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Steps to Take to Resolve Disputes at Nursing Homes

In long-term care situations, there are numerous opportunities for misunderstandings to occur and disputes to arise. Some of these could be the quality of the food, bothersome roommates, lack of privacy, insufficient occupational therapy, or the expected quality of attention and care given residents. None of these concerns should be dismissed lightly because they greatly affect the resident’s quality of life. When residents aren’t treated with due respect, when promises are broken or when expectations aren’t met, it’s time to open a dialogue to see what can be done to alleviate the situation that is causing your family member’s distress.

There are few nursing homes that meet the ideal standards we want for our parents, our spouse or ourselves. The difficulty is in knowing how far and how hard we can push the nursing home toward providing the attention and care we think residents deserve. There is a vast difference between wanting more or better care and the point where care is so inadequate that legal intervention is necessary. Sometimes it takes the skills of an experienced, knowledgeable geriatric care manager to do an independent evaluation of the resident and the facility to determine whether the nursing home is delivering the appropriate standard of care. There are a number of steps that the family can take before it becomes necessary to call in a third party. The following list provides a step-by-step guide to escalating the process, if the facility or staff fails to respond to your concerns. In following this process of escalation, be sure to make detailed notes of your contacts with the staff, including dates and names of those you communicate with concerning your family member.

Step 1: Talk to key members of the staff. Let them know about your concerns, what is important to you and your family member, and what you expect to happen as a result of the conversation. Listen to their constraints and how they think they can resolve the situation. Often, this is enough to resolve the matter.

Step 2: Talk to the supervisor. Often there will be an available director of nursing as well as an administrator you can talk with. Explain the situation from your perspective and the resident’s perspective. Be positive. Listen to their perspective. Let them know that you believe they can favorably resolve the problem. Most problems are resolved at this step, if not before.

Step 3: Hold a meeting with the appropriate nursing home personnel. You can request that you have a regular care planning meeting at specified intervals letting the nursing home staff know that you intend to stay involved. You may want your family member’s physician involved in some way in this meeting. You can also request a special meeting if your issue has not been resolved to your satisfaction through more informal conversations.

Step 4: Contact the ombudsman assigned to the nursing home. His/her function is to intervene with the facility on behalf of the resident and achieve a satisfactory resolution to your issue.

Step 5: If the unresolved issue is a violation of the resident rights, report it to the Massachusetts state licensing agency. They will exert pressure on the facility to correct the violation.

Step 6: Hire a geriatric care manager to intervene. This is a knowledgeable, objective third party who can serve as an advocate for you, but who is not emotionally involved. This professional understands how nursing homes function as institutions and can help you determine what is possible to accomplish and can work with the facility to take the necessary corrective action.

Step 7: Hire a certified elder law attorney. (You can find one via  This is a drastic action which can often make the dispute more difficult to resolve. While a certified elder law attorney may be necessary to assert the resident’s rights, it should be considered a last resort. When every other effort to resolve the problem has failed, you may have to utilize a certified elder law attorney to compel the facility obey the law.

Step 8: Move your family member. When every effort at resolution has failed, move the resident to a more cooperative facility. This may be difficult, but it may be the only solution. Again, a geriatric care manager can be invaluable in helping you find the facility that is best suited to provide the appropriate care for your family member’s needs. Such a move, however, does not prevent you from seeking legal compensation for any harm inflicted on your family member while a resident at the previous nursing home.

The important message is to speak up, but then listen as well. Most people are willing to work with you provided you are willing work with them. There will be short-term problems that arise due to shortages of staff, staff turnover, new management, etc. The key is to find out the cause early and intervene early enough to work things out before a misunderstanding becomes a much bigger problem.