The Most Powerful Thing a Family Can Do in a Nursing Home Costs Nothing

The Most Powerful Thing a Family Can Do in a Nursing Home Costs Nothing

Last week, a Lake Charles television station told the story of a man who spent the final year of his life in a Southwest Louisiana nursing home. His partner of 38 years — who asked not to be named — sat down with reporters and brought three things with him: photographs, a handwritten journal, and a request that other families learn something from what he went through. 

I did not represent that family. I have no involvement in their situation, and nothing here is a comment on it. But I have practiced law in Central Louisiana long enough to recognize the object he carried into that interview, because I have seen versions of it many times. 

The journal is the part I want to talk about. 

Research is round one. It is not the whole fight.

The advice that came out of that story was to research a facility before admitting a loved one. That advice is correct, and I would not talk anyone out of it. Medicare’s Care Compare tool at medicare.gov/care-compare will show you inspection history, staffing data, and penalties. Use it. 

But I want to be honest with you about what that research can and cannot do, because I think families carry a great deal of unearned guilt about this. 

Most families do not get a leisurely search. They get a phone call from a discharge planner telling them coverage ends in a matter of days, and a list of facilities that actually have a bed. The choice is often between two options, or one. A star rating is also a rear-view mirror — it is built from inspections that already happened, describing conditions that may have improved or worsened since. 

So yes, research. But understand that the research ends the day your loved one is admitted, and something else begins. What protects a resident from that point forward is not a rating. It is a present, organized, persistent advocate — and the record that advocate keeps. 

Why I care so much about what gets written down

I grew up in a family of lawyers. My father and my grandfather both practiced, and what I absorbed from them before I ever went to law school was a simple idea: the law is a tool for people who otherwise have no way to be heard. 

That is also why, during the four years I served in the Louisiana House of Representatives representing District 25, I put a good deal of my energy into people who could not protect themselves. 

One of those efforts became law. In 2010 I authored House Bill 762, which passed as Act 831. Before that act, Louisiana’s crime of cruelty to the infirmed had a ceiling but no floor — someone convicted of deliberately abusing a nursing home resident could receive probation and serve no time at all. Act 831 changed that. Under the law as it stands today, when the cruelty is found to have been intentional and malicious, at least one year of the sentence must be served without the possibility of parole, probation, or suspension. 

I am proud of that law. I also want to be honest about its limits, because those limits are the whole reason I am writing this article. 

A criminal statute is only as strong as what can be proven. So is a civil claim. So, for that matter, is a complaint to a state inspector or a conversation with a director of nursing. In long-term care, the written record decides almost everything. 

When a family raises a concern months or years later, the question is never really whether the family is telling the truth. The question is what can be shown. Facilities keep charts, notes, and care plans. Families, most of the time, keep memories. 

Memories are honest and they are also imprecise. Was that the second week of March or the third? Was it the night nurse or the day nurse? Did they say the appointment was scheduled, or that they would try to schedule it? Under the pressure of a difficult conversation — or a formal one — “I think it was around then” is a very different thing than “March 14th, 2:15 p.m., I asked Nurse ______ and she told me she would call the wound clinic.” 

A family that writes things down as they happen is not being difficult. They are being accurate. And accuracy changes how seriously a concern gets taken — by the facility, by state inspectors, by a court, and frankly by an insurance adjuster who is deciding whether a claim is worth taking seriously. 

What to actually write down

You do not need anything fancy. A spiral notebook from the drugstore is enough. A notes app on your phone is enough. What matters is that entries are made the same day, not reconstructed later. 

For every visit, record:

• Date and time in, time out. This alone establishes a pattern of presence that is difficult to argue with.
• Physical condition observed. Skin, especially over the tailbone, hips, and heels. Alertness. Weight and appetite. Cleanliness — hair, nails, teeth, linens, clothing.
• What you asked for, who you asked, and exactly what they said back. Names and titles when you can get them. Quote the response rather than summarizing it.
• What you were told would happen next, and by when. Then a follow-up entry recording whether it did.
• Anything unusual in the room. Call light out of reach, meal tray untouched, equipment unplugged or unused, a device prescribed but not in use.
• Who else was present. Another family member, a roommate’s family, a specific aide.

Two habits multiply the value of everything above.

Photograph carefully. Photos with a visible date carry weight that descriptions do not. Be thoughtful and respectful here: photograph your own loved one only, never other residents or staff, and consider your loved one’s dignity and consent in what you capture and where it ends up. 

