I guess when it comes to elder care, many problems encountered by residents in U.S. nursing homes sadly seem to make their way across the border to our friends in Canada. The recent news report of an elderly Canadian nursing home resident who fell and fractured her hip-- yet sat for days without medical attention or adequate pain medication is an unfortunate story unnecessarily repeated on a daily basis at nursing homes across the world.

In the U.S., upon learning of a fall or other injury, the nursing home staff must conduct an assessment to ensure no injury was sustained.  In cases where there is an apparent injury, the staff physician should alerted immediately as to the incident.

Once a physical assessment has been completed, federal law requires nursing homes to provide pain medication to the resident as soon as feasible.  As recipients of Medicare funding (the overwhelming majority of nursing homes) must comply with F-Tag 309 pertaining to Quality of Care:

Each resident must receive and the facility shall provide the necessary care and services to attain or maintain the highest practiceable physical, mental and psychological well-being, in accordance with the comprehensive assessment and plan of care.

Although the above language can be generally interpreted to included pain management for nursing home patients, CMS has proposed interpretative guidelines that undeniably require nursing homes to provide sufficient pain management:

Recognition and Management of Pain

In order to help a resident attain or maintain his highest practiceable level of well-being and to prevent or manage pain, to the extent possible, the facility:

• Recognizes when the resident is experiencing pain and identified circumstances when pain can be anticipated;
• Evaluates the existing pain and cause, to the extent possible; and
• Manages or prevent pain to the extent possible, consistent with eh resident's goals, the comprehensive assessment and plan of care and current clinical standards of practice.

Unfortunately, many nursing home residents needlessly suffer from acute (falls) and chronic medical conditions (pressure sores) due to facilities failure to properly follow CMS regulations.  On the surface, this omission may simply be a violation-- but when a resident sits without medical attention with a broken hip or open wound these violations represent a complete lack of compassion and destruction of the quality of life.

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