Chiziviso Chekudzingwa kweNzvimbo Yekugara Inobatsirwa kana Kuvharwa Kwepakarepo¶

Kugamuchira chiziviso chemazuva makumi matatu chekudzingwa kubva kunzvimbo yekugara yakabatsirwa (ALF), imba yekugara, kana ndangariro yekuchengetedza nzvimbo, kana kudzidza kuti nzvimbo iyi iri kuvharika nekuda kwekubhuroka, kubvisirwa rezinesi, kana kugashira, zvinogadzira dambudziko rekugara nekukurumidza kune akura. Kusiyana nemitemo yepamba inochengeterwa vakoti, iyo inomisikidza kodzero dzekubvisa kukwidza munyika yose, nzvimbo dzekugara dzinobatsirwa dzinonyanya kudzorwa mudunhu, purovhinzi, kana kanzuru kuburikidza nekupindirana kwemitemo yemarezinesi ehutano uye mitemo yedzimba dzevaridzi. Zvivakwa zvinowanzoshandisa gaka iri nekuudza mhuri kuti mugari "achembera" padanho ravo rekuchengeta, anoratidza kushushikana kwepfungwa, kana kuti haakwanise kudzoka kubva kuchipatara zvakanyanya, achida kuti mhuri irongedze mukamuri mukati memazuva.

Haufanire kutamisa mudiwa wako kunze kwenzvimbo yenguva, uye nzvimbo haigone kuvharira mugari kunze, kurongedza zvinhu zvavo mukoridho, kana kuvasiya kudhipatimendi rekukurumidzira muchipatara pasina kuteedzera kudzingwa kwemutemo uye nzira dzekuburitsa. Kunyangwe iwe uri kurwisa zvisirizvo zvemazuva makumi matatu "level of care" chiziviso, kupokana kuramba kudzoserwa mushure mekugara muchipatara, kana kubata kuvharwa kwekuvaka kwechivako, kutora matanho epamutemo uye ekiriniki anochengetedza nhengo yemhuri yako uye yakachengetedzwa iwe uchikwikwidza chiziviso kana kuchengetedza shanduko yakachengeteka.

Ita izvi ikozvino¶

1. *Chengetedza mugari mufurati yavo uye usasaine chero chibvumirano chekuzvidira chekubuda. Udza Executive Director uye Director weNursing nekunyora kuti: "Hatibvumi kuburitswa uku, uye isu hatisi kuzobvisa mugari kunze kusvikira ongororo yemutemo yapera uye imwe nzvimbo yakachengeteka, ine mishonga yakachengetedzwa." Usambosaina nguva yeziviso yeawedzero yekubvisa kana kubvuma kuenda nekuzvidira.
2. Kumbirai chiziviso chepamutemo chekudzingwa kana kubvisirwa chigaro nezvinhu zvese zvinosungirwa pamutemo. Yambiro yekutaura kana email yakajairika kubva kumutungamiriri haina simba repamutemo. Kumbira chiziviso chakanyorwa chinotsanangura chikonzero chaicho chekuburitswa, zuva rekushanda, magwaro ekiriniki anotsigira chikumbiro chekuti nzvimbo iyi haigone kuzadzisa zvinodiwa nemugari, nzvimbo yakanzi yakachengeteka yekugamuchira, uye ruzivo rwekusangana kweLong-Term Care Ombudsman uye sangano rinopa rezinesi rehurumende.
3. Fonera iyo Long-Term Care Ombudsman neState Licensing Agency nhasi. Bata chirongwa chako chedunhu cheLong-Term Care Ombudsman (chinowanikwa mudunhu rega rega reUS pasi peFederal Older Americans Act), Dhipatimendi rako reHurumende reHutano kana Social Services Assisted Living Licensing Division, kana yako Care Quality Commission (CQC yekuUnited Kingdom) neLocal Authority Adult Social Care team. Kumbira Ombudsman kuti avhure ongororo yekudzingwa nekukasika uye kupinda musangano wechirongwa chekuchengeta.
4. Kumbira dziviriro yedare revaridzi vemba kana nzvimbo yako ikaronga vanobatsirwa kugara serondi yekugara. Munyika zhinji dzeUS nematunhu eCanada, imba yekugara inobatsirwa inzvimbo yekurenda inochengetedzwa nemitemo yemuridzi wemba. Kunyangwe mushure mekunge chiziviso chemazuva makumi matatu chapera, nzvimbo yacho haigone kubvisa mugari, kushandura makiyi, kana kuvhara chikafu nekuchengetwa kwemunhu pasina kuisa musungwa zvisiri pamutemo (kudzingwa) mudare uye kuwana chirevo chemutongi.
5. Ramba "kuraswa muchipatara" kana mugari iye zvino ari muchipatara chekukurumidzira mukamuri kana muwadhi. Kana nzvimbo yekugara inobatsirwa yakatumira mubereki wako kuchipatara nokuda kwekuwa, utachiona, kana maitiro ekuita uye ozofonera mushandi wezvemagariro evanhu wepachipatara kuti "Musavadzose, tiri kuramba kuverengerwa," zivisai murongi wekubuda muchipatara uye Long-Term Care Ombudsman is eviction of the hospital nekukasika.
6. Kana nzvimbo yese iri kuvharwa nekuda kwekubhuroka kana kubvisirwa rezenisi, nyoresa nekukasika neState Relocation Team. Kuda kudzoserwa accounting yakasimbiswa yemubhadharo wekupinda munharaunda yako, deposit deposit, uye prepaid yerendi yepamwedzi nemwedzi, chengetedza bepa rakazara reMedication Administration Record (MAR) nechati yekurapa makomputa emakambani asati aenda kubhengi otomatiki.

