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Nursing Homes - Individualized Personal Health Care Plans
By: Dennis M. Seaman, Attorney

Dennis Seaman & Associates

According to national statistics, 60% of all Americans at some time in their life will require some type of continuous health care. The average stay in a nursing home is three years.

One of my greatest fears is spending the remainder of my existence either in a vegetative state on a life supporting machine or being in a nursing home, drugged up, and placed in front of a television playing cartoons all day.

Citizens don't realize that they have it within their power to prevent such unpleasantries through the use of ADVANCE DIRECTIVES.

Most of us would say what are Advance Directives? They are the documents that would prevent such nightmares from occurring. Without them, the person who is about to become a patient or resident will not have the legal representation necessary should they become ill enough to require the assistance that Advance Directives provide.

In Ohio, Advance Care Directives consist of two different forms: the Living Will, and the Durable Power of Attorney. The Living Will is what allows you to state your exact wishes for life-sustaining measures, in the event that a time comes when you are unable to state them, usually due to a terminal condition and/or permanently unconscious state. This diagnosis would be made by your own physician and one other to determine that it is time to invoke the living will.

The Health Care Power of Attorney is also used when you are unable to make decisions for yourself. However, this is a document where you have assigned someone to speak in your place if you are unable to. This usually comes into play with someone who no longer has the capacity to make an informed decision due to an illness such as Alzheimer's or a stroke that incapacitates a person.

The assigned person becomes your agent and your physician will discuss all treatments with your agent on your behalf. The Health Care Power of Attorney also includes a section that allows your agent to refuse or stop any artificial means of life support, such as nutrition or hydration.

These forms are not just for the elderly. Unfortunately, there are many younger people who are living in nursing homes or at home with Home Health Care assistance, who have been victims of a tragic accident or have become seriously ill. Neither parents nor children have any idea what their children or parents would do.

Remember the pain and suffering caused to the family of Terry Schiavo because there was no written documentation of her desires? The truth be told, most people do not want to discuss the potential of no longer being able to care for themselves or speak for themselves regarding care.

Worse than being hooked up to a machine while unconscious is to be somewhat aware of the prison-like conditions in which one may find himself in a nursing home. However, there is also a mechanism to insure a patient's right to live with dignity. People have the right to create and enforce their own individualized HEALTH CARE PLAN. These plans are written by registered nurses who are supervised by attorneys.

The Federal government has mandated that a plan of care be created for every person admitted to a health care service, such as a hospital, nursing home, or home health care. In addition, this plan of care must be personalized to each individual's needs.

In an ideal world, your Care Plan would be specific to your personal daily needs and the quality of your life would be maximized during your stay. Realistically, most Care Plans prepared by a nursing home are basically the same. If Mrs. Jones falls and breaks a hip, her Care Plan in the hospital and subsequent rehab unit will read almost identical to Mr. Smith, who arrived a week prior to her.

Actual Case

Mr. Smith refused to sleep at night. He was in a rehabilitation unit of a nursing home and had progressed to being up with a walker. He refused to sleep at night, and kept getting up and walking in the hall with his walker. Originally, the plan was to send him back to his apartment, where he was independent prior to his fall and fractured hip repair.

The night shift nurses and the doctor (who has been randomly assigned to Mr. Smith on admission) were concerned that he may fall and they thought he had his nights and days mixed up. He had difficulty expressing himself due to a past stroke and was unable to tell the staff why he preferred to stay up at night and sleep days. The physician gave orders for a sleeping pill.

Not accustomed to taking sleeping medication, Mr. Smith slept like a baby. He slept so soundly that he woke up with a wet bed, making him upset and agitated. The day shift observed this change in his behavior and felt a psychiatric consult was in order. Observing Mr. Smith in his agitated state, the psychiatrist added an anti-anxiety medication. His family was upset over the change in his behavior. They felt he had declined so they accepted the recommended treatment

Within two weeks of admission to the rehab unit, Mr. Smith was now incontinent of urine most of the time, incontinent of bowel at times, and wasn't eating as well as usual because he was too tired during the day. His participation in physical therapy declined as well. At this point, the physician talked with the family about possible long-term placement in the nursing home rather than the original plan that would have sent him home to his own apartment.

What is wrong with this picture? Mr. Smith was completely independent, healing and rehabbing well, and now he was incontinent, sleepy and agitated at times, and no longer using his walker like he should. He has become a high falls risk, at the least. The sad part of the story is that Mr. Smith was a night watchman for over 40 years, and no one ever learned that part of his history.

If that information had been made available, he never would have received that sleeping medication or the anti-anxiety medication and would have progressed and probably gone home.

This story is actually true. The outcome would have been much more positive and the quality of life much higher if the staff were aware of Mr. Smith's personal information and needs. He is only one person of thousands who are living in nursing homes today, most of whom are not receiving the personalized care that is government mandated.

Personalized Care Plans

Care plans should include demographic information as well as contact information for relatives and friends who can provide insight to caregivers. When done in advance, customized care plans can include this information, along with personal preferences for bathing, washing, sleeping, and activities.

Perhaps a person in the early stage of Alzheimer's had done a great deal of traveling in younger years. In that case, knowing the places he had traveled to would be helpful in reminiscing and slowing down the loss of memory. Pictures of places he had been would be a source of pleasure as well as interest. A good activities therapist would be able to plan activities accordingly for this Alzheimer's patient.

The bottom line is that at some point in life, the chances are high that every person will require medical care in a hospital, nursing home, or at home with home health care. Doesn't it make sense to write your own plan of care ahead of time and help ensure that your values and personal needs will be addressed and respected, along with your medical needs?

Whether you are 30 or 60, no one knows better than you what is important to you and how you want to be cared for. In addition, the forms can be updated annually or as needed.

By completing an Advanced Care Plan, Living Will, and Durable Health Care Power of Attorney, your needs and wishes will be clearly defined to any caregiver. All are legal documents that become a part of your medical chart in any health care setting.

Do your loved ones, and most importantly yourself, a favor and complete these forms before you need these directives and aren't able to do so. There is no better gift you can give yourself and your loved one than quality of life when care by others is required.

For information on how to obtain a personal health care plan call me at 216-696-1080 or contact me at DMS@SeamanAtty.com

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