live in a perfect world that doesn’t always happen. And that’s one of the ways that residents end up. Having problems. So as a family member, just knowing that is how that process is supposed to work and holding the facility accountable for actually following through with that is a big step.
Just meeting, just talking and being making them come together and say that we need to evaluate what’s going on with this resident is a huge step towards making sure that nothing happens.
Schenk:
I think that some, that’s exactly right. I 100 percent agree with all that. I think that for somebody out there that’s listening, that sounded, it’s, it sounds like it’s a, um, it’s a complicated process, but it really boils down to the, they need to, the nursing home needs to assess your loved one, understand what’s going on.
They need to make a plan. to know what they’re going to do about it. And then they need to revise it to the extent that it’s not working. And all of that, you can be involved if involved in something that I like that I harp on a lot is that don’t be scared of this process. As Hannah has just laid out.
And. And don’t think that you’re just a pitcher. You being the listener, don’t think that you’re a pitcher that they fill with information because in reality, you as the family member are providing pertinent information that they’re going to need. For example, If your loved one has a tendency to wander to get up and walk around, that might be a symptom of something that only you know about.
And what I mean by that is we’ve had cases in which the individual was a police officer and he’s and he is walking the beat. We’ve had with experts on that. And they say that they’re on a mission. That’s what they’re, that’s their term for it. And so you would be able to provide that nursing home with what the mission is by way of example.
So it’s a two way street, that care plan meeting. It’s not just, they’re telling you, you’re giving them the information that they need. So I guess for me, my, I. Adding on of the two cents to what Hannah has described is you’re you as the family member are just as important to that meeting as anybody else.
Hannah, quick question about that though. So you mentioned some people that would be involved in that. I think you mentioned that was the IDT team, which is typically interdisciplinary team. So this needs to be there are federal regs for that, et cetera. But typically, Who should the family member be flagging down?
What is the position if they walked in there and they didn’t know names? They only knew positions. What are some of the positions titles that they would want that person want to talk to in a care plan meeting or for any other reason?
Garrett:
Yeah. The there are two main people that come to mind.
The first is the director of nursing. In a nursing home, that’s going to be the person who is responsible for overseeing the clinical care side. So they oversee all of the nursing staff. They are supposed to be a registered nurse, usually. They have experience, they have provided direct one on one care before.
They’re the ones that are knowledgeable about how the facility works. from a direct care standpoint. The other person that you want to talk to is going to be the administrator and the administrator is usually in charge of the entire facility as a whole. So they oversee all of the department heads there.
They’re the people who are in charge of each department. It’s their boss and they are supposed to be from my understanding involved in the the IDT team and in coordinating all of that. They are typically the ones who the buck stops with them at the facility. So if you really want to make sure that the person who can get things done.
Is hearing what you’re saying. I think that, you can talk to floor nurses and they can help give you some guidance because it doesn’t always work in a facility like that. Sometimes there’s an assistant administrator or an assistant director of nursing, who is the one who actually greases the wheels and gets things going.
But typically, every nursing home Every nursing home is required to have a director of nursing and administrator. So those are good places to start with asking to talk to people and to get the ball rolling on stuff.
Schenk:
I agree. And although the administrator typically, unless you have some cap of unicorn administrator does not have any type of medical background.
You’re right in the sense that I feel like. They get it done. The boss, they’re the boss, right? So they’ll have a tendency to get done. So that that’s who I would say the D O N. If you’re going in on a regular day and it’s not a care plan meeting, but you want to find out what’s going on.
I agree with you that it’d be a charge nurse or the floor nurse, whoever the head nurse on the floor is at that point would be a good person to go to. So we’ve talked about Hannah. We’ve talked about being present in the sense of being involved in the care plan process, meaning going to the care plan meetings, providing your two cents to what’s going on, receiving that information, meaning you don’t have to know exactly everything in the medical chart, but if you under, if you have a copy of the care plan or you understand typically what they’re supposed to be doing you’re probably good.
What are some other things or what are some resources that you would also advise to help? Family members keep their loved ones safe and nursing home.
Garrett:
So I think one thing that I think is really helpful is like you said, I think that what you’ve made, what you said earlier is a great point.
Family members are the experts in their family member. You may not be a medical expert and you may not be a nurse. You may not know what all the technical terms mean or how nursing homes work or what the regulations are. But you are the single best expert in your parent or your uncle or your sister or whoever it is It’s there that you are advocating for you’re the expert in them And so I think understanding that you don’t have to have technical knowledge to be able to participate in that process is You are empowered to do that because you’re the expert in them another thing too is understanding that accountability happens when people ask questions and and that it’s not a problem to ask questions, even if you get the feeling or are treated like you’re being a bother, that’s okay.
If being a bother means that there is accountability and it helps people too on both sides. I think when someone in a nursing home has asked a question that they don’t know the answer to, it forces them to figure it out. And it holds them accountable To figuring out what’s going on and to making sure that things are working the right way.
So one tool that I think is really helpful is the Medicare Compare website. That website, for those who don’t know, is just a website where each nursing home has its own site they have a star rating for the facility overall, and then they have star ratings for different sections of the facility, or different aspects of running the facility, like staffing, quality care measures infection control is another one, but If you are familiar with that facility, if you’re seeing what the government is saying about that facility, if you’re seeing what the government is saying about, are they complying with things?
I think that gives you the ability to collaborate with your loved ones care team and to say, okay, I don’t think that there are ever enough staff here when I’m here. And I’m seeing on the internet that they’re also just the government doesn’t seem to think that there’s enough staff here. How can we fix that?
