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Care Planning for Residents of CCRCs: Know Your Rights!

By Lillian L. Hyatt, M.S.W. and a Resident of a CCRC

Excerpted from the Spring 2010 The CANHR Advocate newsletter

When a resident enters a skilled nursing facility, California law requires that the nursing home perform a comprehensive assessment of the resident’s health and physical condition and identify what type of assistance the resident needs. The assessment must be done within 7 days of admission and at least once a year thereafter. Within 7 days of completing the assessment, the nursing home must complete an initial care plan that addresses all of the resident’s needs and concerns. Care planning conferences are required to be held soon after admission and at least every three months to design and update the care plan. The resident, family members and/or representatives have the right to be invited and to be involved in each meeting. This is a great opportunity to make sure the care plan honors the resident’s choices about care, services, daily schedule and life in a nursing home.

Residents of Residential Care Facilities for the Elderly (RCFEs)/assisted living have similar rights in California. In addition to a pre-admission appraisal that evaluates a prospective resident’s functional capabilities, mental condition and social factors, the RCFE is required to meet with the resident, the resident’s family and/or representatives within two weeks after admission to develop a care plan. A reassessment and care plan revisions are required at least annually, or more frequently if there is a significant change in the resident’s condition.

Pre-admission assessments, frequent reappraisals and individualized care planning involving the resident, the resident’s family and the resident’s health care providers are important factors in ensuring that the resident receives the highest level of care in order to attain and maintain the resident’s optimal physical, mental and psychosocial well-being.

Unfortunately, residents of Continuing Care Retirement Facilities that offer long term life care, i.e., Assisted Living/RCFE and Skilled Nursing Home care, are often unaware of their rights when they are threatened with a transfer out of independent living into a higher level of care. CCRC residents should become familiar with their rights under Health and Safety Code §1788 – Provisions of Contract, required by California Law. Even when a resident of an independent living unit has significant medical needs due to mental illness, memory loss, or physical disabilities that would potentially justify the transfer to a higher level of care, California law provides important due process protections.

Before a CCRC can transfer a resident, the provider must involve the resident, the resident’s responsible person, and upon the resident’s request, the resident’s family members, physician or other appropriate health professionals in the assessment process that forms the basis for the level of transfer decision. Prior to sending any notice of transfer, the provider must conduct a care conference with the resident, the resident’s family members and health care professionals to explain the reason for the transfer. The law also includes important notice provisions, the right to review the transfer decision at a subsequent care conference and, for a disputed transfer decision, the right to a prompt and timely review by the Continuing Care Contracts Branch. These and other rights to contest a disputed transfer are required to be included in your CCRC contract.

I personally experienced the problem that the lack of information about your CCRC rights can pose. At age seventy-six, after living in my independent living apartment only a year, I developed a physical condition called Crico Phatengeal spasms. This condition required that I receive pureed and soft foods as a needed service from my CCRC kitchen. Since two doctors had certified this condition as required by law, that it was a medical necessity I felt confident that this service would be provided. However, CCRC informed me that I had to be moved out of my apartment to the SNF in order to receive proper service. I required no help with any activities of daily living. My contract and state law both assured me that this demand by the CCRC administration was unjust. The law stated that if it was a certified medical necessity it was my right to remain in my apartment. I had to hire an attorney at a $3,000 fee and puree my food for one year before I was given this service in my apartment. Apart from the financial burden, I was made most uncomfortable and anxious since I had to fight the very people who were supposed to be caring for me for the rest of my life.

Become familiar with your rights under California law and read the fine print of your CCRC contract to make sure they comply with the law. This will save you undue stress and enable you to live independly as long as possible. After all, this is why you chose a CCRC in the first place.

(Ms. Hyatt is a resident of a CCRC and AARP Policy Specialist on CCRCs)