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Spotting High-Risk Admissions in Nursing Homes

Written By : Joe Casciani

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Skilled nursing facilities are frequently faced with admissions that, although initially are very appropriate, eventually turn into headaches for the administration. This Blog post is about spotting high risk admissions in nursing homes and taking steps toward prevention. What characterizes the high-risk admission?

  1. Families who present with conflicted decision making: they disagree with one another on the course of the care, and what is the most effective or the most appropriate care necessary;Risk management flow chart on paper
  2. Family members residing in different cities yet there has been no single person to assume a primary role or more care than the others, and suddenly the parent has to be placed in a nursing home. This diffusion of responsibility can mean no one and everyone wants to decide what’s best for dad;
  3. A family member who has been out of the picture and now surfaces, taking control of all affairs, or attempting to take control, and wants to make all health care decisions;
  4. Families with unrealistic positions on resident care, such as demanding special schedules or personalized care.
  5. Unrealistic expectations about the treatment that is required for a given condition. Families may disagree on how aggressive the treatment should be. Is palliative care desired, or is aggressive treatment desired for the patient who has a terminal condition?
  6. Conflicts about the “Do not Resuscitate” orders or living will, with disagreements about how much care and how much cost to put into the long-term treatment of a loved one. Or, when the resident has clear desires about what type of care he or she wants, and the family refuses or vice versa, especially when the resident is alert and capable of his or her own health care decisions.
  7. The presence of a strong emotional overlay to placement, such as when the prospective nursing home resident engenders feeling of guilt and helplessness on the spouse or children. These families may become very conflicted about what the best course of action should be, and although it doesn’t necessarily mean there will be problems, there is a potential cause for concern, especially if the resident makes the family feel worse throughout the placement.
  8. Placements that are rushed can plant the seeds for future discord, such as when there has not been proper time to locate the most appropriate level of care needed. When coupled with regrets about the costs of long term care, and fears of depleting the parent’s savings, can easily generate dissent and may lead to serious care giving complaints among the family members.
  9. “Hot buttons” are observed on admission. Examples here include the family that brings up their influential friends or a neighbor who happens to work for the District Attorney’s Office, the family who stresses that they really want to be involved and want to be part of all the decision making, but they are available by phone only between 7:00 and 8:00 p.m. on Monday nights. Other “hot buttons” include endless complaints about prior, multiple placements, or reports of a pending law suit against a former nursing home.  This is not to say that dissatisfaction with prior placements is never warranted, only that the more hot buttons there are, the greater the risk of future conflicts.

Look for other CoHealth blogs in this series on high-risk admissions in nursing homes.

Filed under: Long Term Care

Written By :

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

has written 5 articles