Assisted living- what happens when patients need more care?

dbsn00 · Mar 31, 2005

This patient obviously needs more supervision & care then the AL can provide & it sounds like it's time for LTC. In LTC there is more supervision & assistance from staff then AL, tab alarms on beds, chairs/wheelchairs are also used.

webblarsk · Apr 1, 2005

Wow, usually Assisted Living Facilities have a policy that as the patient becomes worse and unable to care for themselves they have to be moved to a LTC. Can you discuss other options with the family? Or are they even open to suggestions?

Blackcat99 · Apr 1, 2005

Wow, usually Assisted Living Facilities have a policy that as the patient becomes worse and unable to care for themselves they have to be moved to a LTC. Can you discuss other options with the family? Or are they even open to suggestions?

Yes when a patient gets worse they should be moved to a LTC. However, when I worked at assisted living they always allowed the "private pay" patients to stay at the assisted living even if they were violent or totally unable to care for themselves.

lexilou · Apr 2, 2005

Thanks for your responses, Just found out that Vitas can provide continuous care . If this is true, facility must be assuming that all hospices can provide this. Does anyone know if this is the case? If so, we'll just need to do some further education regarding our hospice services.

aimeee, BSN, RN · Apr 2, 2005

Thanks for your responses, Just found out that Vitas can provide continuous care . If this is true, facility must be assuming that all hospices can provide this. Does anyone know if this is the case? If so, we'll just need to do some further education regarding our hospice services.

I am not quite understanding your question. All hospices are supposed to provide continuous care if the situation merits, but many are not able to do this do to the difficulty of maintaining adequate staffing. Still, it is only for resolution of acute needs and not the solution for a long term decline need.

Is the patient falling while attempting to walk? Is the patient falling because they try to get out of bed but cannot stand without assist? If so, a low bed and a floor pad may be the answer.

I don't think that a nursing home is necessarily the answer because there are falls a plenty in nursing homes too. In a LTC the staff ratio is generally something like 15 patients to every aide at night so there is no way they can keep an eye on everybody every second.

A lot of ALF's will allow hospice patients to stay on in their "home" but they often require that additional help is provided by family to meet the level of need required by the patient.

lexilou · Apr 2, 2005

I am not quite understanding your question. All hospices are supposed to provide continuous care if the situation merits, but many are not able to do this do to the difficulty of maintaining adequate staffing. Still, it is only for resolution of acute needs and not the solution for a long term decline need.
Is the patient falling while attempting to walk? Is the patient falling because they try to get out of bed but cannot stand without assist? If so, a low bed and a floor pad may be the answer.
I don't think that a nursing home is necessarily the answer because there are falls a plenty in nursing homes too. In a LTC the staff ratio is generally something like 15 patients to every aide at night so there is no way they can keep an eye on everybody every second.
A lot of ALF's will allow hospice patients to stay on in their "home" but they often require that additional help is provided by family to meet the level of need required by the patient.

Yes, our hospice does provide continuous care if the situation merits. However, I've found that this facility if offerring this service to the family on our behalf. The family is confused because they are hearing different things from us and the facility. I believe that the facility has had experience with Vitas who supposidly can offer continuous care to all their hospiice patients when they are imminent. I'm not quite sure about that. It's merely what I've heard. Unfortunately, it's not a service we can offer everyone. Like you said, if the situation merits, we can provide it but it is not customary for us just to provide it if the patient is imminent. As I get more involved with this case, I'm finding that the need for more communication and education regarding our particular hospice is required. Thank you for responding. It always helps to get different perspectives and ideas. It is much appreciated.

aimeee, BSN, RN · Apr 3, 2005

Ok, let me see if I have this straight...your hospice (not Vitas) offers Continuous Care for emergency situations and you did this for a short time for this patient. The facility has historically had a relationship with Vitas, who routinely did continuous care for dying (imminent) patients. The facility figured since Vitas does it, that your hospice would be able to provide it under the same circumstances and told the family that your hospice would provide continuous care without checking with your hospice. Is that it?

Penguinurse · Apr 14, 2005

My most frustrating experiences have been at ALF's...they are designed to assist basically well people, and the caregivers are generally not trained to care for the ill. Tons, tons, tons of education, frequent visits, and yet more education have helped me cope. And in my state, Nevada, a really ill person can stay in an ALF or group home if the facility submits a waiver to the state to the effect that hospice (or another outside agency) will assume management of the patient's care. This doesn't mean it's always appropriate; I would much rather move my hospice pts. to LTC than try to manage them in ALF's. However, many of the patients have lived in the ALF for a long time, it's their home, and they (understandably) don't want to leave.

aimeee, BSN, RN · Apr 14, 2005

I think much depends on the particular ALF and the staff there and the same with nursing homes. If the family can afford to hire in some extra care that is often a good solution.

Rosie6 · Apr 17, 2005

I think much depends on the particular ALF and the staff there and the same with nursing homes. If the family can afford to hire in some extra care that is often a good solution.[/quote
Hello - I just found this web site , but I a m going to jump right in . . . have you thought baout moving the patient to an inpatient hospice residence? I work in one with 4 residents and 24/7 hospice staff - rate is compoarble to NH and care is phenomanal!

CHPN1680 · Apr 24, 2005

I have run into similar problems with patients as ALF's. Often, the problem becomes a financial one because some patients are often running low on financial resources and the addition of private caregivers can threaten their financial ability to stay at the facility. This is especially a problem when it has truely become their home and they wish to live out the rest of their days in this place.

If the patient is alert and oriented enough to understand the risks associated with staying in his/her current situation, then one should consider the patients right to make the decision to stay in his/her home even if you don't think that it is the right decision. If the patient does not have the capacity to understand the risks, then the situation is more complicated.

The sad part is that for the most part, LTC facilities are institutional in feeling and don't necessarily mean that the pt. will have any less falls. This is not to criticize LTC employees. It is just a fact. I worked LTC for 12 years. Great co-worker's but a frustrating environment. Too low on resources which translates in too little time to focus on the individual.

These situations are going to increase in number as the population ages. I hope that we can find better and more dignified ways to care for our elders.