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I have a family member in a SNF in Florida for physical rehabilitation following a hospital stay. That family member has gotten out of bed and fallen several times. The facility is now demanding that we hire outside workers to facilitate 1:1 supervision with that family member. My question is, is this legal?

Yes.
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Reply to mommabeans
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Speak to the facility administrator.
Facility rules and regulations should have been provided to you / whoever signed in your family member at the facility. Ask for this information in writing.

The facility is not providing 24/7 round the clock care.

If you want a resident / patient to be watched 24/7 to monitor the possibility of falling out of bed, then it would be up to you to hire / pay for this service ('a sitter').

I believe facility CANNOT demand that you hire an outside caregiver/sitter although if the facility cannot manage care needed for a specific patient / resident, they likely can tell the family (or whoever checked that person into the facility) that they cannot offer the care needed and require the person to be moved from the facility. Additionally, it is a liability issue.

My friend fell out of bed twice (he was bedridden).
They put a 1-2 inch 'padded' mat on the floor to 'break his fall'. Of course, this doesn't do any good although it is what a nursing home facility does in my experience.

There are very strict state/federal rules about bed railings. 'Mostly', only short bed railings are permitted. (I went through this).

I purchased a long 'body pillow' and this helped keep my friend in bed.
He never fell out of bed again.
It depends on the person's mobility (to move/remove a long pillow).

If you want more information, call the licensing board of the facility and ask them. I believe you can find out all you need by talking to the facility administator. County, State and federal laws differ so you need to check in your location/area.

Gena / Touch Matters
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Reply to TouchMatters
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marco742: Sometimes family members will hire a sitter for their LO.
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Reply to Llamalover47
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Well, I don't know if it's illegal. But, the SNF is letting you know that they do not have the resources to watch this patient 24 hours and prevent falls. They do not have a ratio of 1:1 caregivers to patients.

You can try and find another SNF rehab which may have a better solution - such as an alarm to let them know when a patient has gotten out of bed. Or hire someone to provide one-on-one 24 hour supervision.
You don't have to hire someone if you have family members willing to volunteer for this job.

Care facilities are not allowed to use any type of physical restraint - even for the patient's safety.
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Reply to CaringWifeAZ
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If a facility takes medicaid/medi-cal they are a SNF. SNF is a skilled nursing facility, also know as a nursing home. A Rehab facility also know as a SNF also know as nursing home. Regardless of what they call themselves they are licensed as a SNF. No you do not have to pay for a one on one sitter. you can help as best you can but they cant ask you to pay out of pocket for a sitter as thats double dipping and thats fraud, for anything that relates to her care. All facilities are short staffed. however the facility took her as a patient as Medicare pays up to 100days forher rehab and thats where facilities make their money. After the big money days are gone they will want her out. And boy do the bs lines come out not to keep her. When in doubt contact Licensing and report the issue. Contact the Ombudsman they will advocate for her.
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Reply to LoniG1
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CaringWifeAZ Jun 20, 2025
LoniG1, thanks for the insight.

I think I understand a little better why my husband was kicked out of a skilled nursing facility.
He was an extremely difficult patient, rolling out of bed onto the floor, and scooting across the floor, trying to go home. They claimed he had hurt a staff member, and on the third occasion, they called 911 and had him taken to the hospital ER. I had to decide what to do with him, as there was no reason to admit him to the hospital.
I did not advocate for the nursing home to take him back or to keep him there. He was already being neglected and was miserable. I have been taking care of him at home ever since.
I was hit with a pretty big bill. Once his medicaid was approved, which took months, the patient's share of cost was calculated, retroactive 6 months or more, which I had to pay.
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Well, when mom was admitted, and you or mom or whomever signed all of that paperwork, what did it say? If they're demanding this, then I'm guessing there was wording in that paperwork - which is considered a contract - stating they can demand the hiring of additional caregivers if they deem it necessary.

Medicare uses reported falls as part of the data used to assess the quality of care provided by nursing homes.

Check the paperwork that was signed upon admission. If there is a clause stating they can require additional caregivers, paid for privately by the patient (or whomever is the responsible party) then yes, it's legal.
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Reply to notgoodenough
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LoniG1 Jun 15, 2025
They can not make a contract like that as it would be fraud double dipping. They could lose their license for that.
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They can ask but you do not have to provide if you can't afford it. Does this person have Dementia? If not, why does this person not understand that they need assistance to get out of bed. If they have Dementia, I found they don't do well in rehab. With my Mom she could not remember the exercises from day to day or understand instructions.

Do they put the bed almost to the floor? Put a concaved mattress on the bed? Put mats around the bed? They need to do what they can to make them safe. The law prevents them from using bars or any restraints of anykind.
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Reply to JoAnn29
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No, they cannot require family to hire workers. They can, if the resident can afford help, require the resident to hire in care as a stipulation to remaining in care. If the place cannot render safe care to this person, they can transfer them to hospitalization.

The real question here is what sort of rehab care is being accomplished here? Not much I am imagining.

I think this is the wrong level of care and memory care and medication may be a better fit for this senior.
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Reply to AlvaDeer
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Yes it is. You have the option to move your loved one to a different SNF, but if the same situation goes on there, the same request will be made in an effort to keep your family member safe. The SNFs simply do not have personnel available on a 1:1 basis.
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