It is a difficult decision, but sometimes a resident either cannot be admitted or must be moved from your facility to a higher level of care. Residents and their families can make this challenging if they are not willing to accept your recommendation. While you want residents and their families to be happy, admitting or keeping a resident despite being unable to meet their needs is not good practice. Do not do it.
How do you put the best practice in place?
- Maintain and stick to a procedure for documenting comprehensive admission assessments of prospective residents and regularly reassessing them during their residency.
- Establish a policy and guidelines related to conditions that require you to either reject admission to your facility or initiate the process to move them to a higher level of care as soon as possible.
Your policy and guidelines can be clearly drawn from state law and regulation. For instance, California regulations provide guidelines for admitting and retaining residents with prohibited and restricted health conditions. Failure to ensure this care is provided by competent healthcare professionals exposes you to claims that you are liable for the resident’s worsening condition.
Prohibited conditions include:
- Stage 3 and 4 pressure injuries
- Active communicable tuberculosis
- Ongoing behavior caused by a mental disorder that would upset the general resident group
- Dependence on others to perform all activities of daily living
- Gastrostomy care
- Naso-gastric tubes
- Staph or other serious infection
- Tracheotomies
Other circumstances which require a resident to relocate are:
- Requiring 24-hour licensed nursing care on a chronic basis, or unscheduled skilled nursing care
- Continued residency endangering the safety, health, or welfare of the resident or others
- Failing to abide by the community’s written general policies
- Failing to pay for basic services within 10 days of the due date
- Failing to comply with state or local laws after receiving notice of the alleged violation(s)
- Needs of the resident no longer able to be met by the facility as indicated by an assessment
- Change of use in the facility
In some cases, certain restricted conditions may necessitate the termination of the admission agreement and transfer from your community. Some conditions may require the community to meet additional regulatory and staffing requirements. These restricted conditions are:
- Wound care
- Stage 1 and 2 pressure injuries
- Administration of oxygen
- Catheter care
- Colostomy/ileostomy
- Contractures
- Diabetes
- Enemas, suppositories, fecal impaction removal
- Incontinence care
- Injections
- Intermittent positive pressure breathing machine
These prohibited and restricted conditions reflect the nature of your care as a non-medical residential care facility. This makes your guardrails clearer than you might think, and limits your discretion. Residents with any condition requiring regular medical care, including these prohibited or restricted conditions, must be in a facility that can provide it, not yours. So, when you are assessing a resident’s level of care, follow the “stay in your lane” approach. This will keep everyone safe.
