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Independent LOA

Posted

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Do any of your facilities allow residents to go out unescorted? I'm not talking about a trip on the chair car with a driver....I'm talking walking through town to buy food or smokes or God knows what else. I recently started as the DNS of a facility where there were people with independent loas! At another facility a few towns over, which allowed the same thing, a 42 year old woman got hit by two cars on her way to the movies and died! I've worked in at least 7 facilities and none of them ever allowed this. I changed the rule of course to try to keep them all safe and keep my license as well and am getting nothing but push back from the residents, which I expected, and the staff which I didn't expect. Any comments?

I think the safety/liability issues are huge.

I worked in a facility that allowed a resident to go out in her motorized wheelchair and drive down the street about a quarter mile to do some shopping at the grocery store and drug store. They had her sign that she wouldn't attempt a street crossing. Once the battery in her chair died suddenly (it was charged before she left, not sure what happened) and she got stuck on the sidewalk halfway back. Thankfully passersby were kind and called the facility and she was fine, but they stopped allowing it after that.

I understand how the residents feel about it but I don't see where you have much choice. Even if they are signing that they are totally responsible for what happens when they leave I think it would come back on the facility if something ever happened.

I have only ever known one resident who was allowed independent LOA and he was a young A&O3 quad.

If someone can take care of himself well enough to be out unescorted why does he need an LTC?

devil's advocate....lol...........you are not running a prison...

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

My point exactly. Unfortunately, we have residents with no place to go. I keep telling them we are responsible for them and we are NOT a hotel....it'll be interesting to hear what the ombudsman has to say.

Butterfliesnroses

Specializes in LTC.

There are some pts who are allowed to sign out and leave. In the sign out book, whoever signs them out (being themselves or a family member or friend, that person is responsible for the pt. Of course if a pt isn't deemed safe then they are talked into not going. But we have some pts that go across the street to get some smokes or snacks. Or they go a few blocks down to eat out. Give the town I live in is quite small. I don't know if that has something to do with it or not. But I could see the ombudsmen saying it's against pt rights to not allow them to leave the facility for a bit. I would probably call the ombudsmen and see there take on it. As a CNA I've called them with questions and they've always been a very good resource.

I don't know the technical, legal side of the issue however have heard of assisted living allowing independent LOA if that is any help in doing a comparison.

If they want hotel privileges, then they should move into a hotel. You have legal responsibilities to worry about and can't be all things to all people. I don't blame you for your concern.

devil's advocate....lol...........you are not running a prison...

Yeah, those electronic ankle bracelets that set off the alarm if you escape (excuse me, elope) mean nothing. Repeat after me, "There's no place like home. There's no place like home."

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

I know the LTC facility closest to me allows it. They are right in town and some residents go out shopping at the dollar store.

when my dad was in rehab, following bka, there was a pt that had off-premises privilege...he used to walk down to the corner liquor store, and pick himself up a 6pack...don't know how or why the facility allowed that.

DPRN

Specializes in long term care, school nursing.

At my facility, only the personal care residents are allowed to sign themselves out and go uptown to shop or run errands. The intermediate care residents need accompaniment.

Nascar nurse, ASN, RN

Specializes in LTC & Hospice. Has 35 years experience.

I'm sure there's a subassessment form out there somewhere that you could probably use to determine who is and who is not appropriate to be an independent LOA. Seems as if we have a subassessment form for everything else. :uhoh3:

Of course I would also want a physician order that this is OK.

nursinger

Specializes in LTC. Has 40 years experience.

when my dad was in rehab, following bka, there was a pt that had off-premises privilege...he used to walk down to the corner liquor store, and pick himself up a 6pack...don't know how or why the facility allowed that.

Years ago when I first started working at my facility, we had pts leave campus and go to "Bill's Corral" :cheers: which was right next to the facility and then they staggered home. :lol2: I was brand new and could never understand that.

Years ago when I first started working at my facility, we had pts leave campus and go to "Bill's Corral" :cheers: which was right next to the facility and then they staggered home. :lol2: I was brand new and could never understand that.

Because years ago it was truly a home and not a quasi-hospital with more regulations than a nuclear power plant.

debRN0417

Specializes in LTC, ER, ICU, Psych, Med-surg...etc.... Has 31 years experience.

I echo the statement- "If they can go running all over town without help, then why are they in a nursing facility?" I mean, I am all for independence and getting out and having outings, but that sounds more like independent living to me than long term care. I would be afraid of the liability issues.