Nursing Home's Relaxed Care Philosophy Does Not Exempt It From Federal Law

Some facilities for the aging are moving away from the "hospital" model of nursing homes and replacing it with more resident-centered environments that give meaning to residents' lives. One pioneer in this movement is Eden Alternatives, founded by Dr. William Thomas, who calls himself a "nursing home abolitionist."

But however much such facilities disassociate themselves from the conventional nursing home model, they are not exempted from federal law governing nursing home care, as a Tennessee case recently described by the Center for Medicare Advocacy illustrates.

In the case, Tennessee nursing home inspectors cited a nursing home, Community Care of Rutherford County, Inc., for eight "deficiencies," including a failure to keep residents from falling repeatedly. One resident fell 28 times, with nine injuries, between March and July 2008, and his last fall proved fatal. A second resident fell at least 41 times between July 1, 2008 and April 30, 2009. Tennessee imposed a stiff fine, and Community Care appealed.

In its defense before an administrative law judge, the nursing home said that the falls were a byproduct of the Eden Alternative philosophy of care, which it described as giving residents maximum freedom. "Eden promotes allowing residents mobility and the ability to express preferences, recognizing that there will be ensuing risks," the nursing home told the judge. "Eden promotes allowing residents to take reasonable risks and enjoy the last years of their lives."

The judge complained that the nursing home had never explained exactly what the Eden Alternative program consists of, but in any case he ruled that the program's philosophy does not eliminate the need to follow the protections of the 1987 Nursing Home Reform Law, which establishes minimum standards of care. Calling the nursing home's shortcomings "so egregious as to comprise immediate jeopardy for residents," the judge upheld the fine.

Comments the Center for Medicare Advocacy: "While new and innovative ways of providing care to nursing facility residents should be supported and encouraged, the fundamental requirements of federal law, care plans, and facility policies remain critical to providing residents with the care they need."

To read the judge's decision in the case, click here.

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