Resident discharge or “evictions,” is a complex issue, no doubt. I write this without blaming any party – the point is to determine what we can do in the long-term care industry to decrease the occurrence. I am encouraged by the many comments on my initial post as it means others care as well, no matter their perspective. The report illustrating the increasing eviction events of residents in long-term care should raise concern and alarm, within and outside of the industry.
Though in my first post I addressed the importance of initial and ongoing staff training and support, another opportunity to decrease discharges is for the facility to assess potential admissions in advance, and determine their ability to provide the necessary care. It requires taking the time to conduct a thorough in-person assessment prior to admission to the facility. This is especially significant when the individual has memory loss.
While as the initial report and article states that the practice to evict or remove residents “allows a facility to admit more profitable residents who are less problematic and time-consuming,” we all know that census is a constant struggle and facilities feel a continuous pressure to “fill the beds.”
Facilities also face pressure from hospitals to “accept” residents quickly and feel that they have no control over who and when someone is admitted. However, for many facilities that is not the case. Many long-term care facilities choose to take the time to determine their ability to provide the necessary care and “manage” admissions.
Managing admissions is a choice and especially important for individuals with memory loss. Gathering information i.e. “knowing the person” is significant for planning and providing care. Facility admitting personnel need to secure all information from records, family and caregivers. This individualized, person-centered information regarding the potential admission should be discussed with nursing and appropriate colleagues in advance to know whether or not the facility is able to provide the type and level of care that is required. It is understandable that when a facility accepts residents blindly, uncertain that they can manage the care, that evictions will occur.
An in-person, pre-admission and personal assessment is invaluable. It enables the facility and staff to prepare for the admission and create a plan for success. It is an opportunity to determine important factors that impact outcomes. Is the individual stable and ready for discharge? What initiated the hospitalization and is it resolved? How will you manage the transition? What are the specific care needs? Who are the best staff/people to work with that particular individual? What will the initial strategy be for providing care – person before task? What will the family need to do and what will they need to know upon admission and in the days to follow?
Following the visit the personal, medical, social history and caregiving information gathered must be communicated to staff – prior to admission or as soon as possible. This critical information on the desk of the admissions department will not serve anyone – not the staff, resident or family. Unless there is a system and consistent practice of communicating information about the resident to the direct care providers, collecting health information, personal history and care strategies is fruitless. And if you expect staff have time to dig through an electronic health/medical record to find it, think again.
An in-person assessment of a potential resident does not have to take a great deal of time or need to be the responsibility of a single person, but simply a commitment on the part of the facility. A personal assessment visit enhances the relationship with the family and resident. Even hospitals, though pressuring to discharge as soon as possible, respect the decision to move carefully in order to decrease the possibility of a hospital readmission and as a means of enhancing resident and family care and satisfaction.
Can it be done? Yes it can. Despite the outside pressures, you control admissions, discharges, evictions and your reputation. Determine internally what level of care you can manage at any given time. While it will require a little additional time or in some cases saying no to some resident admissions, in the long run it will be better for the resident and family, your staff, liability, reputation, census, and financials.