ejpip1

We had a case at my nursing facility of a resident who passed away about 2 weeks after admission and there were no funeral arrangements. The son said he didn't have the money to take care of a funeral. It took a few hours but we were fortunate enough to find a funeral home that would do a direct burial into a VA cemetery because the resident was a vet and since he was hospice they picked up some of the cost to the funeral home. Because of this we decided to review all the charts to ensure we had funeral arrangements and found several without. My question is....what do you do if the family won't make arrangements or can't afford to pay for the cost? I have a Medicaid only resident without a plan and a family who says they can't afford to pay. I can't do a circuit breaker because MD is picking up his care. He has no SS. Gets $40.00 per month personal spending. Does anyone know of any programs out there (especially in the state of Missouri) that would help with funeral arrangements? Does anyone have any ideas on how we can get families to make funeral arrangements? Even with his personal spending money I'm not sure we are allowed to set up any kind of funeral plan without the family approval. I would appreciate any thoughts! Thanks.

Have state inspectors in the building and are going to cite for our CNA inservice training. We provide a minimum of 12 hours of inservice every year but this year we are being cited because not all 12 hours aretient care related. Per surveyors cannot count HIPAA, Hazard Comm, TB, how to do ADL coding, workplace violence, advance directives, or training on our elopement policy as part of the 12 hours. I can't find anything like this in the regs and was wondering if someone out has heard of this before. Thanks.

I guess this just hasn't happened before because I am not sure what to do. I have a resident who went into the hospital. He is returning on hospice so a significant change assessment will need to be done. He returned today and his annual is due by 7/20 (in 2 days). What happens when someone has been in the hospital and comes back that close to a due date for OBRA MDS? Do I need to try to do a annual now or can I wait for a week and just do a significant change? The annual assessment would be late. Thanks.

I could use one too!! [email protected]

Thanks for the input. I know now that I am on the right track. It had been care planned and I had documented my conversations with him. I was alsowondering if anyone also had any ideas on how to keep him from falling! Any new ideas that have worked besides what I mentioned. Thanks again

In trying to be supportive of residents rights and culture change I am having a problem with one of my residents. He is a bilateral amputee who has fallen out of his bed or chair numerous times. He is in a low bed, we have had OT evaluate him and have tried putting his commode lower. WE put a seatbelt on his W/C that he can remove himself. He has 1/2 side rails because he uses them to reposition himself in bed. He has a slide board he utilizes for transfers. Due to a decline his cognitive state has somewhat diminished but is still very able to tell us what he does and does not want. Our doctor ordered bed/chair pressure alarms. WE had tried these in the past but he would remove them. We are trying again but he has asked me to remove them. He states he does not fall but he is. We worked out a compromise that if he can go 30 days without a fall they would be removed and he was agreeable to that. Unfortunately, he continues to fall. Fortunately, despite the many falls he has only ended up with stitches to a nose one time. Does anyone have any suggestions on what I can do with a chronic faller yet keep within him wishes to remain independent?

Can a discharge RA or RNA be signed as completed the same day as the ARD?

I have a resident who is totally dependent on staff for the majority of her ADLs. During her BIMS she scored a 3 because she gave sensical answers but they were incorrect. My software is not triggering ADLs because of the BIMS score. Has anyone else run into this problem? We will still address her ADLs in her care plan but I'm trying to figure out why the BIMs score makes a difference in the trigger. Thanks

WE use Accu-care. It looks like I got several different opinions on what to do. SOT or no SOT. I'll look at this more tomorrow. thanks for the input.

Resident was readmitted 11/16 on MA. Starting to receive therapies on 11/17 and also rec'd 11/18 and was discharged that evening back to the hospital. I did an entry for 11/16. Can't I do a 5 day, start of therapy and discharge along with a short stay (to get my nursing and rehab rug) with an ARD of 11/18? Or do I need to separate them somehow?

Had a resident return to the sNF, received Pt/OT then was discharged 2 days later back to hospital. I tried to do a 5 day, SOT and discharge RA together. I am getting an red error and default rate for RUG. Can I combine all of these? Admit 11/17, DC to hospital 11/18, received therapy starting 11/18 through 11/19. 0 (not an OBRA), 5 day PPS, Start of therapy and DCRA with aRD 11/19. I want to do this as a short stay assessment but when I do the assessment section Z has a "no" under short stay and I can't change to "yes". Is this a software problem or am I coding incorrectly. Thanks

I was hoping to use something you could see at a glance while caring for the resident. We have tried putting information inside the closet door but unfortunately it is not always updated as it should be. We have dots on doors to indicate how much help needed for transfers, colored tape on SRs that are to be left down, etc. I'm thinking of making a board with felt and colored pictures with velcro that would reflect their care, i.e. picture of bee for honey thick liquids, cup of juice to encourage fluids, picture of an alarm for personal safety alarms, a tree with falling leaves to show someone at risk for falls, etc. Has anyone tried doing anything like this? I know of one facility that made mobiles with this kind of information. I don't have time to do that! Wish I did!

I am the administrator of a long term care facility. It seems that we spend a lot of time writing care plans but I don't believe they get where they are supposed to go - to the staff caring for the residents. I was wondering if anyone can tell me how they go about letting the aides know what is to be done for the resident without printing out the entire care plan they then would have to muddle through. Has anyone tried using pictures on a board, etc. that would give information without violating HIPPA? I'll take any suggestions. Thanks

We have a resident at our long term care facility who came to us after breaking both legs at home. The hospital/family decided not to do surgery due to her other medical conditions. The problem we have is that her legs are becoming severely contracted due to the inability of therapy to do ROM secondary to the fractures. They have attempted but feel uncomfortable due to her pain and possibly re-fracturing her legs and of course the nursing staff doesn't feel anymore comfortable. We have her pain in control as long we we don't mess too much with her legs. Does anyone have any ideas of something we could do to work with her legs to prevent the progressive contractures or if not, is there surgery that may need to be done as it has become increasingly difficult to give her personal care?