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Life in Michigan nursing homes should be a positive, enriching experience. So say our laws, our regulators and our hearts. Sometimes nursing homes live up to this expectation, sometimes not. Residents and families often ask what can be done to bring about change in nursing homes when our expectations of quality care are not met. Families and consumers frequently work with the home and others for improved care. Also, families and consumers sometimes turn to government agencies for help.

One of the steps state regulators can take to motivate a nursing home to correct problems is a "ban on admission".

This fact sheet explains when and how state regulators can use a ban on admissions to solve nursing home problems. We hope it will be useful to residents and families who want to talk to state agencies what can be done to get a nursing home to correct problems, to change a home’s policies and procedures, and ultimately, to provide better care.

Most of the time, homes correct the problems identified by the inspectors. Nursing homes are expected to submit to the Michigan Department Bureau of Health Systems (MDBHS) a "plan of correction" explaining steps the home will take to correct problems and improve care. When a nursing home repeatedly fails to meet standards or when the violations jeopardize the health and safety of residents, consumers expect regulators to take strong action.

The following sanctions can be used by MDBHS to encourage or enable nursing homes to comply with laws and provide quality care for residents:

• regular visits by inspectors to check the home’s progress at correcting problems,
• a monetary fine that the nursing home must pay to the government,
• ban on admissions,
• ending Medicare or Medicaid payments,
• appointment of a temporary management team to run the facility,
• closure of the home.

A ban on admissions means that the nursing home may not admit new residents until the home meets acceptable standards of care. CBC has seen nursing homes work very hard to improve care after a ban on admissions is imposed. A ban on admissions is used:

• so the facility can focus its resources on improving care and services to current residents,
• to protect future residents from receiving inadequate care,
• to provide enough time so that inspectors can assure that changes are firmly established in the facility,
• to give the home a financial interest in correcting problems – limiting admissions decreases he home’s revenues, and
• to prevent a nursing home that is closing from admitting new residents.

Frequently, a ban on admissions is not implemented often enough or early enough to prevent problems from getting worse. In general, only nursing homes with severe widespread and persistent failure to meet key care standards are subjected to enforcement actions.

If you believe a ban on admission would help your nursing home solve problems, communicate your thoughts and ideas to the home’s Licensing Officer at MDBHS immediately following the inspection. The Licensing Officer decides when survey findings indicate a need for enforcement and makes this decision within 10 work days after the inspection. You local Long Term Care Ombudsman can help you determine who the Licensing Officer is for your nursing home. You may also want to talk to your state Representative or Senator about the need for a ban on admission.

When communicating with the Licensing Officer, keep in mind that MDBHS policy says that a ban on admission my be used when the home’s problems:

• are a pattern or trend which impair the ability of the home to provide for the residents safety or meet the residents’ needs and respectfully care for residents,
• have been repeated over a period of time and impair the home’s ability to provide for the residents safety, meet the residents’ needs and respectfully care for residents,
• present a potential danger to the health or safety or residents and the home has not fixed the problems,
• are the result of insufficient staff including when the home does not have enough staff to meet resident care needs, does not have a director of nursing, does not have a licensed nurse on duty at all times, or does not meet minimum nursing staff to resident ratios on all 3 shifts.

According to MDBHS policy, a ban on admissions can be lifted after the care problems have been corrected and the home continues operating well for at least one month. Usually, inspectors revisit the home to assure the problems have been corrected. Often, the MDBHS may permit the home to admit a limited number of residents each week. By permitting the home to slowly increase its census, the MDBHS hopes to assure changes are long-lasting. The MDBHS hopes to assure changes are long-lasing. The MDBHS can re-impose a ban on admission at any time if problems reappear.

MDBHS can also ban readmissions to the home or require the Licensing Officer approval for any readmission. A ban on readmissions means the nursing home cannot readmit resident who were away from the home due to a hospitalization or a leave of absence. Usually, MDBHS uses this option to protect residents with special care needs from returning to a nursing home that is not capable of meeting the resident’s special needs. The Licensing Officer must approve the readmission of each resident. The nursing home must inform any resident who wants to return about the ban on readmissions and the basis for the ban.

If you need the name and address of your home’s Licensing Officer or a copy of the MDBHS ban on admission policy, please contact your local long term care ombudsman in the nearest office.

Rev: 09/98, 04/99, 03/00, 03/03