Know rights, pro­tec­tions in a nursing home

The Kent Island Bay Times - - Senior Satellite -

Nursing homes, now more com­monly known as Skilled Nursing Fa­cil­i­ties (SNFs), serve as li­censed health­care res­i­dences for in­di­vid­u­als who re­quire a higher level of med­i­cal care than can be pro­vided in an as­sisted liv­ing fa­cil­ity or at home. Res­i­dents in a Medi­care and/or Med­i­caid-cer­ti­fied nursing home have cer­tain rights and pro­tec­tions un­der fed­eral and state law. These rights and pro­tec­tions help make sure you get the care and ser­vices you need. You have the right to be in­formed, make your own de­ci­sions, and have your per­sonal in­for­ma­tion kept pri­vate.

The nursing home must tell you about these rights and ex­plain them in writ­ing in a lan­guage you un­der­stand. They must also ex­plain in writ­ing:

• How you should act while you’re in the nursing home

• What you’re re­spon­si­ble for while you’re in the nursing home

This must be done be­fore or at the time you’re ad­mit­ted, as well as dur­ing your stay. You must ac­knowl­edge in writ­ing that you re­ceived this in­for­ma­tion.

At a min­i­mum, fed­eral law states that a nursing home must pro­tect and pro­mote the rights of each res­i­dent. You have guar­an­teed rights and pro­tec­tions as a per­son with Medi­care. These Medi­care rights in­clude:

Be treated with dig­nity and re­spect at all times; Be pro­tected from dis­crim­i­na­tion; Have your per­sonal and health in­for­ma­tion kept pri­vate; Get in­for­ma­tion in a way you un­der­stand from Medi­care, health care providers, and, un­der cer­tain cir­cum­stances, con­trac­tors.

Get un­der­stand­able in­for­ma­tion about Medi­care to help you make health care de­ci­sions, in­clud­ing: What’s cov­ered, What Medi­care pays; How much you have to pay and What to do if you want to file a com­plaint or ap­peal. You have the right to have your ques­tions about Medi­care an­swered; Have ac­cess to doc­tors, spe­cial­ists, and hos­pi­tals; Learn about your treat­ment choices in clear lan­guage that you can un­der­stand, and par­tic­i­pate in treat­ment de­ci­sions; Get health care ser­vices in a lan­guage you un­der­stand and in a cul­tur­all­y­sen­si­tive way; Get Medi­care-cov­ered ser­vices in an emer­gency; Get a de­ci­sion about health care pay­ment, cov­er­age of ser­vices, or pre­scrip­tion drug cov­er­age.

When a claim is filed, you get a no­tice let­ting you know what will and won’t be cov­ered. The no­tice may come from Medi­care, your Medi­care Ad­van­tage Plan (Part C), your other Medi­care health plan or your Medi­care Pre­scrip­tion Drug Plan (Part D). If you dis­agree with the de­ci­sion of your claim, you have the right to file an ap­peal; Re­quest a re­view (ap­peal) of cer­tain de­ci­sions about health care pay­ment, cov­er­age of ser­vices, or pre­scrip­tion drug cov­er­age. If you dis­agree with a de­ci­sion about your claims or ser­vices, you have the right to ap­peal and file com­plaints (some­times called “griev­ances”), in­clud­ing com­plaints about the qual­ity of your care.

In ad­di­tion, your rights as a nursing home res­i­dent in­clude the right to:

Be free from dis­crim­i­na­tion; Be free from abuse and ne­glect; Ex­er­cise your rights as a U.S. cit­i­zen; Have your per­sonal rep­re­sen­ta­tive no­ti­fied; Get proper med­i­cal care; Be treated with re­spect; Be free from re­straints; Have pro­tec­tions against in­vol­un­tary trans­fer or dis­charge; Par­tic­i­pate in ac­tiv­i­ties; Spend time with vis­i­tors; Form or par­tic­i­pate in res­i­dent groups; Man­age your money; Get in­for­ma­tion on ser­vices and fees; Get proper pri­vacy, prop­erty, and liv­ing ar­range­ments; Make com­plaints.

Mike Zim­mer is pres­i­dent of Bay State In­sur­ance Agency Ltd. in Cen­tre­ville. He is avail­able to an­swer your ques­tions or speak to your groups re­gard­ing Medi­care, Medi­care Ad­van­tage, Medi­care Sup­ple­ments, Medi­care Part D (Pre­scrip­tion Plans) and Home Health Care In­dem­nity Plans. He may be reached at 410-758-1680.

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