Assisted living- what happens when patients need more care? - page 3

by lexilou 4,196 Views | 27 Comments

Help- new to hospice and don't know how to approach this subject. I have a patient who is in assisted living and is falling much. We provided temporary continuous care til facility and family could provide back-up plan for... Read More


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    I find sometimes the ALF will promise things of hospice that hospice can't reasonable deliver like continious care for a non immnient patient for more than a few days because then it takes the onus off them. Most ALF's are great but some I have found when the CC nurses stop checking on the patient at all. I don't mind doing my job but the ALF is still being paid and should provide the same level of support. It's more comfortable for the patient when there is an assist with turned and ADL's and in the home the family usually helps.
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    I will input but only what I know for my facility. We have 43 residents. 2 CNAs do the care and the LPN does the meds. In assisted living our resident must be able to transfer and ambulate without excessive falls. They must be able to go to meals in the dining room. They must be able to toilet themselves. If they have a low mini-mental or mental health issues that put them at risk for self-care or are agitated or combative--they cannot be admitted nor can they stay. We transfer to LTC or SCALF depending on situation. When this originally posted, CC was offered by many hospices. This is no longer the case. Only in immenent death is that allowed by Medicare now (at least where I am at). Also, ALF and SCALF in my state DO NOT require licensed or certified caregivers so if you have someone who needs a lot of care--well, those people may not can properly care for them as they may not know how. Each ALF is different, though. Oh, and if you have a resident on ALF who needs turning--they are in the wrong place. They need to be in LTC.
    Last edit by DSkelton711 on Aug 5, '12 : Reason: addition of info
    SuesquatchRN likes this.
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    "[ALL of our patients who are not in their private homes are in ALF. They remain there when they become unresponsive and require total care."

    Unless death is imminent or there is a round the clock person and they are expected to die, this is completely wrong for ALF and may be against regulation. I feel bad when a resident must move from ALF but my license will not be in jeopardy by not following regs. If you don't know ALF regs then you should read them so there will be no problems when state comes to survey. Each state is different and usually you can go to a website to look at the regs.
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    Continuous care never met fulfulling the job of a sitter. It's for crisis/EOL.
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    Quote from SuesquatchRN
    Continuous care never met fulfulling the job of a sitter. It's for crisis/EOL.
    Yup though sometimes when a patient has a primary caregiver the caregiver will over represent the patients symptoms so they can get a CC nurse to come out. The CC nurse ends up being a "sitter" while the caregiver takes off for a while. There is nothing more mind numbing arriving at a case ready to 'do your thing" and find you have 8 hours of sitting in front of you
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    @tothepointeLVN: That is probably what I saw happening. Death wasn't imminent but coming at some point. I know the only "sitter" I ever saw were hospice. ALF is one of those weird places where people are PROMISED they can age in place or die, but they don't ever bring up what truly happens because staffiing is too low or a person needs skilled nursing care. No one is told about the possibility of going to the "nursing home" because of xyz.
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    Sometimes the billing justification for me being there is "caregiver" educaion. Caregiver often being the ALF staff. Really? Like thats going to go over well and they don't have time to spend more than 3 minutes talking about that patient. Caregiver education for a private home not so bad but still pretty boring. Had one case where the caregiver somehow convinced the young admitting RN to give her a weekend of CC coverage when another finally came to evaluate the case he was shocked.
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    You would not be bored where I am. I could use help with caregiver ed as well as resident ed. I am crunched for time and just had more put on me. I work 9 hour days and I still can't keep up. Our residents are very needy, we have an in-house doc and dentist so there is always work to do! We just had 2 call ins so I gotta get my beauty sleep.


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