Long-Term Care Survey Alert

Facilities ask mentally competent residents to sign on the dotted line.

Maryland nursing facilities using the Health Facilities Association of Maryland "Guidelines for Resident Behavior" ask cognitively intact residents to review and sign an agreement to follow rules for conduct in the following areas:

• Cooperation with the plan of care.

• Compliance with federal, state or local laws.

• Ban on weapons in the facility or premises, including knives with blades greater than four inches or firearms of any kind.

• Prohibition against illegal drug or unauthorized alcohol use. The facility must authorize alcohol possession or use. The staff will contact the police about illegal drug possession or use. The facility will make a reasonable effort to provide the resident voluntary access to addictions resources such as Alcoholics Anonymous, Narcotics Anonymous, support groups and counseling.

• Smoking rules.

• Drug testing. The guidelines let residents know up front when the facility may drug test a resident.

• Visitors' conduct. "Visitors who bring drugs, drug paraphernalia, weapons will be directed to leave the facility and the police will be notified," state the guidelines.

• Inspections. The guidelines define when the facility may conduct inspections of "plain view or public areas," areas viewed by staff while performing routine duties--and residents' locked personal space.

• Rules for leaving the unit or facility (the guidelines provide an attached sign in/sign out form). Residents must return to their unit/facility by 11 p.m. unless they or their responsible party have made arrangements with the facility.

• Leave of absence. The guidelines spell out the rules for authorized LOAs.

• General conduct. The guidelines note, for example,  that "loud and obtrusive noise and music, interfering with the operation of the unit and residents' comfort will not be tolerated. Residents and visitors are encouraged to use headphones."

• Noncompliance. The guidelines note that failure to comply with the rules may result in the initiation of a behavioral management plan between the resident and facility developed under the guidance of trained professionals. Other options include referral to local law enforcement authorities--or discharge from the facility "when the violations meet the thresholds of state and federal regulations (for example, if the violations are a danger to the resident or others)."

The agreement asks residents who feel they are being treated unfairly or without appropriate respect to follow the complaint procedures in the admission agreement.

Resource: You can receive a copy of the behavioral guidelines from HFAM for a $25 fee. For more information, contact Sheila Mackertich at the following e-mail address: smackertich@HFAM.org.

Editor's note: The guidelines note that they were developed in consultation with the state survey agency (Office of Health Care Quality), which supports them when "used appropriately and in conjunction with medical, psycho-social and substance abuse supports, as a method to address the issues raised by residents with behavioral problems." Facilities making changes to the document must seek clearance prior to implementing it.