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Contact Information

DeGraff Memorial Hospital
445 Tremont Street
North Tonawanda, NY 14120

Dose Index

DeGraff Skilled Nursing Facility
Resident Rights

Each resident has the right to:

  1. Be informed and receive in writing a copy of the Resident Bill of Rights.
  2. Be informed of facility services and related charges.
  3. Be informed of bed reservation policy.
  4. Receive appropriate medical care, obtain diagnosis and prognosis, etc. from the physician.
    Self medicate if desired and deemed appropriate.
  5. Take part in any room transfer or discharge plans prior to a move.
  6. Voice concerns, have complaints resolved, invite advocates and be involved in a resident council to discuss concerns and interests of the resident. Participate in the established
    resident council.
  7. Be advised of complaint procedures.
  8. Manage personal finances and/or be given at least a quarterly accounting of
    transactions made.
  9. Be free from physical/chemical abuse, mistreatment or neglect as well as the
    use of physical measure/safety devices unless indicated by a physician.
  10. Security in storing personal possessions and confidential treatment of medical records.
  11. Dignity, independent decision making and respect.
  12. Receive assistance in obtaining guardianship or conservatorship.
  13. Freedom from performing services not included in the plan of care.
  14. Communicate privately with persons of his/her choice, send and receive mail unopened.
  15. Take part in social, religious and community activities.
  16. Be informed of visiting hours.
  17. Keep and use personal clothing.
  18. Privacy in personal care and visitation with spouse.
  19. Civil and religious liberty.
  20. Be provided with kosher foods as required per religious beliefs.
  21. Inquire as to his/her specific assignment to category under RUG classification. (If you wish to know your PRI score, please contact your social worker).
  22. Be informed of Advance Directives (Do Not Resuscitate Order, Living Will, and Health Care Proxy) and the right to implement advance directives.
  23. Right to refuse to serve as a medical research subject.
  24. To use tobacco in accordance with applicable policy, rules and laws.
  25. To consume a reasonable amount of alcoholic beverages.
  26. Right to review results of the facility annual survey and corrective action plan.

I. Policy

Each resident is fully informed of the Resident Bill of Rights and its Policies and Procedures, as evidenced by the resident’s or designated representative written acknowledgement upon admission. He/she will receive a copy of the facility’s Resident Handbook, and an explanation of the resident’s responsibility to obey all reasonable regulations of the facility and to respect the personal rights and property of other residents.

Procedure:

  1. At the time of admission the resident and/or designated representative will be given, verbally and in writing, an explanation of the Resident Bill of Rights by the Director of Social Work. The resident and/or designated representative will also be given a copy of the Resident Handbook. The Resident Handbook will include:
    1. Statement of resident responsibilities
    2. Statement of Rules and Regulations for residents
    3. A list of services available to the residents
    4. A statement of financial information and obligations of the residents and/or designated representatives.
  2. Each resident and/or designated representative shall read or have read to them the Bill of Rights, application packet, and Resident Handbook and sign the applicable form indicating that they have been read and understood. This form will be placed in the medical record and a copy will be kept in the Social Work file.
  3. Copies of the Bill of Rights are clearly posted throughout the facility.
  4. The staff of the facility is trained and involved in the implementation of these policies and procedures and are to respect and protect each resident’s rights. Staff members are made aware of the ethical issues involved in the resident’s care and advocate on the resident’s behalf.
  5. The Bill of Rights is reviewed with the residents and/or designated representative annually.

II. Policy

Each resident and/or designated representative is fully informed upon admission as well as during his/her stay, of services available in the facility, of related charges for services not covered by medical coverage, and services not included in the daily rate. The resident will be informed in advance of the cost of any procedure not included in the daily rate, and of the availability of services.

Procedure

    1. At the time of admission, the resident and/or designated representative will be provided with a written of services available at the facility and the cost of care, and all items included in the daily rate. Any items excluded shall also be listed individually.
    2. Residents will be informed ahead of time of any changes in charges or the availability of services.

