Family guide
What families need to know inside a nursing home
Plain-English answers about care plans, the medical chart, who does what on staff, and the rules that protect residents.
Understanding care and the chart
Care plans, the MDS, medication and nursing records, and how to check on skin and safety.
- What is a nursing home care plan? A care plan is the facility's written plan for how it will meet a resident's needs.
- What happens at a nursing home care plan meeting, and how do I prepare? A care plan meeting is a sit-down with the team that cares for the resident, usually nursing, social work, dietary, therapy and activities, to review how the resident is doing and update the care plan.
- What is the MDS (Minimum Data Set) in a nursing home? The Minimum Data Set (MDS) is a detailed, standardized assessment that every Medicare- and Medicaid-certified nursing home must complete for each resident.
- What's in a nursing home chart? A guide to the medical record A nursing home chart is made up of many separate records, most of them now electronic.
- What is a MAR and TAR in a nursing home? The MAR, or medication administration record, lists every medication a resident is ordered and records each dose: the time, the nurse's initials, and a code if it was refused, held or not available.
- What are ADL flow sheets and CNA documentation? ADL flow sheets (also called CNA documentation or "point of care" records) are where nursing assistants record the hands-on care they give each shift: bathing, dressing, eating and how much of each meal was eaten, toileting and incontinence care, transfers, walking and turning and repositioning.
- What is the Braden Scale for pressure sore risk? The Braden Scale is a standard tool nurses use to estimate a resident's risk of developing a pressure injury (bedsore).
- Why do staff ask me to leave during changing, and how can I check for bedsores? Staff usually ask visitors to step out during bathing and changing to protect the resident's privacy and dignity, and sometimes a roommate's.
- Bedsore stages explained: what do stage 1, 2, 3 and 4 mean? Pressure injuries are staged by depth.
- Health care proxy, MOLST and DNR: what do they mean in a New York nursing home? A health care proxy names an agent to make medical decisions if the resident cannot.
Who's who in the nursing home
What each person does, who to ask about what, and who is responsible when something goes wrong.
- Who's who in a nursing home? Staff titles and roles explained A nursing home is run by a licensed administrator.
- What does a CNA do in a nursing home? A certified nursing assistant (CNA) provides most of the hands-on care a nursing home resident receives: bathing, dressing, grooming, help with eating and drinking, toileting and incontinence care, turning and repositioning, transfers and walking, and taking vital signs.
- What does the director of nursing (DON) do in a nursing home? The director of nursing (DON) is the registered nurse responsible for all nursing care in the facility.
- What does a nursing home administrator do? The nursing home administrator is the licensed manager responsible for running the entire facility: operations, budget, staffing levels, hiring, policies, regulatory compliance and responding to inspections and complaints.
- What does a nursing home social worker do? The social worker (often called "social services") helps residents and families with the non-medical side of nursing home life: admission, scheduling care plan meetings, family communication, emotional and behavioral needs, roommate issues, missing belongings, benefits such as Medicaid, grievances and discharge planning.
- RN, LPN and charge nurse: what is the difference in a nursing home? A registered nurse (RN) has the broadest training and is responsible for assessing residents, care planning and supervising.
- Who is the doctor in a nursing home, and how often must a resident be seen? Every resident has an attending physician, who may be assisted by a nurse practitioner or physician assistant.
- How many staff must a New York nursing home have? New York law requires nursing homes to provide an average of at least 3.5 hours of direct nursing care per resident per day, with at least 2.2 hours from certified nursing assistants and at least 1.1 hours from licensed nurses (RNs and LPNs).
Rights, problems and next steps
Restraints, notification, falls, weight loss, discharge, visiting and complaints.
- What is a restraint in a nursing home? A physical restraint is anything attached to or near a resident's body that the resident cannot easily remove and that limits movement or access to the body, such as a vest, lap belt, tray table or tucked sheets, and sometimes bed rails or a chair the resident cannot get out of.
- Are bed rails allowed in nursing homes? Bed rails are allowed only under conditions.
- Is my loved one being overmedicated? Antipsychotics in nursing homes Antipsychotic drugs such as quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa) and haloperidol (Haldol) carry an FDA boxed warning of increased risk of death in elderly people with dementia.
- When must a nursing home notify the family? A nursing home must immediately inform the resident, consult the resident's physician, and notify the resident's representative (such as the health care agent or a designated family member) when there is an accident that results in injury and has the potential to require a doctor's intervention, a significant change in physical, mental or psychosocial condition, a need to change treatment significantly, or a decision to transfer or discharge the resident..
- What should happen after a fall in a nursing home? After a fall, a nurse should immediately assess the resident for injury, including neurological checks if the resident hit his or her head or the fall was unwitnessed; notify the physician and the family; obtain any needed x-rays or hospital care; investigate how and why the fall happened; and update the care plan with new interventions to prevent another fall.
- How much weight loss in a nursing home is too much? Nursing homes generally treat as significant a weight loss of 5 percent in 30 days, 7.5 percent in 90 days or 10 percent in 180 days.
- Can a nursing home kick out a resident? Discharge rights in New York A nursing home may transfer or discharge a resident against the resident's wishes only for limited reasons: the facility cannot meet the resident's needs, the resident's health has improved, the resident endangers the safety or health of others, the resident has failed to pay after notice, or the facility is closing.
- What are the visiting rules in New York nursing homes? Residents have the right to receive the visitors they choose at the time they choose, subject to the resident's own wishes and reasonable clinical or safety restrictions.
- How do I make a complaint inside the nursing home? Every nursing home must have a grievance policy and a grievance official responsible for handling complaints.
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