Group Home Influence

[Kabin]

For those that have group homes in your territories. Do they provide an increased number of dementia and, in the past, debility terminal diagnoses?

We're seeing caseloads with these diagnoses 3x the national average and they seem to be mainly from group homes. It makes sense but is a bit disconcerting.

[NC29mom, ASN, LPN, RN]

When you say" group home", are you referring to an assisted living facility? Or, an actual group home? Because I was under the impression the rules had changed for both (as far as the level of care which can be provided.) When I think group home, I think of mentally ill pts (fully functional otherwise....independent or minimal assistance needed with adl's). When I think ALF, I think of pts who are mentally stable, they just need additional help with adl`s. Some ALFs do have "memory care units" for the pts with dementia. Most of the time though, if the pt has true end stage dementia, they are bed bound/total care which would require more than a" group home setting", and sometimes ALF setting.

I would be very weary of admitting pts for dementia which are in group homes. Some ALFs will keep a pt who has rapidly progressed towards end of life if hospice is involved.

Supposedly, pts with >stage II (or full thickness wound) must be in a snf. ..

[Kabin]

Good point. Group home have different meanings. Group homes could be rehabilitation, mental health, etc. I was thinking more along the lines of smaller, mom and pop owned. converted home, assisted living residences.

[NC29mom, ASN, LPN, RN]

Ok......so then as long as the pts are meeting criteria for Dementia, and their attending & your medical director has certified their life expectancy is 6m or

I have been doing chart audits for the company I work for due to ADR's (additional documentation requests) from Medicare contracted agencies. Whereas the LCD's are just "suggested" criteria, they will guarantee payment if your pt meets them when audited. Dementia trajectory is very slow and lengthy. A pt isn't true" end stage" unless 7C fast, minimum 40% PPS, pressure ulcers (>stage II) OR recurrent infections (aspiration pneumonia or UTI's). Now, a pt with numerous co-morbidities/secondary conditions can also meet criteria.

I would be concerned if I had numerous pts at 1 facility who was receiving hospice services. There are times when this might be appropriate, but likely far and few between. In the end, YOU are the one performing routine visits; therefore, responsible for documenting continued eligibility. If you feel as if a pt is no longer appropriate, you are legally and ethically responsible for alerting the IDT.

Please remember, you are not the ONLY one seeing this pt. Your chaplain, social worker, etc are also documenting pt status. I can't tell you how embarrassing it would be if your other team members were documenting actual conversations they had with your pt, yet you are documenting a 7E or 7F fast scale. An auditor will pick up on these little discrepancies, only to totally discredit all of your documentation. Being truthful when documenting is THE ONLY WAY!!!!!

Good luck to you, and congrats on asking such a question. .....agencies tend to be stuck on the "numbers" (census), yet if audited. .....guess who they are going to be looking to if they get denied payment?.....