Grace Nursing Care Center works within clearly set boundaries of law and standards of medical practice which require a resident may be admitted only on the orders of a physician and cannot be admitted by personal or family choice alone. GNCC can choose who they will accept for admission and are not required to approve every applicant even if they have empty beds. The reasons for disapproving admission vary and the facility is not required to justify to the applicant or their representative why someone is not accepted for care.
A medically acceptable applicant is referred to the nursing home with a clearly established medical diagnosis and physician’s orders for care. The nursing home requires specific information on medical condition, care regimen, ability to pay for services, and the psychosocial background to consider the person for admission.
It is a medical institution primarily providing skilled nursing care, rehabilitation therapies, and related services for residential clients who require such care and/or treatments for their illness, disability, or injury on a scheduled basis and available only through such a facility. The nursing home is not primarily for the care and treatment of mental diseases nor the provision of room and board.
Residents of long term care most often come directly from a hospital stay with discharge planners making the referral and providing the necessary information and medical orders. Referrals are also made by personal physicians, assisted living facility staff, home health services, hospice, social service agencies, or someone with an interest in the wellbeing of the person needing care. Although the referral or initial contact with the nursing home may come from another source and admission may be approved before formal application is made, an application process is necessary by the individual themselves or a qualified representative. Meeting care needs of the applicant.
A nursing home is required to meet, at the facility’s acuity level, all the medical care needs of a resident without exception. Admitting a resident and then failing to meet their medical or psychosocial needs due to factors limiting the facility’s ability to provide adequate care and protection is not acceptable. Even if beds are available, a nursing home is not required to admit a person if they judge themselves unable to fully meet the applicant’s care needs. The facility must assess the potential resident with what information is provided and decide if they are the appropriate placement to satisfy the needs of that person.
Some reasons for not admitting someone would be the nursing home does not have an open bed or a bed appropriate for the needs of the applicant. The applicant may not meet the level of care criteria required for admission or may be judged to have a primary need for the treatment of mental disease. The facility may not have a contract with their insurance carrier or the applicant may not have clearly identified sources of payment.
The facility may feel they cannot provide adequate care in areas other than medical for a prospective resident, the prospective resident may not fit into the population already being served, necessary equipment or building design may not be available to adequately serve the patient, the applicant and/or their family may have a history of disruptive behavior, an applicant does not provide sufficient medical and/or financial information, or there are not payment sources to cover the full cost of care and services.
The facility may choose to avoid residents with a history of wandering because their building design would make it difficult to prevent elopement. Admission of someone with a history of drug or alcohol abuse with the need to go through withdrawal may be a care process they are unable to adequately provide.
To prevent discrimination due to payment source, our nursing facility must not charge, solicit, accept, or receive, any gift, money, donation, or other consideration as a precondition of admission, expedited admission, or continued stay in the facility beyond any amount otherwise required to be paid under the State plan.
Our nursing facility may solicit, accept, or receive a charitable, religious, or philanthropic contribution from an organization or person unrelated to a eligible resident or potential resident, but only if that contribution is not a condition of admission, expedited admission, or continued stay in the facility.
There are many details to the admission process for both the family and nursing home. The paperwork and questions that must be answered may seem endless and sometimes of questionable value but they are all necessary.
From a variety of sources we require that the resident or their representative be informed of rights, choices to make, procedures to follow, limitations of service, behavioral restrictions, financial obligations, facility policies, and other requirements, benefits, services, and limits governing care in our nursing home. Some of the questions and decisions called for may be surprising, such as the designation of a mortuary in case of the death of the new resident, but all are necessary.
This mass of information and choices should be presented to the applicant verbally and in writing with copies supplied. There will be many pages. The new resident or their representative will be asked to sign forms acknowledging the presentation of this information and the choices made.
Because of the stressful conditions under which most admissions are made, much of the information presented at this time may not be understood or remembered. It could be helpful to review, with appropriate facility staff, all the material provided at admission in a week or so after the new resident has settled in.
GNCC nursing home is not required to accept an admission without a clearly identified source of payment for services. We have the right to decline admission when they are unlikely to be paid for the resident’s care. We require both a primary and a secondary payment source before approving admission. The most common combination of a primary and secondary source would be a person qualifying for and payment out of pocket.
A licensed nursing home may choose not to certify beds for National Insurance Scheme (NIS) and can decline an admission when either of these would be the only source of payment for services.
When someone other than the new resident is completing the paperwork for admission, they will be confronted with a financial agreement to sign. They may be a guardian, have financial power of attorney, or be in some other way empowered to function as the resident’s financially responsible party. The facility may require an individual who has legal access to a resident’s income or financial resources to sign a contract to pay for facility care. This agreement is often thought to be a personal commitment guaranteeing payment from the signer’s assets but this is not the case. Although the paperwork may be an agreement to pay the cost of services, it is not cosigning for a debt or a guarantee to pay from their personal assets. It is an agreement to, as payment agent; utilize the resident’s financial resources only.
The facility is prohibited from requiring a third party guarantee of payment as a condition of admission, expedited admission, or continued stay in the facility.
The facility must inform each resident in writing before, or at the time of admission, and periodically during the resident’s stay, of services available in the facility and of charges for those services, including any charges for services not covered under NIS or by the facility’s per diem rate.
Each resident who is entitled to NIS Medicaid benefits must be notified in writing at the time of admission or when the resident becomes eligible for NIS Medicaid of the items and services included in facility services under the State plan and those items for which the resident may not be charged.
The facility may charge any amount for services furnished to non-NIS Medicaid residents as long as notification requirements are met. Notification must also be given identifying other available items and services offered by the facility that may be charged to the resident and the charges for those services. An updated notice is required when changes are made in the items and services covered by NIS Medicaid or by the resident.
