What are the laws at group homes?

[Blackcat99]

I am a nurse who is taking care of a mildly DD/physical birth defects patient at a group home. I was told by the night shift live-in aide at the group home to stop waking her up at night to help me turn my large paraplegic patient during the night. I want him turned every 2 hours because he has bedsores. What I want to know is: Are group homes required to have "awake staff" on the night shift? Are group home staff required to help me turn the patient at night or am I out of luck?. It is very difficult to turn this man by myself. The night aide says she is allowed to sleep at night and that she is not obligated to help me turn the patient at night.

[txredheadnurse, BSN, RN]

The quick answer is that the rules and regs about whether or not a group home requires awake staff 24/7 vary state to state. The method for determing whether or not there needs to be awake staff 24 hrs (for those states who allow 8 hours/day for live in staff to sleep) is based on assessments regarding ability to evacuate the home unassisted in the case of emergency, the type of Medicaid waiver program the group home is licensed under and company policies basically.

From what info you have given it sounds as if your patient's requirement for 24 hr awake supervision is being met by your bedside presence with him. I know you need assistance to re position him and you are providing appropriate nursing care to do so and for the sake of safety you need a second person to help you do this. On the other hand the live in aide has a right to sleep since the group home is basically her home except on her days off. If her sleep is interrupted repeatedly she doesn't have an opportunity to nap or take a break during her awake duty time which is 16 hours a day.

So my advice to you is to contact the case manager or group home manager and tell them you need an IDT meeting to determine what to do to provide the care needed to this man in a safe and responsible manner so you don't injury yourself and his decubitis has an opportunity to heal utilizing proven techniques of q2 hour repositioning while in bed. Sorry if this isn't a quick solution but I have had many years of dealing with DD Medicaid waiver/funded programs and they are a maze of requirements. They are not medically based approaches and nurses who work in this field have to become virtually cross trained in non nursing case management and programmatic theories in order to navigate successfully.

[Blackcat99]

Thank you so very much for your help. I will notify my supervisor about this situation and see what can be done.

[jpdlnc]

I agree with txredheadnurse post, regulations are state by state. In Pa the level of staff is determined not by the group home but rather by the individuals service plan based on their needs assessment. It is up to the provider to insure that the individual is place in a "group home" that meets their needs. If this individual is receiving service based on their developmental disability and requires 24 hour nursing care they the plan has to specify the level of staff they require.

[Blackcat99]

Thanks. It is a small group home. There are only 3 patients and they have 2 live in home aides. It seems to me that one aide could work day shift and the other could work night shift. I left a long note for my supervisor about this situation and I hope she will give me a call soon. I will check his service plan more closely and see what it says too.

[TX.RN.Shannon]

Another possible answer to help you, if the supervisor says the aide can sleep, is to see about getting a specialized bed. Maybe with an air mattress to avoid pressure. And there are some that actually turn and tilt the patient, so all you would have to do is tilt him to the desired position and place pilliws for support. Just an idea...