Wednesday, March 17, 2010

Supreme Court Refuses to Hear Nursing Home Civil Rights Case

By: Laura E. Troshynski

www.knudsenlaw.com <http://www.knudsenlaw.com>

Can alleged inadequate nursing home care lead to a civil
rights lawsuit? According to the United States Court of Appeals for the
Third Circuit, the answer is "yes." In July of 2009, in the case of
John J. Kane Regional Centers-Glen Hazel v. Grammer, the Third Circuit
held that the Federal Nursing Home Reform Amendments (FNHRA) guarantee a
nursing home resident's civil rights. Consequently, according to the
Third Circuit, private civil rights lawsuits may be brought against
nursing homes in the event of alleged wrongful death or inadequate
patient care. Recently, the United States Supreme Court declined to
review the case, allowing the Third Circuit decision to stand.

The Third Circuit's ruling was the result of a claim brought
by Sarah Grammer against a Pittsburgh-area nursing home in which Grammer
alleged that her mother, Melvinteen Daniels, was neglected by the John
J. Kane Regional Center. According to Ms. Grammer, the facility
provided inadequate care which eventually resulted in her mother's
death. Instead of filing a typical negligence claim against the nursing
home, Ms. Grammer chose to sue under the Federal Nursing Home Reform
Amendments. According to Ms. Grammer, the FNHRA guarantee various
patient rights, including the right to quality care. Therefore, Ms.
Grammer contended that the alleged inadequate care received by her
mother constituted a civil rights violation for which she could bring a
civil rights lawsuit under the FNHRA. The nursing home, however,
contended that the FNHRA were simply meant to outline requirements for
Medicaid and Medicare certification.

Initially, the District Court ruled in favor of the nursing
home facility. However, the Third Circuit overturned the District
Court's ruling, holding that the FNHRA creates the right to a private
civil rights lawsuit in the event of inadequate care. Various groups,
including the AHCA, the American Association of Homes and Services for
the Aging, and various individual states petitioned the Supreme Court to
review the holding of the Third District. However, despite this
petition, the Supreme Court refused to hear the case. Therefore, it
appears as if nursing homes throughout the country may be exposed to
potential civil rights lawsuits in the event of alleged inadequate
patient care.

Monday, March 8, 2010

What to do when a Loved One Passes

Although first taken aback by shock and grief, you may be called upon to handle the necessary details surrounding the loss of your loved one and it is important to know what to do.

First, you have to get help and depending on the scenario, local law enforcement may have to be contacted first (i.e. if the death was not attended or due to unknown circumstances.) In most other circumstances various parties must be immediately notified, including:

  • The attending physician, a coroner or medical examiner to officially pronounce the death. If the deceased was in a hospital or other care facility, this is typically arranged by the staff.
  • Family members or a legal representative of the deceased. They will need to locate the deceased's pre-arranged funeral plan, if one exists, for direction in how to proceed with funeral arrangements.
  • A Funeral Director to transfer the body from the place of death to a funeral home or comparable care facility. Funeral directors are available through funeral homes and other funeral service organizations.

In the absence of instructions from the loved one, or a pre-arranged funeral plan, you'll need to make a series of decisions relatively quickly. If there are several family members and friends assembled, make a list of the necessary tasks and delegate responsibility. Organizing a funeral usually entails planning the funeral ceremony and the disposition of the deceased's body, accommodating guests and, usually, arranging for a subsequent gathering.

If it is too difficult or you want it handled by a Funeral Director and one hasn't been pre-selected, you should call a recommended funeral home, cremation service or other service provider that will handle all the funeral arrangements. Funeral directors help you plan the funeral ceremonies and then direct the ceremonies in accordance with your wishes, including coordinating with the cemetery. A typical cemetery offers various types of grave spaces for earth burial and mausoleum crypts for entombment. Similar options are available for burial or entombment of cremated remains. The cemetery also provides services to open and close the grave or crypt and to install grave markers. Some cemeteries charge recurring fees for the perpetual maintenance of the grounds. Since you are likely to visit the cemetery periodically to remember your loved one, location is an important consideration in selecting a cemetery. Many people purchase cemetery property in advance to relieve their survivors of this responsibility. There are several cemeteries available in Lincoln and you should decide where you may want the "final resting place" for your loved one. A few local cemeteries are listed below:

