Families are the safeguard for their loved ones who cannot protect themselves.

What You Can Do

The Sentry Box

Mixed Media on Canvas by Carol J. Hay

Families can learn about their loved one, the nursing home, and the regulations, to equip themselves to be advocates for services that will provide the best practicable quality of life for their loved ones in nursing homes.

1. Stay involved with your family member after s/he is placed in the nursing facility. Visit. Learn the plan of care, and make sure it meets your loved one’s needs. Provide information to staff that will help the plan of care to be complete and meaningful. Communicate regularly with your family member’s social worker.

2. Observe your surroundings when you visit the facility: your loved one, other residents, the building, the staff. Note anything good, and let the staff know. Note anything that doesn’t seem right. Look for “trends” – more than one occurrence of that thing.

3. Ask questions of the staff, and work with them if you see anything that needs attention, even if it is not a trend. If not addressed, it could become one.

4. Become familiar with the facility policies and state regulations that apply so that you know what should be happening. Identify specific problems or violations that exist and talk with management staff.

5. Approach the facility administration, and then the corporate leadership if those violations or problems persist. Cite the policies and regulations that are in violation, and give examples of your observations and efforts to work with staff to correct them. Make notes for yourself so that you will be thorough and accurate when you approach these officials.

6. If these efforts fail, the state regulatory agency has a complaint reporting process. They will need the information you have in writing (you should already have it from following steps 1-5 above), and they will refer you to the agency staff who takes reports of complaints or violations.

7. The regulating agency will determine whether investigation is warranted. Follow up with the regulatory agency after they have completed an investigation, to learn what they found and what to expect the facility to do in response to the investigation.

Ideally, you should not have to go beyond step 4. If you know what should be happening, understand the policies and regulations, and work with staff, you should be able to resolve most issues. We have included steps 5 – 7 because there are a small number of cases in which they may be needed.  

8. Many facilities have Family Councils, organized to provide families with a voice and a venue to discuss, learn, and interact with the facility administration on behalf of all residents and their families. Often these Councils also occasionally conduct special activities for residents. You may want to become involved with the Family Council if your loved one’s facility has such a group. If not, you may want to advocate for the establishment of a Family Council.

9.  Each state has a Long-Term Care Ombudsman program to assist consumers in advocating to resolve individual issues of quality of care.  You can find your state’s Ombudsman HERE.  These programs vary in structure and scope, so ask: “Are you independent, or are you a part of a governmental agency?” and “Do you take cases in (assisted living / in-home care / day services, etc.)?”  Some states serve only nursing facilities, while others serve any setting.  If the program falls under a governmental agency, and the facility in question is government-affiliated in any way (funding, ownership, etc.), you will need to be alert for any potential conflict of interest.

Exception: Abuse and neglect concerns are not discussed here. Those concerns are more serious and should be handled according to your state’s laws of reporting. Every facility must post those laws clearly. The Code of Federal Regulations, 42CFR488.301, defines abuse, neglect, and misappropriation of property as follows: 

Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.

Neglect means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. 

Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent.