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General Assembly Raised Bill No. 7103
January Session, 2019
LCO No. 3679
Referred to Committee on AGING
Introduced by:
(AGE)
AN ACT CONCERNING NURSING H OME FALLS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-550 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2019): 2
(a) (1) As used in this section, (A) "nursing home facility" has the 3
same meaning as provided in section 19a-521, (B) "residential care 4
home" has the same meaning as provided in section 19a-521, and (C) 5
"chronic disease hospital" means a long-term hospital having facilities, 6
medical staff and all necessary personnel for the diagnosis, care and 7
treatment of chronic diseases; and (2) for the purposes of subsections 8
(c) and (d) of this section, and subsection (b) of section 19a-537, 9
"medically contraindicated" means a comprehensive evaluation of the 10
impact of a potential room transfer on the patient's physical, mental 11
and psychosocial well-being, which determines that the transfer would 12
cause new symptoms or exacerbate present symptoms beyond a 13
reasonable adjustment period resulting in a prolonged or significant 14
negative outcome that could not be ameliorated through care plan 15
intervention, as documented by a physician or an advanced practice 16 Raised Bill No. 7103
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registered nurse in a patient's medical record. 17
(b) There is established a patients' bill of rights for any person 18
admitted as a patient to any nursing home facility, residential care 19
home or chronic disease hospital. The patients' bill of rights shall be 20
implemented in accordance with the provisions of Sections 1919(b), 21
1919(c), 1919(c)(2), 1919(c)(2)(D) and 1919(c)(2)(E) of the Social Security 22
Act. The patients' bill of rights shall provide that each such patient: (1) 23
Is fully informed, as evidenced by the patient's written 24
acknowledgment, prior to or at the time of admission and during the 25
patient's stay, of the rights set forth in this section and of all rules and 26
regulations governing patient conduct and responsibilities; (2) is fully 27
informed, prior to or at the time of admission and during the patient's 28
stay, of services available in such facility or chronic disease hospital, 29
and of related charges including any charges for services not covered 30
under Titles XVIII or XIX of the Social Security Act, or not covered by 31
basic per diem rate; (3) in such facility or hospital is entitled to choose 32
the patient's own physician or advanced practice registered nurse and 33
is fully informed, by a physician or an advanced practice registered 34
nurse, of the patient's medical condition unless medically 35
contraindicated, as documented by the physician or advanced practice 36
registered nurse in the patient's medical record, and is afforded the 37
opportunity to participate in the planning of the patient's medical 38
treatment and to refuse to participate in experimental research; (4) in a 39
residential care home or a chronic disease hospital is transferred from 40
one room to another within such home or chronic disease hospital only 41
for medical reasons, or for the patient's welfare or that of other 42
patients, as documented in the patient's medical record and such 43
record shall include documentation of action taken to minimize any 44
disruptive effects of such transfer, except a patient who is a Medicaid 45
recipient may be transferred from a private room to a nonprivate 46
room, provided no patient may be involuntarily transferred from one 47
room to another within such home or chronic disease hospital if (A) it 48
is medically established that the move will subject the patient to a 49
reasonable likelihood of serious physical injury or harm, or (B) the 50 Raised Bill No. 7103
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patient has a prior established medical history of psychiatric problems 51
and there is psychiatric testimony that as a consequence of the 52
proposed move there will be exacerbation of the psychiatric problem 53
that would last over a significant period of time and require 54
psychiatric intervention; and in the case of an involuntary transfer 55
from one room to another within such home or chronic disease 56
hospital, the patient and, if known, the patient's legally liable relative, 57
guardian or conservator or a person designated by the patient in 58
accordance with section 1-56r, is given not less than thirty days' and 59
not more than sixty days' written notice to ensure orderly transfer 60
from one room to another within such home or chronic disease 61
hospital, except where the health, safety or welfare of other patients is 62
endangered or where immediate transfer from one room to another 63
within such home or chronic disease hospital is necessitated by urgent 64
medical need of the patient or where a patient has resided in such 65
home or chronic disease hospital for less than thirty days, in which 66
case notice shall be given as many days before the transfer as 67
practicable; (5) is encouraged and assisted, throughout the patient's 68
period of stay, to exercise the patient's rights as a patient and as a 69
citizen, and to this end, has the right to be fully informed about 70