flowchart TD
    A["Dambudziko rekurarama rekubatsira: chiziviso chemazuva makumi matatu chekudzingwa, kuvharika kwechipatara, kana kuvharwa kwenzvimbo"] --> B{"Irudzii rwetyisidziro iri kuitika?"}
    B -->|"30-mazuva kana 14-mazuva ekurapa kana maitiro ekudzingwa"| C["Ramba kubuda uchizvidira; gara mufurati uye ramba uchibhadhara rendi"]
    B -->|"Nzvimbo inoramba kudzosa mugari kubva kuchipatara"| D["Alert Hospital Case Manager uye Ombudsman: kudzingwa zvisiri pamutemo zero-day pasina chiziviso chemutemo"]
    B -->|"Kubhuroka kwenzvimbo, kugamuchira, kana kuvhara rezinesi"| E["Cancel auto-debit ACH; kopi cheti yezvokurapa uye MAR; batanidza State Relocation Task Force"]
    C --> F["Kumbira chiziviso chakanyorwa, matanda ekuchengetedza akazara, uye yepamutemo Chengetedzo Yekuronga Musangano neOmbudsman"]
    F --> G{"Ko mugari ane Medicaid HCBS waiver kana kuremara pekugara zvinodiwa?"}
    G -->|"Hongu"| H["Faira Medicaid Fair Hearing kukwidza + Federal Fair Housing Act (FHA) inonzwisisika inoda pekugara"]
    G -->|"Kwete: Muripo wega"| I["File State Licensing administrative kukwidza uye invoketera Landlord-Tenant dare maitiro edziviriro"]
    D --> J["Manikidza nzvimbo kuti iverenge panguva yefafitera reziviso OR kuva neshanduko yechipatara yakananga kuSNF rehab"]
    E --> K["File Priority Consumer Deposit Claim (11 USC 507(a) (7)) kana mushandisi akaisa Chitsauko 11 kana Chitsauko 7"]

Misiyano yepamutemo pakati peimba inochengeterwa vakwegura nenzvimbo yekugara inobatsirwa¶

Mhuri dzinowanzoshamisika kuziva kuti Zvivakwa Zvekugara Zvinobatsira (ALFs), Zvivako Zvekuchengeta Vachembera (RCFEs), uye Dzimba Dzinochengeta Pachedu zvinotongwa neimwe nzira yekudzora yakasiyana pane Skilled Nursing Facilities (SNFs / misha yevakoti). Kana mudiwa wako ari mumusha une rezinesi wevakoti pane kugara uchibatsirwa, shandisa gwara redu pa kushungurudzwa kwemba yevakoti, kuregeredzwa, uye kudzingwa zvisiri pamutemo.

MuUnited States, misha inochengeterwa vakwegura inosungirwa nemutemo wemubatanidzwa weNursing Home Reform Act (42 CFR § 483.15), uyo unopa mugari wese kodzero yega yekunzwa nyaya yehurumende inomisa kudzingwa. Nzvimbo dzekugara dzinobatsirwa dzinonyanya kubhadhara-kubhadhara kana kupihwa mari kuburikidza nehurumende Medicaid Kumba uye Nharaunda-Based Services (HCBS) waivers, uye inodzorwa nemasangano anopa marezinesi ehurumende. Zvakadaro, vagari vanobatsirwa vane nhoo mbiri dzine simba dzepamutemo idzo vatariri venzvimbo havawanzo buritsa: ** dziviriro yekudzingwa kwevaridzi venzvimbo yekugara ** uye ** mitemo yemubatanidzwa yekuremara inopokana nerusarura **.

Zvikonzero zvishanu zvakabatsira nzvimbo dzekugara dzinoshandisa kudzinga vakuru (uye nzira yekuvakunda)¶

Vanobatsira vanogara vanoshambadza nharaunda dzavo se “kuchembera munzvimbo” dzekugara. Asi kana kuchengetwa kwemugari kuchida kushanda nesimba, kana chiyero chevashandi vemakambani chikatemwa, kana mugari achinja kubva pamitengo yekubhadhara yakazvimirira kuenda kuhurumende yeMedicaid waiver, manejimendi anowanzo buritsa chiziviso chemazuva makumi matatu nekuzvidira. Pazasi pane zvirevo zvishanu zvakajairika uye nzira yekuzvikunda.

1. "Kuchengeta kwemubereki wako kunoda iko zvino kudarika mwero wedu wekuchengeta kana rezinesi rehurumende"¶

Mutariri anoti mugari zvino anoda "kutamiswa kwevanhu vaviri," "hunyanzvi hwekuchengeta mukoti," "kuchengeta incontinence," kana "kutarisa kwemaawa makumi maviri nemana" iyo nzvimbo isingakwanise kupa.

