criteria for admission to LTC

[wiley6coyote]

Wondering what the thought on admitting a resident to LTC without giving said resident any warning. Over and over we are having to deal with new admissions who have been "duped" by their families- they are told the craziest stories, lies etc by the family, so the family won't have to " deal" with the after math. But we are left with these poor souls who are frightened, confused, angry, resentful ( I could go on and on) and then they try to escape- and escape they do- we found one a mile away hiding in the woods! And then, to prevent any more escapades, there is an order for a heavy sedative so they can't think about escaping anymore. The staff is furious, the management??? who knows - we never hear anything. Doesn't this scenario sound familiar??? like a scene from " One flew over the Cuckoo's Nest" but it is truly playing out- I would like to know what other facilities do to manage or prevent this from happening???

[vampiregirl, BSN, RN]

Wow, it sounds like there are breakdowns at several places in your facility's admission system.

First of all, is admission identifying these residents as potential elopement risks during the admissions process?

As they are being admitted, are there efforts to make the resident feel comfortable in the facility? Finding activities the resident enjoys, making sure all their physical needs are being met (are they looking for food or the bathroom - they know where these things are in their homes) and helping the resident establish a routine of their choosing. It does make me sad that families use deception to get the residents to the facility though and trust (of anyone) is completely broken. It takes time for some residents to learn to trust our staff.

Also, does your facility have technology available to alert staff if a resident trying to leave. Where I work, we have bracelets (with a physician order) that set off an alert and locks the door if a resident tries to elope so that staff can assist them - sometimes residents just want to go outside and walk around (on the property). Either a staff can go with them or they can be directed to one of several secured courtyards.

Thankfully, I work in a restraint free facility (which includes chemical restraints) so sedation is not an option. Occasionally we have a resident who persists in trying to elope and alternative facilities have to be looked into.

[ktwlpn, LPN]

I've seen it done often by families of residents with advanced dementia who are being admitted into our secure unit.They have to do whatever they can to get their loved one into a safe and secure environment.They have to deal with the aftermath just as we do-their visits to the LTC are fraught with anger from their loved one. I really don't have a problem with this scenario and the fscility does not either.. What really upsets me is when this is done to other types of residents-people who are only physically infirm with slight cognitive issues..The families are not doing them any favors when they lie and tell them they are "just in for short term rehab" when they darn well know they are never taking them back home. I love it at the first team meeting when the family demands that we nurses or the doctor break the news (our facility refuses to do so) Social services gets on board from day one and encourages these families to do the right thing but we just can't make them do anything they don't want to do. The DON has gotten involved in the past-we actually have had families request that we not mention the name of the facility around their loved one. I think they figured that their loved one was just out of it enough to think they were still in acute care.They were informed by the DON that we would not comply and they could take their loved one elsewhere if they wished....They stayed....for years-...many,many years.

[SuesquatchRN, BSN, RN]

We didn't need an order for a Wanderguard (bracelet).

We have never had someone duped, but we have had those come for a short stay and never leaving while their rotten families keep strininging them along with "after the ramp is put in" or whatever. Makes it impossible for staff to settle them in.

[itthybitthythpider]

I've had both the family not telling the resident and the resident not telling the family members where they were going. And both times we got blamed Our admissions coordinator is really good about trying to talk to the families and residents long before they come in, so that when they do get to the facility they have a familiar face to turn to. She's awesome!