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High Risk Admissions in Nursing Homes: Taking Steps Toward Prevention

Written By : Joe Casciani

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In a previous blog, I discussed a series of “red flags” that may suggest the presence of a high-risk admission to a nursing home, because of potential misunderstandings, unresolved emotional conflicts about the admission, or just a contrary attitude on the part of families or residents themselves. This article presents some recommended steps to manage these high risk admissions. Here are some preventive steps to take:

  • no-riskEducate the patient and the family on the progression of their particular disease, and what level of care will be offered?  Try to understand the family’s expectations and how these fit with the facility’s routine care practices.  Give a detailed explanation about the progression of the condition precipitating the admission.
  • Clarify what expectations families have, and uncover any misunderstandings about day-to-day issues. What do they think is standard care regarding scheduling, what happens to laundry and personal items, how are the meals selected, what happens when there is a change of condition, and what’s routine, what’s not routine. The more explanation up front, the less risk down the road.
  • Help families to understand there is always a decision between balancing dependence and independence. How much care do we want to offer? How much ADL assistance should be offered? Is it better for the person to do it himself, like combing his own hair, and doing his own grooming and hygiene? Or, is it better for the caregivers? What’s the trade-off? When CNA’s do it, the job may get done quicker, it may even be better, but at what cost? If the patient does it and maintains some level of independent self-care it may not be the best, but it gives him or her some level of dignity and purpose, rather than being so dependent on others.
  • Assign someone on the staff who will take on the role of being the designated risk manager, to do the trouble shooting, to handle the high-risk cases and to provide the role model for other staff so that they can develop these skills, especially those requiring good communication and problem solving.

The family that is part of these decisions and participate in care plans are really much more involved and are less likely to have an angry reaction or become dissatisfied, and less likely to threaten a lawsuit when something does go wrong. Primary prevention means keeping families involved in decision making, and not on the periphery as mere spectators of care.

Thank you for your interest in the CoHealth Blog series.

Filed under: Long Term Care

Written By :

Joseph M. Casciani, PhD, is the founder and President of Concept Healthcare and CoHealth Psychology Services.

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