When residents go to Doctor's appts, activities, home visits, etc....


New to LTC/ SNF and it just occurred to me.....what happens if a resident has an acute problem (such as MI, resp. distress, etc.) or other issues (soaked diaper, vomiting, etc.) when they are taken on doctor's appointments and/ or activities with non-licensed staff? Also, what about when they leave for part of a day, a whole day, and/or overnight with their families? Does the family sign a form that the facility isn't liable?

How do one or two activity personnel handle all the toileting/ transfers/ diaper changes, etc. on an outing? And what if a resident is way past due on their pain meds. What about blood sugars and insulins, etc?

I can imagine a scenario when they're on the way to a doctor's office and/or fun activity, if they were to have any acute problem, they'd get them to the nearest ER....however, what about all the other issues I mentioned? And the people with them are not licensed, so who is responsible?

Thanks :)


52 Posts

Our activities personnel are required to be cna's, only take a manageable number of residents out at a time, the residents are stable and require dr permission to be out of facility. Meds are given prior if able, otherwise are held until they return. Residents are toileted before leaving, and should emergent toileting need come up they are toileting during the trip by activities. Outings are timed to be shorter or little longer depending on what the mix of residents going can tolerate comfortably. Requires a lot of planning, and at times a teamwork effort between nursing and rehab for more therapeutic 'field trips', but the residents enjoy the outings being more tailored for them and its well worth it in the end.


52 Posts

Also, activities outside the facility require a facility cell phone be carried by the aids to retain instant communication with the charge nurse.


24 Posts

I work in a nursing home/LTC facility (in Activities) and in this particular facility we are not licensed as CNA/GNA. We do not take the residents out on outings. However at the place I worked before in Activities, when we took the residents out, we also took one or two CNA/GNA's with us for problems such as you mentioned.

bluegeegoo2, LPN

1 Article; 753 Posts

Specializes in LTC. Has 11 years experience.

Most facilities I've worked in have a "sign out book" for the resident family member or whatever non-employee takes a resident out. They sign them out and are then fully responsible for what happens to the res.


7,735 Posts

Specializes in retired LTC.

Residents ARE permitted to leave the facility whenever for whatever. If we send them out for a consult/MD appt, the ambulance is responsible for them for the short duration. And you need to know, whch or stretcher, and if the office can accommodate the pt (like for steps and if oomphing up on an exam table).

At the office, that staff are responsible for pts but our pts almost always 99% come back wet or soiled as office staff most usually DO NOT do any type care. In fact, some offices WILL NOT see a pt unless a NH staff member absolutely accompanies the pt. Some NHs will send an employee with the pt; some don't and the family must accompany the pt- it's up to the facility. We REALLY must know how to accomplish consults. It is RARE that you can get someone to make a house call to the NH.

Knowing my place's policy, I alert the staffing coordinator in advance that "on July 5th, Ms Jones will need to go to Dr Smith for a derm consult at 1 pm". The coord may get a totally off-duty employee to accompany, or maybe a 3-11 person can come in for the Dr visit and then go to their regular assigned unit when they return (they figure it out and some staff like the OT).

For social outings, it also varies. As other posters said, we can medicate early and/or a little late. If it's a prolonged trip like a bus trip to Atlantic City, we've sent an off-duty nurse who can medicate as nec (she just packs the needed meds). Our CNAs and nurses usually love to volunteer for trips - no shortage. They have trips to the mall for Christmas shopping, local lunches at pt-friendly restaurants, movies, etc. One thing - if the pt is so unstable that hypoglycemia or recent seizing occurred, then leaving usually is not be allowed. We have cancelled outings because of nasty weather problems also.

Remember that NHs are the pts' homes...they are not imprisoned inside. Pts are allowed to leave with responsible parties who sign them in/out. They can be for quick visits like to go to a short recital. And they can also be overnite (a day or more) for longer activities, like an out-of-town wedding or funerals. The responsible party can give meds that have been prepackaged & labelled (BY PHARMACY) for them for specified limited amounts. We educate the family for the dosage and timing like you do for discharge teaching. Just make sure you get a current phone #.

A restriction is that there is usually a set-limited amt of overnites permitted by the insurance or Medicaid. The rational being if the pt is that stable to being out of the facility that long/freq, then maybe there really is no longer a need to be institutionalized and they should be in home health care.

The responsible party will sign back in the pt upon return. The nurse should always ask how the trip was and if there was any problems. Ask the pt also and do a quick body check - you'll find that families neglect to tell you there was a fall or a laceration or some other kind of incident! God help you if you find out there's an undiagnosed fracture because they dropped Mom-Mom when they transferred her out of the car!!!! I'M NOT KIDDING!!!!!! Also, as the family is the responsible party, it is expected that they would do as normal folk would if there were an emergency and call 911 or go to an ER. They do bring them back and tell us "oh, she's had some chest pain since 2:00, but we knew we were coming back..." GRRRRRR

It just takes pre-planning and as you become more experienced you start to think about these things like second nature. And the pts just love it, even if they don't tell you.


7,735 Posts

Specializes in retired LTC.

Just one other thing - some facilities require that you get a MD order for outside social activities. At some places it's part of the admission orders protocol. Just make sure you're set with the MD as nec.

ktwlpn, LPN

3,844 Posts

Specializes in LTC,Hospice/palliative care,acute care. Has 35 years experience.

Families sign an LOA slip-they are responsible for their loved one .We have had a few take their loved ones out "against medical advice".It's on them. We have had to fax medical records to the ED numerous times, things happen.911 has also been called when residents have been out with our activities dept. and they are all CPR certified. We have a clinic with a nurse and a group of CNA's (all CPR certified) and numerous consultants now willing to come to the LTC (opth, opt ,ENT ,a dental group, a cardiac group ,derm,podiatry and a pulmonologist)We are lucky-this has really cut down on the costs associated with transport,much of which the home absorbed.We do contract with a local private ambulance company to transfer our immobile folks. They do a good job. Sometimes folks still have to go out for f/u apts,we have had a few sent directly to the ED from their physician's office,also had a lady code in the dentists office years ago.Our clinic staff transports also-we have a w/ch van and a few cars.They are a pretty good group of people to have around in an emergency-they know what steps to take..

Specializes in NICU, Peds, Med-Surg. Has 29 years experience.

Thank you for the replies. We had a resident go home with her hubby and spend the night. The charge nurse who has been

there forever freaked out and said "WHAT ABOUT ALL HER MEDS?"....I figured she knew the protocol.....