Admission and discharge procedure

Admission and Discharge Process

It is always an exciting time when a new resident chooses to move into your community! Many hours of work from your team have paid off and now you welcome a new member to the “family”- but its not done yet! The state of New Mexico requires a written admission agreement for every new person moving into an Assisted Living Facility. Agreements should always be signed prior to the resident moving in or taking possession of the apartment. Check out the regulations below for more information of the requirements for the admission process:

7.8.2.20                 ADMISSIONS AND DISCHARGE:  The facility shall complete an admission agreement for each resident.  The administrator of the facility or a designee responsible for admission decisions shall meet with the resident or the resident’s surrogate decision maker prior to admission.  No resident shall be admitted who is below the age of eighteen (18) or for whom the facility is unable to provide appropriate care.

  1. Admission agreement.  The admission agreement shall include the following information:

(1)           the parties to the agreement;

(2)           the program narrative;

(3)           the facility’s rules;

(4)           the cost of services and the method of payment;

(5)           the refund provision in case of death, transfer, voluntary or involuntary discharge;

(6)           information to formulate advance directives;

(7)           a written description of the legal rights of the residents translated into another language, if necessary;

(8)           the facility’s staffing ratio;

(9)           written authorization for staff to assist with medications;

(10)         notification of rights and responsibilities pursuant to the Incident Reporting Intake, Processing and Training Requirements, 7.1.13 NMAC;

(11)         the facility’s bed hold policy; and

(12)         the admission agreement may be terminated if an appropriate placement is found for the resident, under the following circumstances:

(a)           there shall be a fifteen (15) day written notice of termination given to the resident or his or her surrogate decision maker, unless the resident requests the termination;

(b)           the resident has failed to pay for a stay at the facility as defined in the admission agreement;

(c)           the facility ceases to operate or is no longer able to provide services to the resident;

(d)           the resident’s health has improved sufficiently and therefore no longer requires the services of the facility;

(e)           termination without prior notice is permitted in emergency situations for the following reasons:

(i)            the transfer or discharge is necessary for the resident’s safety and welfare;

(ii)           the resident’s needs cannot safely be met in the facility; or

(iii)         the safety and health of other residents and staff in the facility are endangered;

(13)         the facility shall provide a thirty (30) day written notice to residents regarding any changes in the cost or the material services provided; a new or amended admission agreement must be executed whenever services, costs or other material terms are changed; and

(14)         facilities representing their services as “specialized” must disclose evidence of staff specialty training to prospective residents.

  1. Restrictions in admission.  The facility shall not admit or retain individuals that require twenty-four (24) hour continuous nursing care, refer to Subsection U of 7.8.2.7 NMAC Definitions.  This rule does not apply to hospice residents who have elected to receive the hospice benefit.  Conditions or circumstances that usually require continuous nursing care may include but are not limited to the following:

(1)           ventilator dependency;

(2)           pressure sores and decubitus ulcers (stage III or IV);

(3)           intravenous therapy or injections;

(4)           any condition requiring either physical or chemical restraints;

(5)           nasogastric tubes;

(6)           tracheostomy care;

(7)           residents that present an imminent physical threat or danger to self or others;

(8)           residents whose psychological or physical condition has declined and placement in the current facility is no longer appropriate as determined by the PCP;

(9)           residents with a diagnosis that requires isolation techniques;

(10)         residents that require the use of a Hoyer lift; and

(11)         ostomy (unless resident is able to provide self-care).

  1. Exceptions to admission, readmission and retention.  If a resident requires a greater degree of care than the facility would normally provide or is permitted to provide and the resident wishes to be re-admitted or remain in the facility and the facility wishes to re-admit or retain the resident.  The facility shall comply with the following requirements.

(1)           Convene a team, comprised of:

(a)           the facility administrator and a facility health care professional if desired;

(b)           the resident or resident’s surrogate decision maker; and

(c)           the hospice or home health clinician.

(2)           The team shall jointly determine if the resident should be admitted, readmitted or allowed to remain in the facility.  Team approval shall be in writing, signed and dated by all team members and the approval shall be maintained in the resident’s record and shall:

(a)           be based upon an individual service plan (ISP) which identifies the resident’s specific needs and addresses the manner that such needs will be met;

(b)           ensure that if the facility is licensed for more than eight (8) residents and does not have complete fire sprinkler coverage, the facility shall maintain an evacuation rating score of prompt as determined by the fire safety equivalency system (FSES);

(c)           evaluate and outline how meeting the specific needs of the resident will impact the staff and the other residents; and

(d)           include an independent advocate such as a certified ombudsman if requested by the resident, the family or the facility.

(3)           The team recommendation shall be maintained on site in the resident’s file.

(4)           When a resident is discharged, the facility shall record where the resident was discharged to and what medications were released with the resident.

  1. Coordination of care.

(1)           Assisted living facilities shall have evidence of care coordination on an ISP for all services that are provided in the facility by an outside health care provider, such as hospice or home health providers.

(2)           Residents shall be given a list of providers, including hospice and home health if applicable, and have the right to choose their provider.  If applicable, the referring party shall disclose any ownership interest in a recommended or listed provider.

 

Top Takeaways:

  • Restrictions in admission.The facility shall not admit or retain individuals that require twenty-four (24) hour continuous nursing care, refer to Subsection U of 7.8.2.7 NMAC Definitions.  This rule does not apply to hospice residents who have elected to receive the hospice benefit.  Conditions or circumstances that usually require continuous nursing care may include but are not limited to the following: 1-11

There is absolutely no grey area for these restrictions (minus if the resident is being cared for by hospice). You cannot accept a resident who is requiring any of these services. If the need for the service begins after the resident is admitted into the facility you must begin the discharge process.

  • (12)the admission agreement may be terminated if an appropriate placement is found for the resident, under the following circumstances:

(a) there shall be a fifteen (15) day written notice of termination given to the resident or his or her surrogate decision maker, unless the resident requests the termination;

(b)           the resident has failed to pay for a stay at the facility as defined in the admission agreement;

(c)           the facility ceases to operate or is no longer able to provide services to the resident;

(d)           the resident’s health has improved sufficiently and therefore no longer requires the services of the facility

(e)           termination without prior notice is permitted in emergency situations for the following reasons:

(i)            the transfer or discharge is necessary for the resident’s safety and welfare;

(ii)           the resident’s needs cannot safely be met in the facility; or

(iii)         the safety and health of other residents and staff in the facility are endangered;

If you plan on discharging a resident, you must provide them with a 15-day notice, unless it is deemed that a more expedient discharge is warranted for the safety of the resident. It would behoove you to have documentation on the reasoning as to why you are discharging the resident to ensure it is justified.

 

 

 

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