Assume that you are the attorney for Pine Acres Nursing Home. The administrator has approached you regarding the facility's obligations under federal Medicaid standards concerning two of the Home's residents.

One patient, Francis Scott, aged 88, has been a resident of the facility for a few months. Mr. Scott's mental and physical condition has been deteriorating slowly for several years and much more rapidly in the past year. His family placed him in the nursing home because they wanted him to be safe. They were concerned because he had often left his apartment and become totally lost on the way back. Mr. Scott's family always promptly pays the facility's monthly fee. Mr. Scott is angry about the placement, tends to be rude to staff, and insists on walking through the hallways and around the fenced-in grounds of the facility on his own. He has always been an early riser and likes to take his shower at the crack of dawn. He refuses to be assisted in showering by a nurses' aide. In addition, his friends from the old neighborhood like to visit. They like to play pinochle when they come, and they usually bring a six pack. 

Another patient, Emma Kaitz, has fallen twice, apparently while trying to get out of bed. The staff is very concerned that she will be hurt. The physician who is the medical director of the facility will write the order for restraints "as needed" for any resident upon the request of the director of nursing. Mrs. Kaitz's daughter is willing to try whatever the doctor advises. The staff have begun using bedrails to keep her in bed, but Mrs. Kaitz becomes agitated and cries. She says she feels like a dog when they pen her up. When she becomes agitated, she is given a sedative to help her relax, but it also tends to make her appear confused. To avoid the agitation as much as possible during the day, they have been able to position her wheelchair so that she can't get out by herself. She stops trying after a while and becomes so relaxed she nods off.

The administrator wants to know what she can do. What would you advise this administrator? Can he restrict the visiting hours for Mr. Scott? Can he require Mr. Scott to be assisted in the shower? Can Mr. Scott be transferred or discharged? Is the facility providing quality care for Mrs. Kaitz? How should the inspector treat Mr. Scott's and Mrs. Kaitz's complaints?

Answer rating: 100% (QA)

As the attorney for Pine Acres Nursing Home I would advise the administrator to take the following s... View the full answer