Tuesday, May 8, 2012

Value of the Pre Nursing Home Admission Visit

The Pre-Admissions Visit Does Have Critical Value Before Nursing Home Admissions
If you talk to Diana Waugh, a registered nurse from Ohio, long-term care quality advocate and former director of nursing she would tell you she believes in the value of the pre-admission visit. What is that? It is when nursing home personnel visit a hospital and gain an in-depth understanding of a referred patient's needs before accepting this person for admission.
Of course this typically does not happen in our age of electronic referrals and stiff competition among skilled nursing facilities. Plus hospitals are gun-shy, afraid that facility reps will come in and try to market to other patients.
Unfortunately post admission many skilled facilities are finding there may be a financial and clinical incompatibility with this new admission and it becomes almost impossible to undo the process without infringing upon the patient's and their family's comfort level and dignity. Typically the discharge, whenever it is time for it to occur is a complicated one.
Of course there is also the convenience factor. Many nursing home personnel rarely leave the building for anything, except for business development staff. Many are simply in a rut and that can be hard to break away from.
However, Diana's concerns are very legitimate. Accepting certain admissions without really feeling confident this patient is an appropriate behavioral, clinical and psychological fit can open a can of worms that can be hard to manage and hard to close.
Further, when the dominant pre-admission questions center around insurance coverage and skilled days already consumed that calendar year, it is easy to slip into that "cattle herding" mode where we start to move away from the human side of care delivery and care management and focus solely on reimbursement.
Of course location plays a role since the hospital referring the patient may be 30 miles away and even if the pre-admission visit became an industry wide rule we still cannot escape the reality that no admission is perfect. Additionally this can never become a system wide practice unless everyone gets on board or the more aggressive marketers will keep accepting anyone who can pay regardless of the lack of person-centeredness involved.
Maybe there is another solution. If you have it we hope you will share. Let's talk about it. In the meantime may families and patients take a more active role in ensuring that every admission is as close a match as possible in order to ensure quality care delivery remains the priority.
Thanks for allowing us to share.

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