• siyanisa "State Licensing Prohibition" kubva ku"Facility Staffing Refusal": Danidzira kuti Executive Director vataure chaiyo chikamu chekodhi yekutonga nyika inorambidza zviri pamutemo kuchengeta mugari. Munyika dzakawanda, mitemo yekurarama yakabatsirwa inongorambidza kuchengetedza vagari vane maronda asingagadzikike eChikamu chechitatu kana mana (kunze kwekunge vari pasi pechipatara kana nehunyanzvi hwekutarisirwa), zvinoda kuenderera mberi kwemaawa makumi maviri nemana sterile IV therapy, vasingagone kutendeuka, kana kutakura hutachiona hwemhepo. Kuda rubatsiro nezvechimbuzi, kufambisa wiricheya, kana kutariswa kwedementia hakuwanzo tyora rezinesi renyika renzvimbo; nzvimbo yacho haingodi kugovera vashandi vakakwana.
• Ongorora Pre-Move-In Marketing and Assessments: Dhonza Chibvumirano cheResidency chepakutanga, mabhurocha ekushambadzira, uye yazvino Individualized Service Plan (ISP). Kana iyo nzvimbo yakashambadzira "kuchembera munzvimbo" kana kukwidza mari yako yemwedzi yekuchengeta-tier mwedzi miviri yapfuura kuti uvhare mamiriro chaiwo avanoti havakwanise kubata, ipa humbowo uhwu kune State Licensing anoongorora.
• Kumbirai Federal Fair Housing Act (FHA) "Kugara Kwakakodzera" Right: Pasi peUS Fair Housing Amendments Act (42 U.S.C. § 3604(f)(3)(B)) uye zvakafanana nemitemo yekodzero dzevanhu muCanada, UK, neAustralia, imba yekugara inobatsirwa inzvimbo yekugara inodzivirirwa. Tumira ** Chikumbiro chakanyorwa chePekugara Pakakodzera ** uchikurudzira kuunza ** Medicare-inotsigirwa nemari Yehutano Hwepamba Agency (mukoti ane hunyanzvi/PT), Medicare Hospice, kana ** mubatsiri akabhadharwa ari pachivande panguva dzenjodzi huru. Pasi pemutemo wehurumende wedzimba, mubatsiri haakwanise kudzinga mugari akaremara nekuda kwekutarisirwa kwepamusoro kana masevhisi ebato rechitatu akavhara gaka pasina kuisa mutoro usina kufanira pachivakwa.

2. "Mubereki wako ari kuita maitiro, kudzungaira, kana kushushikana"¶

Kana mugari wemunzvimbo yekugara yakabatsirwa kana kuchengetedza ndangariro anoita nyonganiso yemanheru, kuramba kugeza, kupopota, kana kuedza kubuda pagonhi, zvivakwa zvinowanzodaidza mugari "ngozi kune wega kana vamwe" uye zvinopa chiziviso chekudzingwa kwemazuva gumi nemana kana 30.

• Nyora Zvikonzero Zvokurapa Zvakanyanya Kutanga: Hasha dzinongoerekana dzaitika, kuvhiringidzika mupfungwa, kana kuti kudzungaira mumunhu mukuru anenge asingambofi akanganisa nemaune; ndicho chiratidzo chekare chechirwere chisina kuwanikwa cheurinary tract infection (UTI), kupera simba, kusaenzana kwe electrolyte, kuvimbiswa, kurwadziwa kusina kurapwa, kana kusangana kwezvinodhaka. Kumbira kurapwa nekukurumidza uye ongorora madhairekitori edu pa kunyura kwezuva, acute agitation, paranoid delusions, uye dementia de-escalation uye polypharmacy, kuwandisa kwemishonga, kupotsa doses, uye zvikanganiso zvemurongi wemapiritsi.
• Imbirai Behavioral Intervention Log uye Bata Memory Care to Its Standard: Mitemo yehurumende inoda kuti zvivakwa zvekuongororazve mugari, kushandura ISP yavo, uye kuedza kudhirowa kusiri kwepharmacological de-scalation isati yatanga kuburitsa pachena. Bvunza Mutungamiriri weVanamukoti kuti awane nguva dzakatemerwa maitiro, ongororo yezvinokonzeresa, uye manotsi ekudzidzisazve vashandi mumazuva makumi matatu apfuura; kana zero yekugadziridza chirongwa chekuchengetedza yakaitika tsamba yekudzingwa isati yasvika, chiziviso hachishandi mumatunhu mazhinji. Kana mubereki wako atogara mubapiro rakakiyiwa re "Memory Care" achibhadhara zvakanyanya kuchengetwa kwedementia uye adzingwa nekuda kwezviratidzo zveAlzheimer's, zivisa nzvimbo yacho ku State Licensing Agency uye ** State Attorney General's Consumer Protection Division**.