III. Policy

Each resident and/or representative is informed verbally and in writing at the time of admission, and again at the time of transfer for any reason, of the facility’s bed retention or reservation policy.

Procedure

    1. When residents on Medicaid have been residents in the Kaleida Health Long Term Care Facility’s for 30 days, and then require admission to an acute hospital, they will have a bed reserved for a period not to exceed 20 days. Private pay residents should make arrangements with the Director of Social Work/Admissions. If a resident returns after the 20 day time period, they are admitted as a new admission.
    2. When a resident is admitted to an acute hospital, a letter will be sent to the resident and/or designated representative regarding the bed retention policy by the Social Work Department. A representative from the Social Work Department will be available to explain and answer questions regarding the bed retention policy.

IV. Policy

Each resident is to be assured of adequate and appropriate medical/dental care. The resident will be fully informed by a physician of his/her medical condition unless medically contradicted (as documented by a physician in the medical record); will be afforded the opportunity to participate in the planning of his/her medical treatment; has the right to refuse participation in experimental research, and to refuse medication or treatment after being fully informed, and has understanding of the consequences of such action. The resident will have the right to self-administer his/her medications if he/she so desires and if his/her assessments demonstrate that he/she is physically and cognitively able to do so.

Procedure

    1. Each resident has the right to designate a surrogate decision maker if he/she cannot understand a proposed treatment or procedure or cannot communicate his/her wished regarding care.
    2. Each resident has the right to select his/her physician and dentist. The physician must be a licensed practicing physician with privileges at The Kaleida Health System. For Deaconess residents, a dentist may be chosen from a panel of dentists within the Deaconess Center Dental Clinic. If a resident chooses to select another dentist, they will be responsible for the arrangements and the cost of care.
    3. The resident’s physician will inform the resident of his/her medical condition, to include: condition and change in condition, proposed treatments or procedures, and potential benefits and risks thereof, course of treatment and any significant changes.
    4. When resident’s involvement in such matters as listed above is medically contraindicted, the physician will document the same in the resident’s medical record.
    5. The resident has the right to give informed consent. The ongoing treatment plan for the resident will be discussed with him/her unless medically inadvisable, as documented by the physician in the medical record. If necessary, the designated representative will be advised of the resident’s medical condition. The resident and/or designated representative ahs the right to know alternatives to recommended treatment and/or consequences of failure to get treatment as a means of assisting him/her in decision making. Necessary information regarding additional costs, if any, will be provided to assist the resident/designated representative in making appropriate and informed decisions.
    6. The resident has a right to involve his/her family or designated representative in making care or treatment decisions. Each resident and/or designated representative will be afforded the opportunity to attend and participate in resident care planning conferences which are held on a regular basis.
    7. The surrogate decision maker will act on the resident’s behalf when: the resident requests for him/her to do so; the resident has been legally declared incompetent; or, the interdisciplinary team, including the physician, find the resident is incapable of understanding or making decisions.
    8. Each resident has the right to participate or not to participate in research, investigation, or clinical trials. Each resident considered for participation in research will be full informed as to what is involved, the nature of the study, as well as the designated representative prior to participation. Verbal consent will be documented in the medical record. The facility respects and protects resident rights during research, investigation, or clinical trials involving human subjects.
    9. Each resident has a right to receive adequate, appropriate care and may refuse medication and treatment after being fully informed of the consequences of such action.
    10. Designated representatives will be notified regarding unexpected incidents.
    11. Each resident will be assessed initially upon admission and yearly thereafter by the Resident Care Planning Team for his/her ability to self administer his/her own medications. Those residents deemed capable of self administering medications and indicate a desire to self administer medications will be afforded the opportunity to do so.
    12. Each resident and/or designated representative will be informed, upon admission and throughout his/her stay, of how to obtain the name and specialty of his/her physician and how to contact the physician as well as the dental provider. This resident will be encouraged to exercise their right to communicate with their his/her physician and dentist.
    13. The facility will arrange appropriate transportation for the resident to and from the facility for medical appointments or other activities as indicated in the care plan. An escort will be provided if medically necessary. The resident may be responsible for the cost of the transportation dependent upon his/her insurance coverage. The resident may choose to have a designated representative transport him/her to appointments. The nursing unit should be notified of such wishes and if deemed appropriate and safe, the request will be granted.

