Standard of Care

Over time, several organizations, and laws were implemented to create specific nursing home standards. The Omnibus Budget Reconciliation Act of 1987 (OBRA) was created to address the care given by nursing homes. OBRA Regulations set out the following:

  • Each resident must receive the goods and services necessary to avoid physical harm, mental anguish . . .
  • Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care
  • The facility must ensure that the resident's environment remains as free of accident hazards as is possible
  • Each resident must receives adequate supervision and assistance devices to prevent accidents.
  • The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care.

The Joint Commission on Accreditation of Healthcare Organizations (JHACO) created standards for long term care including the following:

  • All reasonable steps should be taken to keep residents safe from accident and injury.
  • The organization should provide care, treatment, and services for each resident according to the plan of care, treatment, and services.
  • Residents have the right to be free from mental, physical...abuse, neglect...

The South Carolina DHEC set standards for licensing nursing homes in this state, including:

  • Reports and Records: (a) Accidents/Incident Reports: A record of each accident and/or incident, involving residents...occurring in the facility...shall be retained. Accidents/Incidents resulting in death or serious injury shall be reported in writing to the Division of Health Licensing within 10 days of occurrence. (b) Serious injuries shall be considered as,...fractures of major limbs or joints... (c) All accidents/incidents shall be reviewed, investigated if necessary and evaluated in accord with facility policy.
  • Employees: All persons assigned to the direct care of or service to residents shall be prepared through formal education or on-the-job training in the principles, policies, procedures and techniques involved so that the welfare of the residents shall be safeguarded.
  • In Service-training programs shall be planned and provided for all personnel to assure understanding of their duties and responsibilities. Records shall be maintained to reflect program content and individuals attending.

Finally, the American Nurses Association (Geriatric Nursing Resources for Older Adults) set out the following guidelines for preventing falls:

  • Evaluate patient for risk and attempt to eliminate those risks or prevent them from occurring (Fall Risk Assessment)...
  • Evaluate carefully for cause of fall and eliminate underlying cause. Once that is done implement appropriate interventions most likely to decrease future falls...
  • Consider technological devices for fall recognition and prevention using technology to augment, not replace care...

These are just a few of the specific standards relating to nursing homes. An underlying issue with analyzing the standard of care and the breach thereof, is whether the nursing home has "sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care."

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