Guest Blog Post By Attorney Lauren Ellerman: 10 Ways to Get Better Care For Your Loved One In A Virginia Long-Term Care Facility

The "drumbeat" we are hearing from Virginia families is the following:

“The care my husband received before COVID wasn’t great, but it was nowhere near as bad as the care he is receiving now.” The care is bad.

“The hospital said he needed rehab, and we felt we had no choice. Who knew rehab would be such a horrible experience?” We hoped rehab would be better.

Just yesterday, I spoke with a local woman who felt bullied by a nursing home physician to place her husband on medication she knew he didn’t need, because it would make him an easier patient for a long-term care facility. The doctors didn’t trust that I knew my husband’s needs.

Stated simply – no one wants to place their loved ones in long-term care, even for a short time. It is a choice of last resort, and for good reason. Faculties in Virginia have no current staffing requirement.  [1] The typical resident currently receives less than two hours of care a day out of twenty-four hours. Most of that care is being provided by a Certified Nursing Assistant, who is likely over-worked, under-paid, under-trained and under-valued.[2]

Sadly – it is a broken system, but one many families do not have the luxury of avoiding. As such, we often yield calls from families who don’t want to sue the facility caring for their loved one (point of fact, no one really calls our office wanting to sue) they just want help getting better care.           

There are 10 ways to get better care for your loved one in a Virginia Long-Term Care Facility As such, here are the strategies we advise families to consider, and attempt to get better care:

1. 1. Research the facility before
   2. Make sure you are the Power of Attorney and/or Responsible Party
   3. Be organized – take notes
   4. Attend Care plan meetings
   5. Connect with the physician staff early on
   6. If possible, maintain relationships with outside doctors
   7. Share concerns / complaints in writing – ask for follow up
   8. Visit as much as possible
   9. Request policies and procedures – and READ THEM
   10. Work with the care team, never against

1. Research the facility before: Medicare.gov has a wonderful online tool that allows you to compare local facilities, and offers details on facility ownership. [3] Ownership matters. A Local nonprofit (church affiliated facility) is likely to provide more patient care hours, than a facility owned by a New York hedge Fund or Venture Capital Firm that invests in healthcare to sweep the profits away. Research and understand the ownership structure of the facility before you chose one for your loved one. A quick visit to medicare.gov only takes 30 minutes online and should be part of your decision-making process (not just location).

2. Make sure you are the Power of Attorney and or Responsible Party: Having a medical power of attorney allows you to speak to nursing home staff about your loved one and their care needs. Without it, you want to be appointed “responsible party” – so you can still be involved in decisions. Without either, and you have no legal right to any information, or to be involved in decisions. Ask to see how the facility has recorded your involvement on admission and in the chart. Are you Mr. Smith’s POA and/or Responsible Party? Good. If neither, and you can expect no information from the facility and no real right to be involved in care. 

3. Be organized – take notes: Don’t take notes because you think you may have a lawsuit someday. Take notes to help advocate with and to the care team for better care. "Did they say they would order a lab on Tuesday, results would be back Thursday?" Write that down and follow up on Thursday as to the results. When understaffing occurs, balls get dropped. Tests are not completed, labs missed, symptoms not followed up on. But if you join in the care team as an observer, and someone seeking follow up – that always helps.

4. Attend Care plan meetings: A care plan, is a specific map to care for your loved one. It is a written document (You should ask for a copy 30 days after admission) and attend all meetings wherein the care plan is discussed and modified. Is your loved one a fall risk? The care plan should state what interventions are in place to prevent falls. You want to know what staff is supposed to be doing, so you can help them NOT forget to provide this care.

5. Connect with the physician staff early on: Unless you are in the facility 6am to 8am, and wait by the front door, you won’t see the facility attending physician. They only have to see your loved one every 30 days for the first 90 days, and thereafter every 60 days. Most visits are quick, and when your loved one is still in bed or asleep. You aren’t involved or connected with the MD – unless you request to be early on. Ask for the doctor’s name, practice number and ask to attend all examinations. Ask questions. Share details about your loved one and their medical history. Kindly demand their attention and time. If a nurse says “we will let the doctor know” – you call the doctor to ask the plan, don’t rely on the revolving nursing staff to communicate with the doctors. That won’t be enough to get good care.