www.wyuka.com - (402) 474-3600

(402) 474-4500

(402) 476-8787

(402) 441-0585

www.lincolnfh.com - (402) 423-3826

Some choices will influence others. If the deceased is to be directly cremated before a funeral, then you may opt for a simple casket to transport the body to the crematorium, but choose an attractive urn if the cremated remains are to be present at the subsequent service. If there is to be an open casket for viewings, then embalming becomes a consideration, as does the type of casket. A cemetery interment means choosing between ground burial and entombment in a mausoleum, whereas a scattering of ashes raises the question of location and accompanying ceremony. If you want a funeral or memorial service held at a church or other place of worship, you'll need to make such arrangements with the appropriate officials, and you'll need to discuss the nature of the service. Some of the choices that must be made when arranging a funeral are set forth below:

Method of interment

· Will the deceased be buried or entombed?

· Will the deceased be cremated? If so, will the cremated remains be buried, entombed, scattered or kept by the family?

· Will the body be donated to science? Will organs be donated?

Ceremonies

· Will there be a traditional funeral with the casket present or a memorial service without the presence of the casket? Will both types of services be held or no ceremonies at all?

· Where will the ceremonies be held? At a funeral home? At a place of worship? At the graveside?

· Will there be one or more visitations? If so, will the casket be open or closed?

· Will the deceased be embalmed?

· Should a DNA sample be taken?

· Who will participate in the funeral ceremonies? Clergy? Pallbearers? Speakers? Musicians or vocalists?

· Will the ceremonies feature certain music, readings, or tributes?

· Will there be a procession to the cemetery? Will the deceased be transported in a hearse? Will family travel in a limousine?

Following the funeral a variety of financial, legal and administrative matters must be addressed. The tasks you may need to do include:

  1. Sending acknowledgement notes expressing gratitude for flowers, donations and special assistance.
  2. Commencing estate proceedings. Whether an extensive Probate proceeding is necessary is determined by the size of the estate and the existence of a will and living trusts. An Executor, named in the will or appointed by the Probate Court will shepherd the estate through this process. Also, it may be necessary to hire an estate planning attorney to provide legal guidance.
  3. Accounting for all assets and debts of the deceased. Make arrangements to pay outstanding bills. It may be necessary to have the Probate Court release short-term funds to cover these bills.
  4. Filing death benefit claims with insurance companies, Social Security, the Veterans Administration, pension/retirement funds, unions, etc. Certified copies of the death certificate are usually required in making these claims. See http://www.socialsecurity.gov/pubs/10084.html.
  5. Changing all jointly held accounts including, bank accounts, credit cards, mortgages, loans, brokerage accounts, stocks, bonds and other investments.
  6. Sending notifications of death to:
    • Employers.
    • Fraternal, social, and religious organizations.
    • State and local agencies, such as the Department of Motor Vehicles, to transfer all licenses and titles.
    • Telephone, utility, newspaper and any other services that are registered in the deceased's name.

Try not to take on the entire responsibility for organizing a loved one's funeral and post-funeral yourself. Others will want to help, to share the experience as a way to feel connected to the one who has died and to make a contribution to the memorial, and you need to allow yourself time to grieve.

NEBRASKA FUNERAL & BURIAL REQUIREMENTS

DO YOU KNOW WHAT YOUR STATE REQUIRES?

  1. Does the law of your state require a licensed professional (such as a funeral director) to prepare a body for burial?

In Connecticut, Indiana, Louisiana, Michigan, Nebraska and New York, laws require that a funeral director handle human remains at some point in the process. In the 44 other states and the District of Columbia, loved ones can be responsible for the body themselves. The state of Nebraska requires a licensed Funeral Director to care for human remains. See below, Neb Rev. St. § 71-605.

  1. Does the law of your state require embalming for an open casket funeral service?

In Nebraska, funeral homes have their own rules and factors (such as time) regarding whether or not to embalm. Required embalming depends on such factors as whether the family selected a service with a public or private viewing of the body with an open casket; if the body is going to be transported by air or rail; or because of the length of time prior to the burial or cremation. If a funeral home charges for embalming, they must explain why in writing. EXAMPLES: (i) Selected a service with a viewing or (ii) Arranged for shipment by common carrier or (iii) Selected arrangements that require the funeral home to hold the remains for more than 24 hours provided that no refrigeration is available or a hermetically sealed container is not used and provided that embalming does not conflict with religious beliefs or medical examination.