3. "Hospital Dumping" (Kuramba kudzorera mugari mushure mekushanya kweER kana kugara muchipatara)¶

Chiitiko chekubiridzira chinoitika apo nzvimbo yekugara inobatsirwa inotumira mugari kuchipatara chemuno mukamuri yekukurumidzira mushure mekudonha kana kusagadzikana chiitiko, uyezve inodaidza murongi wekubuda muchipatara kuti ataure: * "Tiri kuramba kudzosa mugari nekuti haana kuchengetedzeka panzvimbo yedu."*

• Nei Kurambwa Kwechipatara Kuri Kudzingwa Kusiri pamutemo Kwezuva Zero: Chero bedzi rendi yemubereki wako ichiri kushanda, rendi yavo inobhadharwa, uye fenicha yavo iri mufurati yavo, chikamu ichocho inzvimbo yavo yekugara zviri pamutemo. Kutumira muroja kukamuri rekukurumidzira uye kuramba kuti vadzoke kunodarika chiziviso chakanyorwa chemazuva makumi matatu, kunodarika musangano wevanotarisira, uye kuvharira kunze kwemutemo kunovaka.
• ** Rongedza Pakarepo neHospital Discharge Planner uye Ombudsman:**
• Udza mushandi wezvemagariro evanhu wepachipatara kuti: "Nzvimbo yekugara inobatsirwa iri kuedza kuvhara kunze zvisiri pamutemo pasina kutumira chiziviso chemazuva makumi matatu chakanyorwa chekudzingwa kana kuwana mutongo wedare. Mubereki wangu ane rendi inobhadharwa pakero iyoyo."
• Fonera ** Yakareba-Yenguva Yekutarisira Ombudsman ** uye ** State Assisted Living Licensing Inspector ** kubva pamubhedha wechipatara. Vakuru vane marezenisi vanogona kubata ALF Executive Director zvakananga kuti vayambire kuti kuramba kuverengerwa panguva yekuzivisa pasina kuraira kwachiremba kwechimbichimbi iko kushomeka kwekutonga nekukurumidza uye kutyora kusiya.
• Chengetedza Mamiriro eChipatara Paunenge Uchikwikwidza Kukiya: Kana kudzoka kusina kuchengetedzeka paunenge uchironga kuchinjirwa kuSkilled Nursing Facility (SNF),usa* kuendesa mubereki wako kumba kwako. Shandisa gwara redu pa kupokana nechipatara chisina kuchengetedzeka kana kuburitswa murehab kuchengetedza mubereki wako akachengeteka mukati mechipatara kana kuvashandura vakananga muMedicare-yakavharwa Skilled Nursing Facility rehab bed.

4. Kudzorera kudzingwa mushure mekunyunyuta kwemhuri kana Medicaid waiver kutendeuka¶

Mhuri dzinonyunyuta pamusoro pekushaikwa kwemishonga, kushomeka kwevashandi, kana mavanga, kana vanozivisa manejimendi kuti mugari ari kunyorera State Medicaid Assisted Living Waiver, kazhinji vanogamuchira chiziviso chemazuva makumi matatu chekuburitswa chinotaura zvisina kujeka "nhanho yekutarisira".

• Nyora Nguva Yekutsiva: Nyika yese yeUS nenyika dzepasirese inorambidza vanopa dzimba kuti vatsivire mugari nekumhan'ara kwechokwadi kuOmbudsman, vamiriri vehurumende, kana maneja. Munyika dzakawanda, chero chiziviso chekudzingwa chakabudiswa mukati me ** 90 kusvika kumazuva 180 ** yekunyunyuta kwakachengetedzwa kunogadzira ** fungidziro yepamutemo yekutsiva zvisiri pamutemo ** iyo nzvimbo yacho inofanira kuramba mudare.
• Kumbira iyo Federal CMS HCBS Settings Rule yeMedicaid Waiver Vagari: Kana iyo nzvimbo ikatora chikamu muState Medicaid Home uye Community-Based Services (HCBS) Assisted Living Waiver chirongwa, federal regulation 42 CFR § 441.301©(4)(vi)(A dhairekitori rinopa vagari vese) zvinogoneka zvekurenda uye dziviriro yakazara yekudzinga muridzi wemba, kusanganisira chirongwa cheMedicaid Fair Hearing.

5. Kusabhadhara kwemakakatanwa, asina kuziviswa "Care Tier" mari inowedzera¶

Nzvimbo zhinji dzekugara dzinobatsirwa dzinobhadharisa rendi yepasi pamwe nemubhadharo we "Care Level" unokwira nemadhora mazana masere kusvika kumadhora mazana maviri nemazana mashanu pamwedzi pese apo nzvimbo yacho inosarudza kuti mugari anoda mamwe maminetsi erubatsiro rwevashandi. Usambofa wakanyima rendi isina kupokana panguva yegakava rekubhadharisa, sezvo kusabhadhara rendi kunopa nzvimbo yekumhanyisa kudzinga. Bhadhara mari yerendi yepamwedzi necheki pamwe necheki, uye kumbira mutemo 30-kusvika-60-mazuva epamberi yakanyorwa muyero-wedzero yekuzivisa padivi peyakasainwa zuva nezuva revashandi rebasa usati wabhadhara chero retroactive care-level surcharge.

