22 July 2009 at 2:52:09 PM
Do Medicare laws/policies, etc trump local laws? I would think that they would, but only if the local entity that is receiving any type of Medicare payment or support follows and participates in those rules. For example, in a different venue, I know that the No Child Left Behind laws require certain things but only if public schools choose to accept federal funding (I'm assuming public schools theoretically could opt out, but that if they do take the money, they have to follow NCLB.)
The reason I ask this is that I've seen a manual on the Centers for Medicare & Medicaid Services site that is entitled R48SOMA Revisions to Appendix PP, "";Guidance to Surveyors of Long Term Care Facilities""; (PDF direct link here) Starting on page 4 of what is clearly an appendix revision is the section "Access and Visitation Rights" (for nursing homes/long term care facilities). In this section some details about who can visit a resident in a nursing home are spelled out. For example:
vii) Subject to the resident’s right to deny or withdraw consent at any time, immediatefamily or other relatives of the resident; and
(viii) Subject to reasonable restrictions and the resident’s right to deny or withdraw consent at any time, others who are visiting with the consent of the resident.
and from page 4
Immediate family or other relatives are not subject to visiting hour limitations or other restrictions not imposed by the resident. Likewise, facilities must provide 24-hour access to other non-relative visitors who are visiting with the consent of the resident. These other visitors are subject to “reasonable restrictions” according to the regulatory language. “Reasonable restrictions” are those imposed by the facility that protect the security of all the facility’s residents, such as keeping the facility locked at night; denying access or providing limited and supervised access to a visitor if that individual has been found to be abusing, exploiting, or coercing a resident; denying access to a visitor who has been found to have been committing criminal acts such as theft; or denying access to visitors who are inebriated and disruptive. The facility may change the location of visits to assist care giving or protect the privacy of other residents, if these visitation rights infringe upon the rights of other residents in the facility. For
example, a resident’s family visits in the late evening, which prevents the resident’s roommate from sleeping. An individual or representative of an agency that provides health, social, legal, or other services to the resident has the right of “reasonable access” to the resident, which means that the facility may establish guidelines regarding the circumstances of the visit, such as location. If there are problems with the facility’s provision of reasonable privacy for resident to meet with these representatives, refer to §483.10(e), Privacy and Confidentiality, Tag F164.
Very interesting. So even people who are not relatives have the right to visit, within reasonable limits, those who reside in a nursing home. That fits with my own experience. I haven't done so lately but I used to visit with people in another town I lived in, and I was not kin to anyone there.
I do wonder about one clause, however, and have called in to ask Medicare how it should be interpreted, that is, what standard of proof ought one to have to know if one is abusing, exploiting or coercing a resident. Seems like one would have to have something beyond just someone's word. For example, what prevents one from arbitraily preventing, say, an ex-spouse from visiting, on what appears to be retaliatory grounds? Look at page 1 of this denial of approved visitation.- Because Susan McLendon reported some disturbing injuries she perceived to be with her son to the sheriff's department (and actually, a deputy from the sheriff's department went with her previously during that complaint and took photos), the father apparently thought it was inappropriate for a mother to have concerns about injuries to her son. He said "Due to these accusations, you have put Luke's healthcare at risk. Also putting Luke through, yet another unfounded, unnecessary physical. " The paragraph previous to this he cancelled her visitation, even though he had a full week to suggest another security person she could bring with her, since the sheriff's department decided not to be involved.
Now, my thought on the Medicare situation is that I would hope one would not be denied visitation because, capriciously, the guardian didn't like the mother's solcitude for her son and decided to up and cancel it. So I'm curious to know exactly what, in the regulations from the manual, spell out "found to be".
Will update when I get back a reply.
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