The quality of care provided to residents is sometimes thought to be based upon the payer source. That is, a resident covered by Insurance, the lowest rate of reimbursement for services to a nursing home, would receive less or poorer care than a resident paying a higher rate from their own funds. This is not true. A certified nursing home is required to establish and follow identical policies and practices for the transfer, discharge, and provision of services for all residents regardless of source of payment.
Generally nursing staff may be aware of the source of payment but have no interest in or reason to provide different levels of care. Clinical services are given to all residents without preference to payment source.
On the day of admission, there is the potential for problems with the availability of a new resident’s medication. Although the admission is made with physician’s orders for the resident’s care, sometimes medication orders are not immediately available to or not in an acceptable form for the facility pharmacy.
When a new resident is discharged from the hospital, be aware of the medications ordered for your family member and verify that the information has been correctly received by the facility before or upon admission. Having the information sooner is better because most nursing facilities use outside pharmacies that may be physically located more than a hundred miles away, meaning the ordered medication is not available within the facility but must come in the daily delivery by courier.
The process and details for leaving another care location with a supply of medication and/or medication orders vary. It is important to work with the facility to clarify what information is necessary to assure that the proper medication is available in the first hours at the nursing home. This transfer process will usually be well planned and organized but it doesn’t hurt to make sure.
Admission from the new resident’s home or a lower level of care may involve bringing medications with the resident but the nursing home may not be able to dispense those drugs without the necessary physician’s orders on record and verification the drugs provided are actually the drugs ordered.
There will be limited closet space for clothing. Before admission or quickly thereafter, ask staff for recommendations on what clothing items would be appropriate and will fit within the limited closet space. Some facilities keep a list of suggested clothing.
It is important to not oversupply clothing or try to provide for all seasons at one time. Too many items make it hard for staff to quickly access resident clothing, make it more likely not all items will be used, and easier for items to become lost without anyone being aware. Resident clothing should be rotated for the change of seasons with the out of season clothing stored at home.
You may be requested to provide an inventory of clothing and other personal items upon admission and to update the inventory when changes are made. The facility may not take responsibility for any personal items not on the inventory. Discuss the labeling of clothing with staff to get their recommendations and learn of any special requirements they may have. Unlabeled clothing usually goes into some form of lost and found collection where it may be labeled and given to residents who need clothing.
The family may choose to do the laundry of their family member, but clothing should still be labeled and treated as if the facility were to be responsible for the resident’s laundry. Do not assume that what is to be set aside for you to launder cannot go missing.
The lost foot wear dilemma may never be solved. Sox and even shoes, especially soft shoes like bedroom slippers, seemingly disappear daily in a nursing home. Before reacting to lost sox, remember how often they go missing at home, then consider that far more items are being washed by the facility and far more opportunities exist to misplace clothing. Shoes and sox should also be labeled and any replacement items added to the written inventory. It is easy to buy replacement sox and place them with the resident unlabeled never to be seen again.
It is important to provide the right footwear. Consult the staff on what they have found to work best. A resident in a wheelchair or walking can drop a loose shoe that never gets back to the owner. The right footwear can limit lost shoes plus make falls less likely. Ill-fitting shoes or those with the wrong sole texture account for some falls. It is important to continually monitor footwear size and condition.
Some nursing facilities allow personal furniture to be in the resident’s room. Before installing something in the room, discuss bringing any item into the nursing home with appropriate staff. What you consider proper may not be suitable or safe in that environment. The nursing home must consider the amount of space available, the potential effect on safety, and the ability of cleaning staff to maintain a sanitary environment. The items to be considered include plants, stuffed animals, pictures, appliances, or other potentially unsafe decorations or furniture. What seems harmless in your home may have the potential to produce serious problems in a nursing facility.
Valuable or sentimental jewelry or other personal items of value should not be left in the resident’s room. The nursing home is an open environment filled with residents, families, other visitors, staff, and delivery persons. It is impossible to maintain the type of security one would have at home. The wide variety of people passing through the facility is sure to include some who cannot resist the temptation to steal.
Without a doubt, smoking is one of the most troublesome behavioral and safety concerns of a nursing home. More and more facilities are refusing to accept smokers or allow new admissions to smoke. Be sure you and your smoking family member will stick to the nonsmoking policy. Smoking is an unsafe practice and can be grounds for discharge from the nursing home particularly if the resident tries to sneak smokes within the facility and family members help them by providing smoking materials. Residents with bad judgment and the addiction to smoking have set themselves on fire with death sometimes the result. Family members assisting a patient to secretly smoke put all residents and staff at risk of injury or death from fire or smoke.
There will be an ongoing attempt by staff to match residents to the most compatible roommate. Being forced to share a room with a stranger in addition to being ill enough to require nursing home care puts a strain on the relationship with even the best roommate.
There are very clear rules about roommate problems and making roommate changes. Ask the social worker to explain what the limits are because there are a number of factors to consider. The most important rule governing such changes is that the person requesting a change must be the person to move to another room. It is then up to facility staff to try to identify a compatible roommate for the complaining resident to move in with. Other residents may not be moved without their permission to open a bed in a room with a preferable roommate for your family member.
For more detailed information and guidance to successful care, the Resident’s Handbook from Grace Nursing Care Center in Kurudu, Abuja is a good reference for anyone preparing to apply for admission to our facility. The handbook is for the facility alone and contains some state specific information but it generally covers all aspects of nursing home admission and living. Such a comprehensive handbook is rare in the nursing home community so do not expect a publication like this from most facilities. Use the book to develop questions for the staff of GNCC if we are being considered.
Phase 1, Block C2 Plot 15/17/19
Police Housing Estate, Kurudu, Abuja, Nigeria.
Phone: +234 (0) 909 884 4220