Nhanho-ne-nhanho protocol yekuongorora uye kumisa 30-yemazuva akabatsirwa anobatsirwa chiziviso chekudzingwa¶

Danho 1: Ongorora chiziviso chakanyorwa kuti uone kukanganisa kwemutemo¶

Pasi pemitemo yekurarama yakabatsirwa nehurumende, chiziviso chekuburitsa zvisina kufanira hachina kukwana zviri pamutemo kana chikasiya kuburitswa pachena kwemutemo:

• Inopihwa nekunyora kune vese mugari uye mumiriri wepamutemo (Simba reGweta / Health Care Proxy).
• Inopa hwindo rezviziviso rizere (kazhinji mazuva 30 ekarenda, kana kuti 14/45/60 mazuva ehurumende). Kana nzvimbo yacho ichiti "chimbichimbi kusunungurwa," tarisa kana chiremba ane rezinesi akasaina gwaro rinoratidza kutyisidzira upenyu kana kuchengeteka iko zvino.
• Inotaura chikonzero chaicho chekiriniki kana chekutonga, kwete mutsara wakajairika. (Kungonyora kuti "Mugari anodarika mwero wekuchengetwa" pasina kunyora mamiriro ekurapa chaiwo, mazuva ekuongororwa, uye kodhi yenyika inodudzwa hazvina kunaka mumatunhu mazhinji.)
• Inodudza nzvimbo chaiyo, yakakodzera, inowanika yekugamuchira. Kunyora "Musha Wemhuri" apo mhuri isingakwanisi pekugara zvakachengetedzeka kutyora mitemo yekudzivirira.
• Inonyora zita, kero, nhamba yefoni, uye email yeHurumende Yenguva Yakareba Care Ombudsman uye State Licensing Agency.

Kana ** chero ** chinhu chisipo, zivisa Executive Director nekunyora kuti chiziviso chinotyora mitemo yerezenisi yenyika uye kuti wachi yemazuva makumi matatu yemutemo haisati yatanga.

Nhanho yechipiri: Danai rekodhi yakazara yekugara uye Individualized Service Plan (ISP)¶

Pasi pemubatanidzwa weHIPAA Privacy Rule (45 CFR § 164.524) nemitemo yekodzero dzevagari vehurumende, inoda makopi ekukurumidza eese Individualized Service Plans (ISPs) kubva pakufamba-mukati kusvika parizvino, mazuva makumi mapfumbamwe ekupedzisira e Medication Administration Records (MARs), ADL inoyerera mashizha, inotsikirira inoyerera**, inonyora **Chibvumirano Chekugara **.

Nhanho 3: Tora yakazvimirira chiremba chitupa uye utumire FHA Inonzwisisika Pekugara chikumbiro¶

Ronga ongororo yechimbichimbi nemugari akazvimiririra anozvimiririra chiremba kana chiremba wezvechiremba kuti aratidze nekunyora kuti mamiriro emugari anogoneka mukati mekugara akabatsirwa kamwe ** Medicare Chikamu A Hutano Hwepamba (hukoti ane hunyanzvi, PT, OT) ** kana ** Medicare Hospice Care ** inorairwa mukati mefurati. Shandira tsamba iyi yachiremba padivi peyakarongeka ** Chikumbiro Chekugara Kwakakodzera pasi pe Fair Housing Amendments Act (42 U.S.C. § 3604(f)(3)(B))** uchikumbira mvumo yekushandisa Medicare Home Health, Hospice, kana mumwe mubatsiri wepachivande (ona mubatsiri wehutano hwepamba hapana-show, kusiiwa, kana kuba), kana kukumbira 60-to-90-day-kufamba-out yekuwedzera kudzivirira kutamisa trauma.

Shoko-ne-izwi zvinyorwa zvekupikisa kudzingwa kwekugara kwakabatsirwa¶

Tumira zvinyorwa izvi kuburikidza neemail ** uye ** tsamba yakasimbiswa ine risiti yekudzorera yakumbirwa.

Script 1: Kuramba kwakanyorwa zviri pamutemo kuziviso yekudzingwa kwe "Level of Care" yemazuva makumi matatu¶

*"Kuna: [Zita], Mutungamiriri Mukuru, uye [Zita], Mutungamiriri weNursing pa[Zita reNzvimbo]. Kopi ku: Regional Long-Term Care Ombudsman uye State Assisted Living Licensing Division.

*Ndokumbira ucherechedze kuti [Zita reMugari] neni, semumiriri wepamutemo ane mvumo, tinoramba zviri pamutemo uye kukwidza [Date] Notice of Discharge. Hatibvumirane kuti [Zita reMugari] zvinodiwa zvinodarika rezinesi renzvimbo yako, uye isu hatisi kuzobva muApartment [#] uku kupokana uku kuri kuongororwa nemutemo.