Move requests into writing. A hallway conversation leaves no trace. A short, polite email or a note handed to the charge nurse — “Following up on my request this morning for a wound care evaluation” — creates a record on both sides. Keep your copy. Keep the reply, and keep it if there is no reply. 

Two more things families should know

You can ask for a care plan meeting. Federal regulations give residents and their representatives the right to participate in care planning, and you can request a meeting rather than waiting to be invited. Go in with your notebook. Leave with a written summary of what was agreed to, and a date. 

You can ask for the records — and there are two different requests. 

To look at them now. Louisiana’s nursing facility regulations require the home, on an oral or written request from the resident or the resident’s legal representative, to provide access to all records pertaining to that resident — including the current clinical record — within 24 hours, excluding weekends and holidays. You do not need a lawyer and you do not need to explain yourself. If something has just happened and you want to see what was charted, this is the request to make, and it is the fastest one available to you.

To get your own copy. After you have inspected the records, you can request photocopies with two working days’ notice. Separately, under Louisiana’s medical records statute, La. R.S. 40:1165.1, a health care provider must furnish copies within fifteen days of receiving a written request and authorization. That statute also caps what you can be charged, and there is one number worth knowing above all the others: if the records exist in digital form and you ask for them in digital form, the total charge cannot exceed $100, plus actual postage. That is a cap on the whole request, not a per-page rate. Nearly every facility charts electronically now, so ask for the digital copy. 

If fifteen days pass and nothing arrives, the statute has teeth — but only if you use them. Send a certified letter stating that the provider has failed to comply and referring to the sanctions available under the statute. If the copies still do not come within five days of that letter, and you ultimately have to obtain the records through a court order or subpoena, the provider can be held liable for the attorney fees and costs of getting there. 

One caution about who may ask. That right runs to the resident and to the resident’s legal representative. If you are the person who visits every day, keeps the journal, and knows more about this resident’s care than anyone on the payroll — but hold no written authority — you may find the door closed at precisely the moment you most need it open. That is a fixable problem, and it is much easier to fix before a crisis than during one. It is the subject of my next article. 

If you have raised a concern and it is not being addressed, there are three places you can turn, none of which cost you anything: 

• The Louisiana Department of Health, Health Standards Section — 1-888-810-1819. This is the nursing home complaint and abuse hotline, and it is the right first call when the concern is about a licensed facility. Complaints can also be filed online through LDH.
• The Long-Term Care Ombudsman Program — 1-866-632-0922. A free, confidential advocacy service for residents of nursing homes and other long-term care facilities. Louisiana assigns a coordinator to each region; the Alexandria region covers Rapides, Grant, Avoyelles, Natchitoches, Winn, LaSalle, Catahoula, Concordia, and Sabine parishes.
• Elderly Protective Services — 1-833-577-6532, with after-hours reporting at 1-844- 945-2377. EPS investigates abuse, neglect, exploitation, and extortion of adults 60 and older. One thing to know: EPS is generally directed at older adults living in a domestic setting, so for someone who lives in a licensed nursing home, the Health Standards hotline and the Ombudsman are usually the more direct route.

Use them. An investigated complaint creates an independent record, and independent records matter.

What this is really about

I want to be clear about something, because I am a lawyer and you are entitled to be skeptical of my motives. 

I am not telling you to keep a journal so that you will one day have a lawsuit. The overwhelming majority of families who do this will never call an attorney, and that is a good outcome. Most of the value of documentation is not what it does in a courtroom. It is what it does in the hallway, on day 30, when a nurse realizes that this family is paying close attention and writing it down. Care improves under observation. That is not cynicism; it is human nature, and it is the entire reason inspections exist. 

Keep the journal because it makes you a better advocate right now, while it still matters most. 

And if a day comes when something has gone badly wrong and you need someone to help you understand what happened, bring it with you. In Louisiana, these cases can turn on questions of timing and legal classification that are easy to get wrong and difficult to fix later. Whether you call my office or another, call sooner rather than later — and call with your notebook in your hand. 

Chris J. Roy, Jr. is an attorney in Alexandria, Louisiana, and a former member of the Louisiana House of Representatives for District 25, where he authored Act 831 of 2010 strengthening penalties for cruelty to persons with infirmities. This article is general information about long-term care advocacy in Louisiana and is not legal advice about any specific situation. Reading it does not create an attorney-client relationship.