Screeners

We have an admission coordinator, who used to be a nurse, that looks over all of the paperwork. Visits to the hospital are only made if they are questionable. I personally think that visits should be made for everyone. Sometimes they come in and are different than we are made to believe. And then she will also let either the other MDS nurse or I look them over or she will let the DON/ADON take a look. I have went out to the hospital and done a look through the chart and all of their paperwork to see about taking someone or not. In my opinion, our system is lacking also.

We have a nurse liason that we share with our sister facility in town. She is suppose to do all the pre-admission assessments (that is when she's not out shopping or getting her hair done). We find the same problem you describe. She has no long term care experience, does not always pick up on special supplies that we may need prior to admit (CPAP's w/ specific settings, CPM machines, etc), and definately doesn't ever see a behavior that she thinks can't be handled - of course she's not available at sundown to see what some of our admits turn in to when the sun goes down!

It always seems the best when the DON, ADON, myself or the skilled unit manager (whoever has the most free time at the moment) looks at the inquiry and makes a determination. The nurse liason is to do an onsite review of anyone we question, but again.. goes back to she has no idea of what she should be looking for or asking about. (Gee they took 4 doses of Haldol in the hospital in 24 hours - that is a problem??)

I would suspect that a good part of the screening has to do with how the bill is going to be paid which is why the marketing person is involved. The nurse with no LTC experience probably knows the Medicare rules. The administration is not going to admit anyone who can't pay the bill, nursing service aside.

I've run into this problem before as well. It's a royal pain. I had a meeting with the DON and Administrator at the LTC I was working at and asked that all potential patients have thier information faxed to us prior to thier acceptance. That way either myself, the DON or the other charge nurse could review the info and make a descision. I was naive enough at the time to believe that the hospitals and rehabs would actually fax us accurate info...they would convieniently leave off the notes about the patient being combative or sexually innapropriate or what have you. So we started physically going to the facilities and reading the charts ourselves. Naturally this was an issue for two major reasons. 1. Who had the time to do that? and 2. A lot of the hospitals won't give you access to the charts anymore. <Sigh> you can never win. And Daytonite is right...you have a private pay patient or medicare patient come along and the facility will just about brown their pants to get thier hands on that one.

Our manager usually goes and does a pre-assessment on prospective residents.Care managers can be.........economical with the facts when they desperatly want a place for someone!Would you want someone who enjoyed rubbing faeces into his carers? This was one fact which did not make it onto the care managers assessment but came to light on the pre-assessment.Needless to say this particular person did not find a home with us!