• Chekutanga, chiziviso chinotadza kutaura kurambidzwa kwerezenisi yenyika kana gwaro rakagadziridzwa ku[Resident Name]'s Individualized Service Plan (ISP). Chechipiri, zvichiteerana neFederal Fair Housing Amendments Act (42 U.S.C. § 3604(f)(3)(B)) uye mutemo wehurumende wekuremara, isu tinotumira Chikumbiro chePekugara Chinonzwisisika kuti tibvumire [Zita reMugari] kuti arambe ari mufurati ravo nekushandisa yekuwedzera Medicare Chikamu A muPamba Hutano/Rutsigiro rwekuchengeta uye nerutsigiro rwepachivande. tsamba, kana neimwe nzira, 60-zuva rekuwedzera nguva yekudzivirira kushungurudza kwakanyanya kwekutamisa apo kuiswa kwakakodzera kunoongororwa. Ndokumbira upe mukati memaawa makumi mana nemasere kopi yakazara yechati ye[Zita reMugari], kuongororwa kweISP, MARs, uye mishumo yezviitiko zvemazuva makumi mapfumbamwe apfuura, uye ronga Musangano weChirongwa Chekutarisira apo Mutariri Wenguva Yakareba Wokutarisira Ombudsman anogona kuuya. Base rendi yepamwedzi icharamba ichibhadharwa nenguva."*

Script 2: Kudiwa kwechimbichimbi kana nzvimbo yekugara inobatsirwa ikaramba kudzorerwa kubva kuchipatara ("Hospital Dumping").¶

"Kuna: [Zita], Mutungamiriri Mukuru we[Nzvimbo Yekugara Inobatsirwa]; Kopira ku: Hospital Case Management, Long-Term Care Ombudsman, uye State Licensing Enforcement.

Nzvimbo yako yazivisa murongi wekubuda muchipatara nhasi kuti uri kuramba kubvumidza [Zita reMugari] kuti adzokere kumba kwavo kwavakarenda muApartment [#] zvichitevera kuongororwa kwavo kwekamuri rekukurumidzira. [Zita reMugari] ane chibvumirano chekugara, chinobhadharwa rendi, uye midziyo yemunhu muApartment [#].

Pasi pemitemo yemarezenisi ehurumende uye mutemo wevaridzi vemba, kuramba kudzorera muroja kubva kuchipatara kushanya pasina kupihwa chiziviso chemazuva makumi matatu chekuburitswa, kuita musangano wechirongwa chekuchengeta, uye kutevedzera nzira dzekudzinga zviri pamutemo kuvharika kwezuva rezero uye kusiiwa nemurwere. Chiremba ari kuenda kuchipatara akabvisa [Zita reMugari] kuti adzokere kunogara rubatsiro [neutano hwepamba/rutsigiro rwehospice]. Ndapota simbisai kumubatsiri wemuchipatara ne[Nguva] nhasi kuti muchagamuchira [Resident Name] chekufambisa chekudzoka, kana kutaura nekunyora chiremera chaicho chepamutemo chamuri kuvharira muroja uyu kunze kwefurati yake inobhadharwa apo State Ombudsman neChikamu Chekupa Marezenisi vachiongorora."

Zvekuita kana nzvimbo yekugara inobatsirwa ichizivisa kuvharwa kamwe kamwe, kubhuroka, kana kugamuchira¶

** Kuvharwa kwenzvimbo yekuvaka-yakakura ** kunoitika kana mushandisi ashaya mari, akanganisa pakurenda, mafaera eChitsauko 11 kana Chitsauko 7 kubhuroka, kana kuti rezinesi rekushandisa rehurumende rakatorerwa. Mhuri dzinogona kupihwa chero kubva ku*maawa 72 kusvika kumazuva makumi matanhatu kutamisa vanhu vakwegura makumi mashanu kusvika kuzana nemakumi mashanu panguva imwe chete vashandi vachisiya basa.

Chikamu 1: Kutanga maawa makumi maviri nemana (Kuchengetedzeka mumuviri, mishonga, uye zvinyorwa zvekurapa kununura)¶

1. Ongorora mamiriro ehupenyu akachengeteka mumunhu: Tarisa uone chikafu, HVAC, maelevator, uye vashandi vepasi. Kana vashandi vabuda uye vagari vasara vasina chikafu, mvura, kupisa, kana kurapwa kwemishonga izvozvi: Fonera nhamba yako yepano yechimbichimbi (911 muUnited States neCanada, 112 muEuropean Union, 999 muUnited Kingdom) uye fonera State Department of Health Emergency Hotline uye Adult Protective Services (APS) kuendesa Chikwata chechimbichimbi ***Kutumira rubatsiro.
2. ** Dhonza makopi emapepa uye mafoto efoni erekodhi yese yekurapa sevha isati yasviba: ** Tora makopi akadhindwa kana mapikicha ezvino ** Medication Administration Record (MAR) **, inoshanda ** Yakasainwa Chiremba Orders **, ichangoburwa ** Nhoroondo uye Yemuviri (H&P) ** uye ** TB / Chest X-ray ray-ray kubvumidzwa nePOLST / yepakutanga kubvumidzwa nePOLST) MOLST / DNR fomu ** uye ** Simba reGweta **.
3. ** Mishonga yakachengeteka uye pfuma yepamusoro-soro: ** Simbisa apo mishonga ine blister-packed, insulin pens, uye ** Purogiramu II-V inodzorwa zvinhu ** zvakachengetwa, uye kumbira chiremba anorayira kuti afonere ** 30-mazuva ekukurumidzira bhiriji refill ** kune imwe kunze kwechitoro chemishonga. Bvisa zvishongo, mabhuku echeki, zvekushandisa pakunzwa, mazino, uye zvitupa paZuva 1 (ona kushandiswa kwemari kwevakuru uye kudzivirira scam)

