LONG-TERM CARE
Posted by recep on March 26th, 2009Long-term care institutions have increasingly come under legal scrutiny, spurred primarily by exposes of neglectful and abusive care of vulnerable, often demented, elderly institutionalized patients. The nature and degree of abuse offended legal, moral, and civic sensibilities. This offense resulted in a framework of federal and state regulations that prescribe staffing patterns, record-keeping procedures, and many aspects of institutional practice. Increasingly, long-term care facilities are being challenged about policies that automatically provide life-sustaining treatment to unknowing patients with no provision for stopping such treatment. Yet, many of these facilities are afraid to adopt policies allowing a resident to die because they may be accused of neglect and abuse. Practitioners should be aware of developments as states struggle to define and regulate these decisions. The legal climate is crucial in discussions with patients and families about possible future care. Many long-term care facilities are adding information about future preference for care and resuscitation status to their postadmission discussions in response to the Patient Self-Determination Act and because of concern for legally supportable decisions.
Federal and state laws and regulations also govern long-term care financing (see also Chs. 110 and 114). Most long-term care is funded by Medicaid, the needs-based cooperative federal and state health reimbursement program. Very little long-term care is funded by Medicare, the age-based federal medical program for the elderly and for some persons with disabilities. Most elderly patients, couples, and families do not understand the complex rules that require spending their income and assets to a level of poverty before Medicaid will assume the cost of long-term care. In most states, legal advocates can protect a spouse living in the community from impoverishment by appealing to state regulations that permit segregation of funds. If such an arrangement is not possible, an attorney may file a suit for support in the Family Court or other appropriate state forum. Every state has a long-term care ombudsman whose office is funded by Medicare. These offices can provide information about some of the rights and protections available to residents of long-term care facilities.
Tags: LONG-TERM CARE
