“Be a squeaky wheel.”

That’s Eric Carlson’s advice to nursing home residents and their family members.

Carlson offers details in “20 Common Nursing Homes Problems – and How to Resolve Them,” a booklet he has written for the National Senior Citizens Law Center.

Carlson suggests “that residents and their families develop a healthy sense of entitlement to high-quality nursing home care.” He doesn’t recommend filing a lawsuit for every problem, but he does believe that residents should know their rights and use them to press nursing homes for the care they deserve.

For example, residents generally can’t be ordered out of a nursing home merely because their behavior – wandering or even howling in the night – becomes problematic. “These evictions almost always are improper,” he writes, “because such residents belong in a nursing home.” Carlson also notes that federal law gives residents the freedom to reject behavior-modifying drugs, feeding tubes and such restraints as seat belts and bed rails.

And regardless of who’s paying, he said in an interview last week, “a resident or family member shouldn’t feel sheepish to ask that necessary therapy be provided or that a resident be allowed to sleep as long as she wants in the morning.”

Gerald Kasunic, the ombudsman for the District of Columbia’s 20 nursing homes and their 3,200 residents, also recommends an assertive stance.

Without someone to “zealously advocate on behalf of a resident,” he said, “most likely the system – I’m not going to say just the nursing home industry, but the system: Medicaid, Medicare, so on – will literally steamroll an individual and … they will get just moderate to poor care.”

Rita Schumacher, director of the ombudsman program that covers almost 11,000 nursing home beds in Northern Virginia, said she encounters unjustified discharges and the improper discontinuation of therapy, but “the No. 1 issue is not enough staff in facilities.”

When visiting a home to which they might send a loved one, she said, family members should note “if residents are lined up in the hallway … don’t look clean … if they have food on their clothing.” These are possible signs of inadequate staffing, she said.

Schumacher recommends reading the actual reports that state inspectors routinely file on nursing homes. The full report can be more informative than the synopsis posted on Medicare’s Nursing Home Compare Web site, she said. Carlson’s booklet is available at www.nsclc.org for $9.95 plus $3 shipping for a printed copy, or $7.95 for an electronic copied downloaded online.