Chikamu chechipiri: Dziviriro yemari (Kumisa ACH zvinyorwa uye kudzoreredza madhipoziti mukubhuroka)¶

Chikamu chechitatu: Kudzivirira "Kutamisa Trauma" panguva yekukurumidza kufamba¶

Kukurumidza kuendeswa kwemasangano kaviri njodzi yekudonha, acute delirium, uye kuora mwoyo mukati memazuva makumi mapfumbamwe ekutanga. Shandisa iyi Nhanho shanu Kuendesa Trauma Shield: 1. Dzokorodza chaiyo fenicha geometry mukamuri idzva usati wasvika: Isa mubhedha pa** chaipo padivi pemusuwo wekugezera , isa chigadziko cheusiku, mwenje, recliner, uye wachi yekumadziro muchimiro chakafanana, uye sungirira mapikicha emhuri akajairwa mugari asati apinda kuti adzivise kudonha kwehusiku. 2. Chengeta mibhedha, gumbeze, uye piro zvakajairwa zvisina kugezwa kwemaawa 72 ekutanga: Kunhuhwirira kwakajairika kunodzikamisa nhengo dzemuviri muvarwere vane dementia pasina mishonga yekurarisa. 3. ** Famba panguva dzepamusoro-soro dzekuziva (10:00 AM kusvika 1:00 PM) kure nekurongedza mhirizhonga: Budisa mugari kunze kwekudya kwemasikati apo imba yacho yakarongedzerwa uye yakagadzirirwa panzvimbo itsva, saka vanobuda mukamuri rakazara vopinda mukamuri yakazara. 4. ** Huya 1-Peji "Inodziya Handoff" Chekuchengetedza Pepa:** Nyora izvo mugari anoda kuti adaidzwe, midziyo yavo yekunzwa uye yekuona (ona kumedza mazino emazino, magirazi emaziso akatyoka, kana kuti yarasika yekunzwa), nzira yavo yekufambisa yekufambisa (ona vakwegura vanodonha kupora kana vasingakwanisi kumira), uye mishonga inokosha nguva. 5. Ramba Zvirambidzo zveMakemikari (New Antipsychotics) ku "Gadzirisa" Mugari: Kutanga haloperidol, risperidone, kana quetiapine mumukuru achangotamiswa kunokonzera kusagadzikana kwakanyanya uye kudonha; ronga kushanya kwemhuri mukati menguva dzemasikati (3:30 PM kusvika 7:00 PM) kwevhiki yekutanga pane kudaro.

International uye redunhu regulatory zvakaenzana¶

• United States: Bata Chirongwa Chako Chenguva Yakareba Kuchengeta Ombudsman kuburikidza ne Eldercare Locator pa 1-800-677-1116 (https://eldercare.acl.gov), State Assisted Living Licensing Agency yako, uye faira Fair Housing zvine musoro zvichemo zvepekugara ne* HUDO 1-800-669-9777**.
• United Kingdom: Inodzorwa ne Care Quality Commission (CQC) muEngland (Care Inspectorate ** muScotland neWales; RQIA muNorthern Ireland). Pasi pe UK Competition and Markets Authority (CMA) Care Homes Guidance uye Consumer Rights Act 2015, imba haigone kudzinga pamazuva makumi maviri nemasere pasina zvikonzero zvine musoro, inofanirwa kugadzirisa zvine musoro pasi peEquality Act 2010**, uye haikwanise kudzinga mukudzorera zvichemo. Pasi pe Zvikamu 48 kusvika ku52 zveCare Act 2014, kana mutarisiri weUK akakundikana mune zvemari kana kuvhara kamwe kamwe, **Local Authority Adult Social Care team ine mutemo wepamutemo basa rekupindira nekukurumidza ** saka pane zero gap mukutarisira kune vese vanopihwa mari nehurumende uye vanozvipa mari.
• Canada neAustralia: MuOntario, dzimba dzekurega basa dzinotongwa ne Retirement Homes Regulatory Authority (RHRA) uye Residential Tenancies Act (RTA) inosimbiswa ne Landlord uye Tenant Board (LTB); muBC, bata Assisted Living Registry. MuAustralia, batai Aged Care Quality and Safety Commission (ACQSC) uye Older Persons Advocacy Network (OPAN) pa1800 700 600; pasi pe Aged Care Act, mupi haakwanise kuda kuti mugari aende kudzamara muongorori akazvimirira aongorora mugari uye imwe nzvimbo yekugara inokwanisika inowanika iripo.

Mibvunzo inowanzo bvunzwa¶

Nzvimbo yekugara inobatsirwa inogona kuvharira mubereki wangu kunze kana kuisa zvinhu zvavo panzira paZuva 31 rechiziviso chekudzingwa?¶

Aiwa, munzvimbo zhinji dzeUS, mapurovhinzi eCanada, United Kingdom, neAustralia, nzvimbo yekugara yakabatsirwa haigone kudzinga zviri pamutemo nekuchinja makiyi, kuvhara chikafu, kana kubvisa mugari paZuva 31 pasina mvumo yekudzingwa nedare redzimhosva kana danho rekutamisa dhipatimendi rehutano. Chero bedzi iwe uchiramba uri mukutaurirana, ramba uchibhadhara risingapikiswe rendi, uye wazivisa Long-Term Care Ombudsman uye state rezinesi agency kuti nzvimbo yakachengeteka haisati yachengetedzwa, nzvimbo yacho inofanirwa kutevedzera nzira dzekudzinga uchienderera mberi nekuchengetwa kwemazuva ese uye kudya.