What can we do? And what can you tell me to help my concerns? What are we doing about that? I think asking those questions, it may be a little bit uncomfortable, but it does force the conversation to happen. And it Negligence is, it doesn’t happen as much in the dark, so shining lights on things helps keep your loved ones safe as much as anything ever does.
And you can do that by asking questions, by trying to, you don’t have to, educate yourself a whole lot, but at least knowing what these websites are where you can go to check and see what’s happening in a facility I think is a really good place to start. That’s a great tool too.
Schenk:
And to piggyback on that, I would say that is an instance in which it would be, oops, it would be a question for the administrator.
If you’re going to start going into, Hey, why are you one star on staffing? The, the administrator probably has the best explanation for that to the extent that there is an explanation. But I definitely agree with the fact that The squeaky wheel gets the grease, right? So like you’re by asking questions about being involved you are shining a light and kind of a corollary to that is I’m not saying that somebody, a family member going in there and rattling the cage.
It’s It’s not 100 percent of the time your loved one’s going to get better care because of light shined on them. Although I think it’s more likely. I say that because there are instances in which sometimes there is retaliation. However, I think that when light is shined, the chances of retaliation are much lower.
I’ve been doing this for a while now, and I don’t, I haven’t had a single client that went in. Raising questions, doing all this stuff and the condition and they were intentionally, it got worse. I haven’t seen that. So anybody out there listening that hears Hannah say, Hey, ask questions. I don’t want to ask questions because I don’t want them to take that out on my level when they’re gone.
I’m not saying that’s not going to happen. Neither is Hannah but in our experience, it’s less likely that’s going to happen. It’s more likely that things are going to get taken care of. Okay, Hannah, in the, in a couple minutes that we have left, can you talk about in Tennessee, at least your experience with the ombudsman program?
Do you guys have a strong ombudsman situation? Can people, if to the extent that they’re not getting answers from the administrator of the DON, can they contact the ombudsman there in Tennessee?
Garrett:
Absolutely. And we have a great ombudsman program here. In fact, whenever we have people call us to say that they need help and that they think they have a case, but we don’t, it doesn’t quite rise to the level of what we can bring a lawsuit for the first place that we’re ever going to send them as an ombudsman, because it’s an excellent resource.
They know how nursing homes are supposed to work. They can tell you how things are supposed to work and they can put you in touch with the people that you need to speak to if things aren’t happening the way that they’re supposed to. So There is a complaint process that you can go through if everything that you’re doing on the nursing home side yourself isn’t working.
One thing that you can do is if there is abuse or neglect, there’s Adult Protective Services. You can call them, that’s its own separate process, but they will come in, they’ll investigate, they’ll see if there’s any basis for it, and they’ll take action if necessary. You can also call the Department of Health who oversees the administration running of nursing homes, and they do what are called complaint surveys.
The survey is just where a, an official from the state that is familiar with the regulations and knows what’s supposed to happen goes into a facility, they look at everything and they make sure that things are happening the way they’re supposed to. If they’re not, they get what’s called a deficiency, and it’s like a citation.
They have to tell the state how they’re going to fix it and make it better within a certain amount of time, or there are other penalties. That can go all the way up to the state revoking their license to operate. There are very serious consequences and nursing homes tend to take that part seriously.
If they’re not listening to you, if they’re not taking you seriously, they will take the state seriously because they can make them stop operating if it comes down to it. That’s an extreme measure. That doesn’t usually happen for everything, but With a complaint survey, the way that happens is you call them, you tell them what your concerns are.
Sometimes, if it’s a specific incident, the nursing home will have an idea of who this survey is about, but it’s technically anonymous. The state will go in and they’ll say, we want records from, residents with this condition, or this condition. They just pull a list of people. a pool of records that would encompass the individual that you have called about, and then they’ll look through it, and they’ll look at the specific issue that you have.
For example if your loved one has a really bad bed sore, they’ll ask to see the records of individuals with bed sores. They’ll look and see whether wound care is being done correctly. They’ll look to see whether or not care planning is done to address some of the issues. They’ll see if they’re, like, putting pressure reducing mattresses in place.
They’ll talk to the staff as well. They’ll talk to the residents and then they’ll make their findings. One thing that I know our state does too is they’ll follow up with the person who is called to make a complaint and they’ll say, these are the, we went in on this state. These are the results of the finding.
We found a deficiency or we didn’t find a deficiency and they keep you updated on it. Going on with it too. I do think that Tennessee does a pretty good job of responding to complaints. I think our ombudsman is a great resource if it doesn’t rise to the level of actually having legal recourse.
I think the ombudsman is a great resource for that too. And they will put you in touch with the people who can do something if it’s not them.
Schenk:
Great. Hannah, this has been extremely informative. I really appreciate you taking time to talk to me today. Thank you so much.
Garrett:
Great. Thank you for having me.
Schenk:
And folks, if you are looking to get in contact with Hannah because you have some questions for her about something that may be going on with your loved one in a nursing home in Tennessee you can go to their website, which is Higginsfirm. com, or you can shoot her an email at Hannah H A N A H At Higgins firm.com again, that’s Hannah at Higgins firm. Com.
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And new episodes so far every Monday. And with that, folks, we’ll see you next time. Thanks for tuning in to the Nursing Home Abuse podcast.
Nothing said on this podcast, either by the host or the guest, should be construed as legal or medical advice, nor is intended to create an attorney client relationship between the host or their guest and the listener. New episodes for now are available every other Monday on Spotify, apple Podcasts, or on your favorite podcast app, as well as on YouTube and our website, nursing home abuse podcast.com.
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