Implied Causes of Action Under § 1396r: Why Grammer
Reminds Nursing Home Residents to Actively Participate in
Their Own Care
By Edward J. Cyran. 
115 Penn St. L. Rev. 253.
I. INTRODUCTION
They made the mistake of thinking of a personality as some sort of
possession, like a suit of clothes, which a person wears. But apart
from a personality what is there? Some bones and flesh. A
collection of legal statistics, perhaps, but surely no person. The
bones and flesh and legal statistics are the garments worn by the
personality, not the other way around.
For centuries, society has been searching for the most economic and
effective way to care for its elderly. Satisfactory and widespread elder
care has remained a constant challenge for society, from the time of
poorhouses to today’s modern nursing homes. At the center of the
situation are a growing number of elderly and an unacceptable quality of
care, particularly in nursing homes. The population of adults aged sixtyfive
and older is expected to almost double by 2030, and even though
many of the nation’s baby boomers will maintain sufficient health to be
independent in the coming years, their sheer numbers will inevitably
exacerbate the health care problems present in our nation. That is not to
say that an effective and comprehensive health care system for the
elderly is infeasible. On the contrary, a successful system of long-term
care is quite possible; however, it requires, among other things, the active
participation of older persons in their own care. Such “collaborative care”
emphasizes patient self-management through education and
treatment planning in contrast to the traditional provider-patient
relationship, which tends to emphasize only provider responsibility for a
patient’s health. While collaborative care may be the preferable model
for the earliest stages of elderly care, the more incapacitated a patient
becomes by illness and old age, the more difficult it becomes for a
patient to self-manage. Nevertheless, a dependent resident may
actively participate in her own care by communicating the quality of her
care to her family and attorney. Such active patient participation among
nursing home residents, whether by the dependent patient herself or
another trusted coordinator, is integral to a successful elder care
system. keep reading.