Ko kana nzvimbo yekugara inobatsirwa yakatumira mubereki wangu kuchipatara ER nekuda kwekunetseka kwepfungwa uye zvino aramba kuti vadzoke?¶

Kuramba kudzorera mugari anobatsirwa mushure mekushanyirwa mukamuri rekukurumidzira kana kugara muchipatara kwenguva pfupi pasina kupa chiziviso chemazuva makumi matatu chekubuda kunze kwemazuva makumi matatu kudzingwa kusiri pamutemo kwezuva reziro kunozivikanwa sekuraswa kwechipatara. Chimbidza zivisa mushandi wezvemagariro evanhu wepachipatara uye anoronga zvekudzinga kuti mubereki wako ane rendi inoshanda panzvimbo yekugara yakabatsirwa, fonera Long-Term Care Ombudsman nesangano rako reState Assisted Living Licensing kubva kuchipatara kuti vataure kuvharirwa zvisiri pamutemo uye kusiiwa kwemugari, uye kuramba kuendesa mubereki wako kune imwe imba isina kuchengetedzeka apo chipatara nevanoronga vanoronga kuendesa rezinesi rezinesi kana kuendesa marezenisi. Facility.

Ndinogona here kushandisa federal Fair Housing Act kumisa nzvimbo yekugara inobatsirwa kubva pakudzinga mubereki wangu nekuda kwekuda kuchengetwa?¶

Hongu, pasi pemubatanidzwa weFair Housing Amendments Act (42 U.S.C. § 3604) muUnited States uye nemitemo yakaenzana yevakaremara pasi rose, imba yekugara inobatsirwa inzvimbo yekugara yakavharwa uye mamiriro emuviri kana ekuziva ane chekuita nezera akaremara. Unogona kuendesa Chikumbiro chakanyorwa chakanyorwa cheKugara Kwakakodzera kuchida kuti nzvimbo yacho ibvumidze rutsigiro rwebato rechitatu, senge Medicare Chikamu A Hutano Hwehukoti hweKumba, kurapwa kwemuviri, Medicare Hospice care, kana mubatsiri anobhadharwa ari ega panguva dzenjodzi huru, kuvharisa zvinodikanwa zvekuchengeta mugari kuti vagare vakachengeteka mumba mavo.

Ndingadzoserwe sei mari yekupinda yakawanda kana dhipoziti yechibatiso kana nzvimbo yekugara inobatsirwa nemubereki wangu yekubhuroka?¶

Chekutanga, nekukasira kudzosa chero otomatiki ACH kubhangi dhizaini mvumo nebhangi rako kuti pasave nekumwe kubviswa kwepamwedzi kunoitika. Tevere, tarisa nesangano rako rezinesi rezinesi kana mutemo wenyika waida kuti nzvimbo yacho ibate chengetedzo yevagari vemo kana mari yekupinda muakasarurwa escrow kana trust account, iyo inoramba iri pfuma yemugari kunze kwe bankruptcy estate; kana mari ikasanganiswa, isai Humbowo hweChirevo (Form Form 410) mudare rekubhuroka uchikumbira federal Consumer Deposit Priority pasi pe11 U.S.C. § 507 (a) (7) uye zivisa dare rakagadzwa Patient Care Ombudsman.

Kwatariswa¶

• Administration for Community Living (ACL, United States): Nguva Yakareba Kuchengeta Ombudsman Program Statutory Authority pasi peOlder Americans Act (45 CFR Chikamu 1324).
• Centers for Medicare and Medicaid Services (CMS, United States): HCBS Settings Final Rule (42 CFR § 441.301© (4) (vi) (A): Dziviriro Yekugara uye Kudzingwa).
• Dhipatimendi reUnited States reJustice (DOJ) neHUD: Chirevo Chakabatanidzwa Pamusoro Pekugara Kunonzwisisika Pasi peFair Housing Act (42 U.S.C. § 3604(f)(3)(B)).
• United States Bankruptcy Code: 11 U.S.C. § 333 (Patient Care Ombudsman) uye 11 U.S.C. § 507 (a) (7) (Inonyanya kukosha yeDeposit Deposits).
• Competition and Markets Authority (CMA, United Kingdom) neDHSC: UK Care Homes Consumer Law Advice on Evictions and Care Act 2014 Zvikamu 48-52 (Kukundikana Kwevapi).
• Aged Care Quality uye Safety Commission (ACQSC, Australia): Chengetedzo yeTenure Responsibilities pasi peAged Care Act.

Mazano anoenderana¶

• Kushungurudzwa kwemba yevakoti, kuregeredzwa, uye kudzingwa zvisiri pamutemo
• Kudenha chipatara chisina kuchengetedzeka kana nguva isati yakwana kana kuburitswa kwerehab
• Sundowning, acute agitation, paranoid delusions, uye dementia de-escalation
• Vakuru kushandiswa kwemari uye scam kudzivirira
• Nhamba dzepasi rose dze emergency