patients' rights by state or federally funded patient advocacy 71
programs, and may voice grievances and recommend changes in 72
policies and services to nursing home facility, residential care home or 73
chronic disease hospital staff or to outside representatives of the 74
patient's choice, free from restraint, interference, coercion, 75
discrimination or reprisal; (6) shall have prompt efforts made by such 76
nursing home facility, residential care home or chronic disease hospital 77
to resolve grievances the patient may have, including those with 78
respect to the behavior of other patients; (7) may manage the patient's 79
personal financial affairs, and is given a quarterly accounting of 80
financial transactions made on the patient's behalf; (8) is free from 81
mental and physical abuse, corporal punishment, involunta ry 82
seclusion and any physical or chemical restraints imposed for 83
purposes of discipline or convenience and not required to treat the 84
patient's medical symptoms. Physical or chemical restraints may be 85 Raised Bill No. 7103
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imposed only to ensure the physical safety of the patient or other 86
patients and only upon the written order of a physician or an 87
advanced practice registered nurse that specifies the type of restraint 88
and the duration and circumstances under which the restraints are to 89
be used, except in emergencies until a specific order can be obtained; 90
(9) is assured confidential treatment of the patient's personal and 91
medical records, and may approve or refuse their release to any 92
individual outside the facility, except in case of the patient's transfer to 93
another health care institution or as required by law or third-party 94
payment contract; (10) receives quality care and services with 95
reasonable accommodation of individual needs and preferences, 96
except where the health or safety of the individual would be 97
endangered, and is treated with consideration, respect, and full 98
recognition of the patient's dignity and individuality, including 99
privacy in treatment and in care for the patient's personal needs; (11) is 100
not required to perform services for the nursing home facility, 101
residential care home or chronic disease hospital that are not included 102
for therapeutic purposes in the patient's plan of care; (12) may 103
associate and communicate privately with persons of the patient's 104
choice, including other patients, send and receive the patient's 105
personal mail unopened and make and receive telephone calls 106
privately, unless medically contraindicated, as documented by the 107
patient's physician or advanced practice registered nurse in the 108
patient's medical record, and receives adequate notice before the 109
patient's room or roommate in such facility, home or chronic disease 110
hospital is changed; (13) is entitled to organize and participate in 111
patient groups in such facility, home or chronic disease hospital and to 112
participate in social, religious and community activities that do not 113
interfere with the rights of other patients, unless medically 114
contraindicated, as documented by the patient's physician or advanced 115
practice registered nurse in the patient's medical records; (14) may 116
retain and use the patient's personal clothing and possessions unless to 117
do so would infringe upon rights of other patients or unless medically 118
contraindicated, as documented by the patient's physician or advanced 119
practice registered nurse in the patient's medical record; (15) is assured 120 Raised Bill No. 7103
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privacy for visits by the patient's spouse or a person designated by the 121
patient in accordance with section 1-56r and, if the patient is married 122
and both the patient and the patient's spouse are inpatients in the 123
facility, they are permitted to share a room, unless medically 124
contraindicated, as documented by the attending physician or 125
advanced practice registered nurse in the medical record; (16) is fully 126
informed of the availability of and may examine all current state, local 127
and federal inspection reports and plans of correction; (17) may 128
organize, maintain and participate in a patient-run resident council, as 129
a means of fostering communication among residents and between 130
residents and staff, encouraging resident independence and 131
addressing the basic rights of nursing home facility, residential care 132
home and chronic disease hospital patients and residents, free from 133
administrative interference or reprisal; (18) is entitled to the opinion of 134
two physicians concerning the need for surgery, except in an 135
emergency situation, prior to such surgery being performed; (19) is 136
entitled to have the patient's family or a person designated by the 137
patient in accordance with section 1-56r meet in such facility, 138
residential care home or chronic disease hospital with the families of 139
other patients in the facility to the extent such facility, residential care 140
home or chronic disease hospital has existing meeting space available 141
that meets applicable building and fire codes; (20) is entitled to file a 142
complaint with the Department of Social Services and the Department 143
