Assisted Living - Monitoring Care/The Bill of Rights/Problem Resolution

As we assist our loved one into assisted living, we trust our loved one to the care of others. When we effect this permanent change, the authors feel that it is the responsibility of the family to be aware and comfortable, at all times, that their loved one is in a safe and healthy environment which provides the compassionate care and competent treatment they need.

Monitoring the care of your loved one is not meant to impinge, in any way, on the abilities, diligence, competence, motives or performance of assisted living providers. In fact, our experience of touring hundreds of residences all over the country, and meeting hundreds of providers over the years, has brought us to know that they are professional, caring and extremely capable. The family should rightfully assume that the staff is competent and compassionate, based on the families' earlier due diligence to select the right home. Staff personnel are, however, human.

In our experience, most providers welcome the involvement of the family, and their help in monitoring the well-being of their loved one. The attitude and approach of the family are very important considerations in this matter. You should not feel as if the provider is an enemy. They have the same goals for your loved one as you do.

Your monitoring and problem solving should be characterized as respectful and constructive.

Monitoring Care:

Around the time of admission into an assisted living home, the Resident Manager and staff will create a care plan specifically for the new resident. This plan is a record of the care and services to be provided daily and weekly while your loved one is living in their new residence. It is normally updated every 6 months, or as needed. This plan should be signed by the family members.

The care plan should be generated from the contents of the geriatric evaluation that was performed very early in the relocation process. The care plan will outline the services to be provided to your loved one and the frequency of them. It will further discuss the goals of maintaining and increasing the physical and mental abilities of your loved one. The plan should additionally outline opportunities for socialization and appropriate recreation for your loved one. You should expect the plan to be followed. A lack of adherence to the care plan can be an area of disagreement. Assistance with bathing, the food being served and the activities being offered can also be issues about which the assisted living providers and families may differ.

You can easily check on a number of common sense things for your loved one. First, weigh your loved one every week. Keep track of the results. Weight changes should be an alarm bell to your family. Find out why this is happening. This is not necessarily an indication of a problem with the residence, but it is a problem that should be addressed. It may be the food, the new surroundings, new neighbors or many other things that disturb your loved one's diet. Of course, it may be a health issue with your loved one. Finding the answer is one of the jobs for your family in keeping your loved one safe and healthy. Second, does your loved one appear well dressed and well groomed? Do they have any bruises or sores that need attention? How did they get them? How long have they had them? Is it noted in the resident records? Is it being treated?

Third, is the living unit clean and well organized? Cleanliness is a sign of a well run home. Uncleanliness is a sign of a poorly run home.

Fourth, find out from the staff how your loved one spends their time when you are not there. Do they socialize or stay in their unit? Do they attend all meals? Do they appear happy or anxious? Do they participate in the activity program? Do they have a best friend? Being aware of your loved one's social environment helps your family know how well your loved one is acclimating to their new home. It also gives you an idea of their quality of life.

Nothing is better for your loved one than visiting them. You can increase the quality of life of your loved one while you are quietly monitoring their health and care at their new home. Each visit will allow you to observe the people and procedures in the residence, as well as their direct effect on your loved one.

Assisted Living and the Bill of Rights

When we help relocate our loved one into assisted living, we place their care and well-being in the hands of others. We have a continuing responsibility to monitor the situation to protect our loved one from neglect, poor care and/or unacceptable treatment. What do we look for? Where are problems likely? What care and treatment expectations should we have for our loved one?

As a provider, as a caregiver for a loved one, or as a patient, it is important to realize that we all have rights. We all know that we enjoy protections under the Bill of Rights in the Constitution. These rights establish protections for us and limit governmental actions against our best interests. These rights may be more broadly classified as rights bestowed on us as citizens of the United States. There are other bills of rights, however. Bills which establish protections for us as patients in a hospital, bills which protect us as consumers of insurance policies, bills which protect us as mental health patients, bills which protect us as hospice care residents and bills for protecting residents in assisted living. Further, many of the bills above differ as each state may have their own. There are many similarities between all of these differing bills of rights.

As an example, Minnesota and other states have written bills of rights especially for assisted living residents. The legislated Minnesota plan [Minnesota Statutes Chapter 144G] involves the following general considerations for their resident bill.

  1. You have the right to be informed that you have rights, before you receive services.
  2. You have the right to know about the services you will receive before you receive them.
  3. You have the right to know what will be covered by insurance and what will be paid by the patient.
  4. You have the right to know what services the provider can and cannot provide.
  5. Before you receive services, you have the right to know the grounds for the provider to terminate providing services.
  6. You have the right to choose plans and providers.
  7. You have the right to a current care plan.
  8. You have the right to participate in planning your care.
  9. You have the right to assess the care you are receiving and to ask for changes.
  10. You have the right to be told of any changes in your care.
  11. You have the right to refuse services or treatment.
  12. You have the right to privacy.
  13. You have the right to access your records.
  14. You have the right to receive care from qualified caregivers.
  15. You have the right to be treated with courtesy, dignity and respect.
  16. You have the right to be told of any changes to your service fees.
  17. You have the right to be given notice before services are discontinued.
  18. You have the right to a coordinated transfer to a new residence.
  19. You have the right to voice complaints.
  20. You have the right to know how to file a complaint.
  21. You have the right to file a complaint without fear of retaliation.

As you can see, there can be many factors that could be included in a bill of rights.

Certain generalities can be made, however. The recurring protections that assisted living bills have are:

  • Disclosure of everything, including services, fees, changes, care plans and rights.
  • The right to participation in all decisions, treatment and care activities.
  • The right to be treated fairly with courtesy, dignity and respect.
  • The right to confidentiality.
  • The right to pursue a grievance without fear of retaliation.

Ask all assisted living residences for their bill of rights when you tour potential homes for your loved one. The bill of rights and the care plan created for your loved one are the key items in directing the care and treatment of your loved one. Knowing what is in both will greatly assist you in protecting your loved one while they reside in assisted living. Knowledge is power and compassion.

When, however, a problem arises, consider following this procedure.

Problem Resolution:

The severity and type of the problem determines whether you should leave your loved one in the home while the problem is being resolved. Abuse and neglect are problems that affect the very safety of your loved one, and would require immediate removal of your loved one.

Put all serious complaints in writing, retaining your own copy. This will document the issue and provide a history of events over time.

Involve the Resident Manager. No one is more important to the satisfactory resolution of the problem.

If there is no satisfactory resolution to the problem or problems, you should proceed within the organization to a higher level of management, normally to a regional manager who controls multiple residences, or to the owner of the home if the organization is smaller.

If, however, you still cannot resolve the issue, the regulating agency in that state has staff to address these issues. The management of the assisted living residence can give you the contacts and their phone numbers. Calls to the regulators will bring a prompt response.