V. Policy

Each resident and/or designated representative will be informed that all admissions to Kaleida Health Long Term Care Facility’s are based upon the resident’s display of medical need as defined in the federal, state and local regulations.

Procedure

    1. Appropriate discharge plans are initiated upon admission.
    2. If a resident admitted to the facility no longer requires the level of care he/she was admitted to, or if the resident’s needs cannot be met after reasonable accommodation by the facility, or if a resident’s continued stay at the facility poses a danger to the health or safety of that resident or of other residents, staff or visitors, or if the resident or designated representative is unwilling to cooperate with the facility in obtaining payment for the stay, the facility will recommend alternate placement.
    3. Prior to any transfer or discharge, the facility will notify the resident and/or designated representative and will state the reasons for the change at least thirty (30) days before the transfer or discharge is made (except if the safety or health of individuals in the facility is endangered, or if the resident’s health improves sufficiently to allow an earlier transfer or discharge, or immediate transfer is required by the resident’s urgent medical need, or the resident has requested the transfer or discharge).
    4. In the event of transfer or discharge, the resident will be given notice of the right to appeal the transfer or discharge, along with the necessary procedural information. If suitable alternate placement is available and the resident is willing to be transferred after consultation with his or her designated representative, arrangements will be made. When several alternate placements are available at the appropriate level, the resident and/or designated representative may choose which placement is preferred. A resident can remain on the waiting list of the facility of his or her choice.
    5. Payment for care provided at any other health care facility or institution is the responsibility of the resident and/or designated representative and in no event is the facility liable for such charges.
    6. Each resident and/or designated representative will be given prior notice (situation permitting) of a room change. Reasons for a room change may include: a resident’s request for a move; a medical situation of a particular resident; a roommate conflict; or an emergency situation.
    7. Each resident and/or designated representative will be informed in advance of a change in roommate assignment.

VI. Policy

Each resident will be encouraged and assisted throughout his/her period of stay to exercise his/her rights as a resident and as a citizen, including the right to vote. He or she may voice grievances, has a right of action for damages or other relief for deprivations or infringements of his/her right to adequate and proper treatment and care established by any applicable statute, rule, regulation or contract. He or she may recommend changes in policies and services to facility, staff and/or to outside representatives of his/her choice, free from restraint, interference, coercion, discrimination or reprisal.

Procedure

    1. Residents will be assisted with voter registration and absentee ballots will be available. Provisions will be made through the Resident Council that allow residents to participate in absentee voting.
    2. Residents are free to express any complaints they may have while a resident in the facility. Residents can do this by speaking with their Social Worker, their Head Nurse, the Director of Nursing, the Administrator, or through Resident Council. The facility encourages suggestions to change any policies or procedures in ways which would benefit the residents as well as involvement in resolving conflicts about care decisions.

VII. Policy

Each resident may participate in the established Resident Council.

Procedure

    1. A resident Council consisting of interested residents will be available to develop or recommend changes in operation of the facility.
    2. A designated staff person will take minutes of the regularly held Resident Council meetings. A copy will be given to appropriate departments to address concerns.
    3. Appropriate departments will respond in writing to concerns stated in the Resident Council minutes.

VIII. Policy

Each resident and/or designated representative is instructed in the facility’s complaint procedures, verbally and in writing, and is provided with the name, address and telephone number of the office established by the New York State Department of Health to receive complaints, and of the new York State Office for the Aging Ombudsman Program. The resident has the right to be involved in resolving conflicts about care issues including treatment, admission, discharge, and room/roommate situations.

