Unbelievable

[CapeCodMermaid]

This is part vent part question. I'm the DNS of a skilled facility. Most of the residents have psych issues...substance abuse issues and homelessness issues. We have been working diligently to change the communities perception of the building. YES we do short term rehab and YES we have very good clinical outcomes.

Census has been down as it has been in most of the facilities in the Northeast. Corporate wants new admissions and marketing people. Big mistake but I get it. So the Administrator tells me today he has found wonderful candidates and wants to hire them.

WAIT a minute I said. Were you going to hire them without anyone else meeting them? You want to meet them he asked. Jeez louise...I'm the DNS! I need to have at least some input into who gets hired.

Then he tells me that the new admissions person he wants to hire will be given the OKAY to admit any one SHE sees fit.

NOT ON YOUR LIFE I hollered. It's MY license on the wall, not hers and she darn well better clear any and all admissions with me. Then he tells me the marketing person he wants to hire is 'drop dead gorgeous'...stupid man. You can't say things like that...and yes, I told him that. He told me it's okay since he's gay. The man is as thick as a brick.

I told him if he gives the admissions person ( an LPN) the okay to admit anyone , he better start looking for a new DNS. When I interviewed I specifically asked who had the final say on admissions. Both he and the corporate clinical nurse said the DNS has the final say. They've lied to me about so many things I suppose I shouldn't be surprised.

Who has the final say in your buildings? I wouldn't mind if most of the residents were straight forward rehab with new knees and fractured hips, but we get referrals for people on multiple antipsychotics ...some are suicidal...some are homicidal.

Yikes.

[fulzgold]

Jeesh! Our admin does stupid stuff like that too. One time she drove 2 hrs away to a womans apartment to assess her for placement. When she came back she was actually considering this patient. The patient was a 42 yr old female who had lived in her bed for the past 3 years. Morbidly obese, wasn't sure how much she weighed or how she would even get to our facility. Admin thought she could just come in a car!!! I said, Uh..No... First of all, she might die if you move her, she has not left her bed because she can't stand much less fit through the door. You'll have to hire an ambulance to bring her here and she may not make the trip. You'll have to rent or buy a bariatric bed as well as numerous other bariatric DME. And, someone at home can have their entire life built up on shelves surrounding the bed within reach, but we can't do that in a facility. Our admin will take just about anybody. She'll even promise them a private room and then when their medicare days are up they won't move and she won't make them move. So there goes our medicare suits. We have spent more money on some of our patients she took than it was worth. I'm pretty sure she doesn't cost anybody out. She is always willing to take people with no or pending payor sources.

[CapeCodMermaid, RN]

Corporate is just crazy...no other way to look at it. We denied someone who would have COST US money and they wanted to know why we said no. Today we decided--we being the administrator and I---not to take a crazy woman because we don't have any beds on our crazy floor (yes, we have a dedicated floor for the crazies). Then the admin says "You'll have to come up with a good reason to deny." I'm about done...we can't take people we can't take care of. We can't put a crazy person on the rehab floor if they ever want to get another rehab person.

[caliotter3]

I once worked in a facility where the DON walked out one Friday collecting her final check along the way when the Administrator went over her head to admit a patient that the DON had rejected. He tried to get her on the phone all weekend long. I guess she showed him who wasn't going to have the final say.

[catlvr]

You are so lucky to have a "crazy" floor...we just stick them in with the other patients, and spend the evening redressing the strippers, trying to redirect the poor lost souls, and hiding the really socially unacceptable folks. All mixed in with the new knees and hips, who look on in horror.

If I ever move to New England, I'm going to beg to work for CCM; she's the best!

e

Corporate is just crazy...no other way to look at it. We denied someone who would have COST US money and they wanted to know why we said no. Today we decided--we being the administrator and I---not to take a crazy woman because we don't have any beds on our crazy floor (yes, we have a dedicated floor for the crazies). Then the admin says "You'll have to come up with a good reason to deny." I'm about done...we can't take people we can't take care of. We can't put a crazy person on the rehab floor if they ever want to get another rehab person.

[Havin' A Party!, ASN, RN]

Admissions usually go per the NHA's directive in general, since she's / he's the one who coaches the liaison on what would be acceptable.

What's acceptable is derived by the NHA with input from the DON, with poor choices attributable to all involved... the liaison for failure to follow guidelines or to consult the NHA or DON on close cases; the NHA for not clearly communicating guidelines and / or approving a poor admission choice; and the DON for not communicating special concerns / appropriate guidelines, and / or not timely responding to the liaison or NHA in unique cases.

[indigonurse]

When I worked in that type of setting I would have to go to the hospital first and look at the pt. talk to the staff and review the med. rec. before making a decision to admit them. This was because many times other health care agencies were trying to "dump" pts. and not being honest about them.