According to the Federal Trade Commission Funeral Rule, all funeral homes are required to get permission to embalm. If you select a funeral service which requires embalming, such as a funeral with a viewing, you may have to pay for embalming. You are not required to have embalming if you selected arrangements such as direct cremation or immediate burial. If a funeral home charges for embalming, they must explain why in writing. EXAMPLES: (i) Selected a service with a viewing or (ii) Arranged for shipment by common carrier or (iii) Selected arrangements that require the funeral home to hold the remains for more than 24 hours provided that no refrigeration is available or a hermetically sealed container is not used and provided that embalming does not conflict with religious beliefs or medical examination.

Truth about Embalming

Preparing the body for public viewing nearly always involved embalming and cosmetic restoration, processes that can add $600 or more to a funeral bill. Is embalming otherwise necessary or required? Not really.

  • Embalming generally is not necessary if the body is buried or cremated within a reasonable time after death.
  • Embalming is not required by law except in certain cases when a body is transported across state lines.
  • Embalming does not preserve the deceased’s body indefinitely; it merely masks the appearance of death and temporarily postpones decomposition.
  • Embalming chemicals are highly toxic. Embalmers must wear a respirator and full-body covering while performing the procedure.
  • Refrigeration is an alternative to embalming for maintaining a body intact while awaiting a funeral service. Although not all funeral homes have refrigeration facilities, most hospitals do.
  • Embalming is common only in the United States and Canada. Orthodox Jews and Muslims consider the procedure a desecration of the body. — From the Funeral Consumers Alliance.

  1. Does the law of your state require the use of a vault or grave liner?

No state law requires a grave-liner or vault, but many cemeteries require them, to keep the grave from caving in. It's a maintenance convenience for the cemetery.

  1. Does the law of your state license or restrict the disposition of cremated human remains?

There are no “cremains police” in any state to ensure proper etiquette, permits, or permission are obtained and used. There are no health, safety or environmental issues to be concerned about. However, if your scattering ceremony is to be held within a city or town limits, city/town ordinances and bylaws should be consulted. See Neb Rev. St. § 71-1381, § 71-1382.

  1. Does the law of your state prohibit the kind of "home funeral" commonly experienced 100 years ago (i.e. a calling in the home of the deceased and burial by the family)?

Home funerals are legal in all states except five. Connecticut, Delaware, Indiana, Nebraska, and New York have restrictions. See Neb Rev. St. § 71-605.

SOURCES:

Nebraska Department of Health and Human Services- Statutes relating to Funeral Directing and Embalming Practice Act Cremation of Human Remains Act..

http://www.dhhs.ne.gov/crl/statutes/Funeral%20Directing%20and%20Embalming.pdf

NEBRASKA REVISED STATUTES

Neb Rev. St. § 71-605 Death certificate; cause of death; sudden infant death syndrome; how treated; cremation, disinterment, or transit permits; how executed; filing; requirements.

Neb Rev. St. § 71-1381 Cremated remains; how treated.

Neb Rev. St. § 71-1382 Cremated remains; final disposition.


Michael W. Khalili
Associate Attorney
*Licensed in Washington State & the U.S. District Court of Nebraska

http://www.knudsenlaw.com/Att_Bio_MWK.htm

Tuesday, March 2, 2010

New Nurses Don't Feel Comfortable Implementing Quality Improvement Measures

An analysis of survey responses by researchers at New York University's
College of Nursing has found that a large number of new nurses feel
ill-prepared to implement quality improvement measures and more than 12%
have never heard of "quality improvement".

The survey was sent to 436 newly graduated nurses with bachelor and
associate's degrees from around the country. The study found that 38.6%
of those surveyed felt that their degree courses either "poorly" or
"very poorly" prepared them to implement quality improvement measures
and 41.7% didn't feel prepared at all to use national patient safety
resources including the National Quality Forum.

The researchers defined quality improvement as the "use of data to
monitor the outcomes of care processes and use of improvement methods to
design and test changes to continuously improve the quality and safety
of health care systems." There is debate over just exactly who should
be responsible for teaching quality improvement with some believing it
should be the school and others believe it should fall to the employer.
However, the study's authors note that only 23.3% of those surveyed said
that their employer provided quality improvement training was "very
helpful."

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 423 4768 (H)

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com