Procedure

    1. If a resident and/or designated representative fell his/her rights have been violated, complaints can be made to the Social Worker, Head Nurse, Director of Social Work, Director of Nursing, Administrator, or through Resident Council.
    2. Each resident and/or designated representative will be afforded the opportunity to complete a “Patient Relations Form” to report a concern. The “Patient Relations Form” will be sent to the administrator and appropriate action will be taken in a timely manner.
    3. Each resident and/or designated representative has the right to file a claim with the NYS Health Department in regard to suspected abuse, neglect, and misappropriations of resident property in the facility. The New York State Department of Health, located at 584 Delaware Avenue, Buffalo, NY 14202 can be reached at (716) 847-4320 or 1-888-201-4563.
    4. The NYS local office for the aging Ombudsman Program is located at Red Cross Headquarters, telephone: (716) 886-7500.

IX. Policy

Each resident and/or designated representative may manage his/her personal financial affairs and is given a quarterly accounting of financial transactions made on the resident’s behalf. The facility may accept written delegation of this responsibility to the facility, for any period of time in conformance with State Law.

Procedure

    1. Each resident may have a personal interest-bearing bank account for his or her own funds, or for the personal allowance which is provided for under the regulations of the New York State department of Social Services.
    2. Residents may make cash withdrawals through the Patient Accounts Clerk and such cash withdrawals will be deducted from the resident’s personal account.
    3. Quarterly statements of financial transactions shall be provided by the Patient Accounts Clerk to each resident and/or designated representative.
    4. The resident may delegate management of personal financial affairs.
    5. Each resident and/or designated representative must give written authorization for cash withdrawals.
    6. Each resident may have a legally appointed person manage his/her finances.

X. Policy

Each resident will be free from verbal, sexual, physical and mental abuse or neglect. Physical and chemical restraints will not be utilized unless authorized by a physician for a specified and limited period of time, or when necessary to protect the resident from injury to self or others, and to assist the resident to attain and maintain optimum levels of physical and emotional functions.

Procedure

    1. Each resident has the right to courteous, fair and respectful treatment.
    2. Each resident has the right of freedom from chemical or physical restraint.
    3. Residents will be restrained physically or by the use of drugs upon the written order of the physician for a specified and limited period of time. Physical restraints will only be used as a last resort in preventing the resident from injuring themselves or others and will be documented in the resident’s medical record.
    4. In the case of an emergency, a qualified licensed nurse may order the use of a physical restraint. The reasons for such use must be documented in the resident’s medical record. The attending physician must be notified within 24 hours of the use of such a restraint.
    5. Chemical restraints will be administered to residents only after prior consultation with the attending physician and only upon his/her order. The effectiveness and side effects of such chemical restraints will be assessed frequently by the professional nurse and recorded in the resident’s medical record. Chemical restraints will only be used as a last resort in preventing the resident from injuring themselves or others. Restraints are used only when alternatives are not effective as determined by the interdisciplinary care planning team.
    6. Residents and/or designated representatives will give consent for ongoing use of physical restraints and be afforded the opportunity to participate in Resident Care Planning meetings to voice concerns.
    7. Any staff person who is found to have committed abuse against any resident will be appropriately disciplined and their actions reported to appropriate agencies.

XI. Policy

Each resident is assured security in storing personal possessions, confidential treatment of his/her personal and medical records and may approve or refuse their release to any individual outside the facility, except in the case of transfer to another health care facility or as required by law or third party contract. Also, each resident and/or designated representative has the right to inspect and purchase photocopies of his/her medical record.

