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One of our new clients recently told us that before he retained our services, a nursing home was requiring his father to get up at 5 a.m. for his bath in order to balance the day and night shift. His father, who suffered from Alzheimer’s, wanted to sleep until 8:30 or 9 a.m. and found the early wakeup disruptive.

By law, nursing homes must make reasonable adjustments to honor the preferences of the residents. The time and place to request these adjustments is in the care plan meeting for the resident. Nursing homes are required to have care plan meetings. A nursing home must have an initial care plan meeting within 21 days of admission, and then every three months thereafter. Also, a care plan can be reviewed and revised at any time as necessary.

The care plan is prepared by a team that includes the resident’s doctor, a registered nurse and other appropriate nursing home staff members. The team should include the resident, the resident’s legal representative and/or a member of the resident’s family. (See Section 483.20(k)(2) of Title 42 of the Code of Federal Regulations). The nursing home staff is required to schedule care plan meetings at a time that allows others to attend.

The resident or the resident’s legal representative should use the care plan meeting as a forum to ensure the resident’s quality of life. While it is not clear what “reasonable adjustments” will be in any given case, it is clear that the law recognizes that a nursing home is the resident’s home and should feel like home.

The law specifically recognizes that the resident should “[c]hoose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care.” (Section 483.15(b)(1) of Title42 of the Code of Federal Regulations).

Therefore, residents and their representatives should not feel constrained because of the procedures suggested by the staff at the nursing home.

The importance of advocating for residents’ rights cannot be emphasized enough. The client’s father who was inconvenienced by the early wakeup subsequently became combative and then the client was faced with a discharge issue because the facility claimed the resident’s presence in the nursing home endangered others’ safety.

While no one will really know what would have happened if the facility had not begun disrupting the sleep cycle of the resident, the family believes the patient would not have become combative. According to law, facilities must be responsive to the preferences of the residents. Had the family advocated for the patient’s rights, a more favorable outcome would have been possible.