of Public Health regarding patient abuse, neglect or misappropriation 144
of patient property; (21) is entitled to have psychopharmacologic drugs 145
administered only on orders of a physician or an advanced practice 146
registered nurse and only as part of a written plan of care developed in 147
accordance with Section 1919(b)(2) of the Social Security Act and 148
designed to eliminate or modify the symptoms for which the drugs are 149
prescribed and only if, at least annually, an independent external 150
consultant reviews the appropriateness of the drug plan; (22) is 151
entitled to be transferred or discharged from the facility only pursuant 152
to section 19a-535, 19a-535a or 19a-535b, as applicable; (23) is entitled 153
to be treated equally with other patients with regard to transfer, 154
discharge and the provision of all services regardless of the source of 155 Raised Bill No. 7103
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payment; (24) shall not be required to waive any rights to benefits 156
under Medicare or Medicaid or to give oral or written assurance that 157
the patient is not eligible for, or will not apply for benefits under 158
Medicare or Medicaid; (25) is entitled to be provided information by 159
the nursing home facility or chronic disease hospital as to how to 160
apply for Medicare or Medicaid benefits and how to receive refunds 161
for previous payments covered by such benefits; (26) is entitled to 162
receive a copy of any Medicare or Medicaid application completed by 163
a nursing home facility, residential care home or chronic disease 164
hospital on behalf of the patient or to designate that a family member, 165
or other representative of the patient, receive a copy of any such 166
application; (27) on or after October 1, 1990, shall not be required to 167
give a third-party guarantee of payment to the facility as a condition of 168
admission to, or continued stay in, such facility; (28) is entitled to have 169
such facility not charge, solicit, accept or receive any gift, money, 170
donation, third-party guarantee or other consideration as a 171
precondition of admission or expediting the admission of the 172
individual to such facility or as a requirement for the individual's 173
continued stay in such facility; [and] (29) shall not be required to 174
deposit the patient's personal funds in such facility, home or chronic 175
disease hospital; and (30) if a patient at a nursing home facility, is 176
informed of the facility's responsibility under federal law to mitigate 177
patient fall risks, including, but not limited to, providing sufficient 178
staff supervision of a patient at risk for falls and assistance devices to 179
prevent such falls. 180
(c) The patients' bill of rights shall provide that a patient in a rest 181
home with nursing supervision or a chronic and convalescent nursing 182
home may be transferred from one room to another within such home 183
only for the purpose of promoting the patient's well-being, except as 184
provided pursuant to subparagraph (C) or (D) of this subsection or 185
subsection (d) of this section. Whenever a patient is to be transferred, 186
such home shall effect the transfer with the least disruption to the 187
patient and shall assess, monitor and adjust care as needed subsequent 188
to the transfer in accordance with subdivision (10) of subsection (b) of 189 Raised Bill No. 7103
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this section. When a transfer is initiated by such home and the patient 190
does not consent to the transfer, such home shall establish a 191
consultative process that includes the participation of the attending 192
physician or advanced practice registered nurse, a registered nurse 193
with responsibility for the patient and other appropriate staff in 194
disciplines as determined by the patient's needs, and the participation 195
of the patient, the patient's family, a person designated by the patient 196
in accordance with section 1-56r or other representative. The 197
consultative process shall determine: (1) What caused consideration of 198
the transfer; (2) whether the cause can be removed; and (3) if not, 199
whether such home has attempted alternatives to transfer. The patient 200
shall be informed of the risks and benefits of the transfer and of any 201
alternatives. If subsequent to the completion of the consultative 202
process a patient still does not wish to be transferred, the patient may 203
be transferred without the patient's consent, unless medically 204
contraindicated, only (A) if necessary to accomplish physical plant 205
repairs or renovations that otherwise could not be accomplished; 206
provided, if practicable, the patient, if the patient wishes, shall be 207
returned to the patient's room when the repairs or renovations are 208
completed; (B) due to irreconcilable incompatibility between or among 209
roommates, which is actually or potentially harmful to the well-being 210
of a patient; (C) if such home has two vacancies available for patients 211
of the same sex in different rooms, there is no applicant of that sex 212
pending admission in accordance with the requirements of section 19a-213
533 and grouping of patients by the same sex in the same room would 214
allow admission of patients of the opposite sex, that otherwise would 215