Procedure

    1. Each resident and/or designated representative must sign a written release form in order to have valuables, personal possessions or medical records released to any individual outside of the facility except when being discharged to another facility or as required by lay or third party payor.
    2. Personal and medical records are available only to those professionals participating in the care and treatment of residents or to the business office.
    3. Residents and/or designated representatives, upon 24 hours notice in writing to the facility, may inspect their medical records and/or purchase photocopies of their medical records at the facility’s prevailing rate for photocopying. Two working days notice is needed in order to purchase photocopies. A designated staff member will be present during personal and/or medical record inspection to assist and answer any questions the resident may have during their review.
    4. Each resident may store valuables in the Patient Accounts Clerk’s office. A resident may bring the items directly to the Patient Accounts Clerk and a receipt will be given. Items may also be left with the Security department and the security Department will forward them to the Patient Accounts Clerk. A copy of the possession log envelope will be made.
    5. Each resident may request a nightstand with a locked drawer for storing personal possessions. Personal items and/or valuables can be given to either the Business Office or Security for safekeeping.

XII. Policy

Each resident is treated with consideration, respect and full recognition of his/her dignity and individuality, including privacy in treatment and in care for personal needs in order to maintain their quality of life. Each resident has the right to perform or refuse to perform tasks in or for the facility.

Procedure

    1. There will be inservice training programs for all staff regarding the need for courtesy and respect to be given to residents.
    2. Each resident will have the right to independent decision making as appropriate for them to do so.
    3. Residents are to be afforded dignity by addressing them as Mr., Mrs., Ms., Miss. and last name unless they request otherwise.
    4. Efforts to ensure privacy during physician and nursing visits will be achieved by either closing curtains of by using the examining room when necessary.
    5. All staff will knock before entering a resident’s room in consideration for a resident’s right to a distinct life space.
    6. Life-long patterns of living will be respected and maintained to the fullest extent possible.
    7. Routines will be flexible and residents given choices. Attendance at religious services and other activities provided are at the discretion of the resident.
    8. If a resident desires to work or volunteer within the facility, a plain is devised and agreed upon by the resident and approved by administration. The services to be performed by the resident will be documented in his/her care plan and any compensation for paid services will be at or above the going rates for the services performed.

XIII. Policy

The facility will assist the resident, if indicated, in obtaining guardianship or conservatorship services.

Procedure

    1. The Social Work Department, in conjunction with administration, will follow the appropriate steps in order to obtain a guardianship or conservatorship for a resident deemed by the interdisciplinary team (including the MD) as needing such a service. Legal counsel will be called upon by administration to assist with legal proceedings.

XIV. Policy

Residents shall not be required to perform services for the facility that are not included in the plan care for therapeutic benefit.

Procedure

    1. Any service in the nature of work that is assigned to the resident, will be done voluntarily and documented in the resident’s care plan.

XV. Policy

Each resident may associate and communicate privately with persons of his/her choice, may join with other residents or individuals with other residents or individuals within or outside of the facility to work for improvements in resident care, and send and receive his/her mail unopened.

Procedure

    1. Residents may have privacy with visitors.
    2. Restriction on visitors is only at the request of the resident or upon the recommendation of the physician for a specific reason.
    3. Mail will be delivered to residents and opened by the resident unless physically and/or cognitively able to do so. A designated staff person, relative or friend may then be permitted to help.
    4. Telephones will be available for resident use, and in the event of the inability to handle his/her own calls, the resident will be given assistance.
    5. Residents may formulate or join a committee with other residents or other interested individuals in improving the care of residents.
    6. Translation/interpretation services will be provided if needed; the facility will also meet the needs of those residents with speech, hearing, and language impairments by obtaining and utilizing devices to assist with communication.
    7. Residents may have access to stationary, postage and writing instruments at their won expense.

XVI. Policy

Each resident may meet with, and participate in activities of a social, religious, and community nature at his/her discretion.

Procedure

    1. Residents will be encouraged to participate in programs and activities presented at this facility and if they so desire, may attend activities outside the facility with the approval of the resident’s physician and so documented in the medical record.
    2. The resident’s spiritual and cultural beliefs are respected and the facility understands that practicing their beliefs may contribute to the well-being of the resident.
    3. The facility provides referral to clergy personnel. If the resident’s choose to do so, they may seek outside clergy members to assist with troubling times.
    4. Religious services and programs are offered and provided within the facility.