The doctor is not a nursing home staff member – they are outsourced, but they control all medications and orders. Become involved with them as much as possible, by getting to know them. Of late, the doctor may be very uninvolved and defer to their Nurse Practitioners and Physician Assistants to do most of the work. If that is the case, get to know them too.

 6. If possible, maintain relationships with outside doctors: Did your loved one have a wonderful primary care physician before the nursing home admission? An excellent cardiologist or nephrologist? Maintain good communication with those specialists. Insist on appointments and take nursing home physician orders with you to these appointments if you have concerns. In the almost 20 years I have been doing nursing home litigation, other than wound care, I have never seen a nursing home physician reach out to and consult with a patient’s consulting physicians. It isn’t done – so you do it. You be the information bridge to help guarantee some continuity of care.

 7. Share concerns/complaints in writing – ask for follow-up: If it’s not in writing – it didn’t happen in a nursing home. That means complaints, following up with changes in care plans, etc., should all be in writing. You can (a) email the Administrator with these issues to document them; and or (b) write a good old fashioned fax to be kept in the patient chart. Either way, if you asked the nurses 10 times for your loved one to get a shower, and there is no documentation from you about that, then it didn’t happen.

8. Visit as much as possible: Squeaky wheel gets the oil. Also, a patient who gets more visitors, gets better care. WHY? Because loved ones see more and ask more questions. It’s simple. If you visit often, you can see the small changes that need addressing. Also, if a facility is understaffing (and trust me, they all are) you want additional eyes on your loved one for their own health and safety.

9. Request policies and procedures – and READ THEM: By law, a nursing home must have written policies on many different subjects regarding patient care. [4] And by law, Policies shall be made available for review, upon request, to residents and their designated representatives. REQUEST to review the policies that relate to your loved one's care. WHY? So you can know what care is supposed to be provided regarding your loved one.

10. Work with the care team, never against: I truly understand how hard it is to have a loved one with chronic medical needs. I also understand how hard it is not to be filled with frustration, or anger, when a third party fails to provide the care they are contracted and legally bound to provide. BUT, as the goal is better patient care, try not to make the staff your enemy. Threats of lawyers and litigation don’t help – and don’t lead to better care. Blame games do not lead to better care. Working with the care team leads to better care.

We know that being a caregiver isn’t easy. Sadly, it doesn’t get much easier when your loved one is moved into a facility for short-term, or long-term care. It just changes your role from care giver, to care coordinator. Be an organized advocate for your loved one, and we hope you will NEVER need our services after the fact. [5]

Thanks go out to Lauren Ellerman with the Frith & Ellerman law firm for this insightful article!

Did you know that the Estate & Elder Law Center of Southside Virginia, PLLC can help your family when a loved one needs long-term care in the nursing home?  Let's discuss how we can help! If you or a loved one are concerned about estate planning or other elder law matters including Asset Protection/Medicaid Planning or have questions regarding long-term care in the nursing home, reach out to us!  Book a call with us on our website: www.VAElderLaw.com to get started. We have offices in Bassett, Danville and Lynchburg to serve you!

Footnotes and Article References:

[1] 2023 General Assembly passed a minimum staffing requirement for Virginia Nursing homes, but it doesn’t go into effect until 2025;  https://richmond.com/news/state-and-regional/govt-and-politics/virginia-general-assembly-backs-minimum-staffing-for-nursing-homes/article_19604f7c-ad5f-11ed-8825-df97a00c4327.html.

[2] https://www.nytimes.com/2021/08/12/opinion/nurses-understaffing-covid.html

[3] https://www.medicare.gov/care-compare/?providerType=NursingHome&redirect=true

[4] https://law.lis.virginia.gov/admincode/title12/agency5/chapter371/section140/

[5] Frith & Ellerman represents families in wrongful death, and negligence cases against Virginia physicians, hospitals and nursing homes when their bad care causes permanent injury.