not be possible; (D) if necessary to allow access to specialized medical 216
equipment no longer needed by the patient and needed by another 217
patient; or (E) if the patient no longer needs the specialized services or 218
programming that is the focus of the area of such home in which the 219
patient is located. In the case of an involuntary transfer, such home 220
shall, subsequent to completion of the consultative process, provide 221
the patient and the patient's legally liable relative, guardian or 222
conservator if any or other responsible party if known, with at least 223
fifteen days' written notice of the transfer, which shall include the 224 Raised Bill No. 7103
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reason for the transfer, the location to which the patient is being 225
transferred, and the name, address and telephone number of the 226
regional long-term care ombudsman, except that in the case of a 227
transfer pursuant to subparagraph (A) of this subsection at least thirty 228
days' notice shall be provided. Notwithstanding the provisions of this 229
subsection, a patient may be involuntarily transferred immediately 230
from one room to another within such home to protect the patient or 231
others from physical harm, to control the spread of an infectious 232
disease, to respond to a physical plant or environmental emergency 233
that threatens the patient's health or safety or to respond to a situation 234
that presents a patient with an immediate danger of death or serious 235
physical harm. In such a case, disruption of patients shall be 236
minimized; the required notice shall be provided not later than 237
twenty-four hours after the transfer; if practicable, the patient, if the 238
patient wishes, shall be returned to the patient's room when the threat 239
to health or safety that prompted the transfer has been eliminated; and, 240
in the case of a transfer effected to protect a patient or others from 241
physical harm, the consultative process shall be established on the next 242
business day. 243
(d) Notwithstanding the provisions of subsection (c) of this section, 244
unless medically contraindicated, a patient who is a Medicaid recipient 245
may be transferred from a private to a nonprivate room. In the case of 246
such a transfer, the nursing home facility shall (1) give not less than 247
thirty days' written notice to the patient and the patient's legally liable 248
relative, guardian or conservator, if any, a person designated by the 249
patient in accordance with section 1-56r or other responsible party, if 250
known, which notice shall include the reason for the transfer, the 251
location to which the patient is being transferred and the name, 252
address and telephone number of the regional long-term care 253
ombudsman; and (2) establish a consultative process to effect the 254
transfer with the least disruption to the patient and assess, monitor 255
and adjust care as needed subsequent to the transfer in accordance 256
with subdivision (10) of subsection (b) of this section. The consultative 257
process shall include the participation of the attending physician or 258 Raised Bill No. 7103
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advanced practice registered nurse, a registered nurse with 259
responsibility for the patient and other appropriate staff in disciplines 260
as determined by the patient's needs, and the participation of the 261
patient, the patient's family, a person designated by the patient in 262
accordance with section 1-56r or other representative. 263
(e) Any nursing home facility, residential care home or chronic 264
disease hospital that negligently deprives a patient of any right or 265
benefit created or established for the well-being of the patient by the 266
provisions of this section shall be liable to such patient in a private 267
cause of action for injuries suffered as a result of such deprivation, 268
including, but not limited to, injuries sustained from falls due to a 269
nursing home facility's failure to mitigate fall risks. Upon a finding that 270
a patient has been deprived of such a right or benefit, and that the 271
patient has been injured as a result of such deprivation, damages shall 272
be assessed in the amount sufficient to compensate such patient for 273
such injury. The rights or benefits specified in subsections (b) to (d), 274
inclusive, of this section may not be reduced, rescinded or abrogated 275
by contract. In addition, where the deprivation of any such right or 276
benefit is found to have been wilful or in reckless disregard of the 277
rights of the patient, punitive damages may be assessed. A patient may 278
also maintain an action pursuant to this section for any other type of 279
relief, including injunctive and declaratory relief, permitted by law. 280
Exhaustion of any available administrative remedies shall not be 281
required prior to commencement of suit under this section. 282
(f) In addition to the rights specified in subsections (b), (c) and (d) of 283
this section, a patient in a nursing home facility is entitled to have the 284
facility manage the patient's funds as provided in section 19a-551. 285
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2019 19a-550
AGE Joint Favorable Raised Bill No. 7103
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