Nursing

NURSING HOMES PROBLEMS
RULES & REGULATIONS FOR PRIVATE NURSING HOMES

BY Dr. SUDHA N. SHETH

When a new nursing home is started, one books a place under construction or buys a place which already exists. When a place is bought under construction, it is easier to follow the specifications required for running a nursing home. In either case a certificate is required from BMC ( Brihanmumbai Municipal Corporation ) for using it as a nursing home. If in "plans" the place is already in use as residence, a change of user to nursing home is necessary which requires society / landlords permission and also BMC approval as change of user.

SPECIFICATIONS FOR NURSING HOMES
Most of the specifications required for starting a new nursing home are available from Building and Construction Department of BMC at Byculla. Following are a few important ones :-

1.) There should be place provided for parking for its patients / visitors.

2.) Water connection has to be separate from rest of the building. Alternatively, separate meters are to be installed at the outlets of the pipes from the water tanks from which nursing homes draws its water supply. Water tax is charged at commercial rates.

3.) Drainage pipes should connect directly to the road drainage / sewerage pipes so as not to clog the building drainage due to nursing home waste.

4.) Doors and passages should be 3 1/2 feet in order to allow smooth passage of stretchers and trolleys.

5.) If the passages do not have natural ventilation, exhaust fans or A. Cs. can be installed.

6.) Patients' room should be 90 to 100 sq. ft.

7.) Ideally, there should be a separate operation theatre and labour room each with minimum 100 sq.ft. area. However, BMC does accept a combine operation theatre and labour room with 200 sq.ft. size. But provision should be there to curtain off labour bad from operation table.

8.) One toilet should be provided for six cots (ideally).

9.) Waiting room should be about 100 sq.ft.Besides structural requirements, before starting a nursing home, it should be registered with BMC under Bombay Nursing Homes Registration Act. This registration is renewable every year by 31st March. At present Registration Fee for less than 10 beds is Rs.100 and for more than 10 beds is Rs.200. The registration certificate should be displayed.

ACTS APPLICABLE TO NURSING HOMES:-
When runs a nursing home, following acts are applicable to nursing homes :-

1.) Minimum Wages Act : Applicable to all nursing homes.

2.) Payment of Bonus Act : Applicable to nursing homes having 10 or more employees.

3.) Provident Fund Act : Applicable to nursing homes having 10 or more employees.

4.) Payment of Gratuity Act : Applicable to nursing homes having 20 or more employees.

5.) Industrial Disputes Act : Applicable to all nursing homes.

6.) Shop and Establishment Act : Applicable to all nursing homes.

Minimum Wages Act :-
Under this act, wages payable at present are as follows :

1.) Sweepers, ward boys, Ayahs, peons, X-ray boys, Rs. 2300 plus DA ward servants, cook-mates, kitchen-mates etc.

2.) Semi-skilled untrained Nurses, untrained Technicians etc.Rs. 2400 plus DA

3.) Qualified Nurses etc.Rs. 2500 plus DA

  • At present DA is Rs. 284 for the period Jan., 2000 to June, 2000.
  • Part time workers can be employed and paid corresponding percentage of full time wages.
  • Daily wages employee's pay has to be calculated by dividing total pay by 26.
  • Once a week off is to be given to each employee.
  • Overtime wages are to be paid at double the regular wages.
  • An employee should not work more than 9 hours a day or 48 hours a week.
  • Spread over work or break duty should not exceed 12 hours.

Minimum wages do not make any provision for earned leave. However, Shop & Establishment Act does provide 21days yearly leave with wages for an employee who has worked more than 240 days in a calendar year. At present the Shops & Establishment Act is applicable to nursing homes but dispensaries and consulting rooms are exempt from it by the recent Orissa High Court judgement. However, there is a very strong case for private nursing homes to challenge the Shops & Establishment Act if individually prosecuted and chances of getting exemption by legal course are very good for nursing homes owned / run by professionals.

Other Acts :-

1.) Provident Fund Act, if applicable, and employer has to contribute 6 ¼ % and deduct 6 ¼ % from the employee and credit the amount to Provident Fund.

2.) Bonus is to be given at 8.33 % of the wages of the employee.

3.) Gratuity is to be paid if an employee has worked for 5 years at the rate of 15 days' wages per year of service at the rate of last pay drawn.

Maintenance of Registers
Following registers are to be maintained by a nursing home :-

1.) Wages cum attendance register of the staff.

2.) Indoor admission register.

3.) Delivery patients' register.

4.) MTP & sterilisation records register.

5.) Operation theatre register.

6.) Admitted patients daily records register.

7.) Alphabetical index register.

Nurses employed should be qualified and their qualification registered under BPNA. This is one of most difficult requirements for nursing homes at present and may be almost difficult to fulfil if authorities implement it strictly

Dr. Sudha N. Sheth is a Senior Gynaecologist practising at Cuffe Parade, Mumbai and is Associate Editor of "The Grasp". She is also a Founder Member of Bombay Nursing Homes Association.

Dr Smita Sharma
President - Amc

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