XVII. Policy

Each resident and/or designated representative will be informed of visiting hours and rights and responsibilities of residents and visitors.

Procedure

    1. Residents are encouraged to have visitors during visiting hours, 8 a.m. – 8 p.m. Visitors are expected to obey the rules of this facility as explained in the Resident’s Handbook. Exceptions are made as appropriate and necessary by the Administrator or Director of Nursing.

XVIII. Policy

Each resident may retain and use his/her own personal clothing and possessions as space permits unless to do so would infringe upon the rights of other residents.

Procedure

    1. Residents are allowed to retain a reasonable amount of clothing and possessions in their rooms while residing in the facility.

XIX. Policy

Each resident is assured privacy for visits by his/her spouse. Each resident has the right to share a room with a spouse, relative, or partner when both individuals reside within the facility and both consent to the arrangement.

Procedure

    1. It will be the responsibility of the admitting physician to determine the advisability of a couple sharing the same room unless there is a medical, social or psychological factor that precludes their being together. This must be documented in the resident’s medical record.
    2. There should be no infringement upon the rights to privacy with a visiting spouse, relative, or friend if only one member is a resident, unless this infringes upon the privacy of another resident sharing the room.
    3. The resident has a right to free and private communication with persons of his/her choice.
    4. The resident has the right to refuse to talk to persons not associated with the organization or not directly involved in his/her care.

XX. Policy

Each resident is assured of exercising his/her civil and religious liberties, including the right to independent personal decisions and knowledge of available choices shall not be infringed upon; the facility shall encourage and assist in the fullest possible exercise of these rights.

Procedure

      1. Personal decision making will be encouraged in choices regarding activities of daily living, and any other matters that the resident may have.
        1. The resident has the right to participate or refuse to participate in social, spiritual or community activities/groups.
        2. The resident has a right to perform or refuse to perform task sin or for the organization.
      2. Staff will be encouraged to allow for resident independence in aspects of daily living.
      3. Resident’s civil and religious liberties will not be denied and the staff will encourage and assist in the exercising of these rights.

XXI. Policy

Each resident is assured of the right to receive, upon request, kosher food or food products prepared in accordance with the Hebrew orthodox belief.

Procedure

      1. The Hospitality Services Department will be notified of a resident’s request for kosher food or food products and will comply with the resident’s request.

XXII. Policy

Each resident and/or designated representative, upon request will be informed of his/her specific assignment to a resident classification category under Resource Utilization Group (RUGII) Classification system.

Procedure

      1. The resident and/or designated representative will be informed of their right to know the resident’s RUGII assignment upon admission and annually during the Resident Bill of Right’s Review.

XXIII. Policy

Each resident and/or designated representative at the time of admission and during his/her stay is encouraged to exercise his/her right to implement advance directives which identify their health care wishes while they are competent, including whether to provide, forego, or withdraw life-sustaining treatment. These wishes can then be followed when or if they become physically and/or mentally incapable of making their own decisions.

Procedure

      1. At the time of admission, the Social Worker will inform the resident and/or designated representative of the options available to the resident regarding advance directives. These include: Do Not Resuscitate Orders, appointment of a health care agent and establishing a living will.
      2. All advance directives documents will be placed in the resident’s medical record.
      3. Advance directives will be reviewed and revised if desired by the resident and/or designated representative.
      4. Residents will be encouraged to be involved in decisions related to care during their stay and at the end of their lives. Meetings with the interdisciplinary team, resident and/or designated representative will be encouraged to discuss issues and resolve conflicts regarding care issues should they arise. The ethics committee may be asked to review certain situations when directives are not known or if a conflict occurs.
      5. The options regarding advance directives will be reviewed annually during the Resident Bill of Rights Review.
      6. The resident wishes to formulate or not to formulate advance directives will be honored and respected.

Rev: 4-01-84, 1-07-93, 2-27-98, 2-13-01, 6-23-04