Chapter 29 Admissions, Transfers, and Discharges All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admission, Transfer, and Discharge   Admission is the official entry of a person into a nursing center.   New residents and families may have concerns and fears.   Transfer, moving the person to another health care setting, such as another nursing unit, or to another agency, causes similar concerns.   Discharge, the official departure of a person from a nursing center, is usually a happy time.   OBRA has standards for transfers and discharges.   The person’s rights must be protected. 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admitting, Transferring, and Discharging   Admitting, transferring, and discharging residents involve:   Privacy and confidentiality   Reporting and recording   Understanding and communicating with the person   Communicating with the health team   Respecting the person and the person’s property   Being kind, courteous, and respectful 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admission   During admission:   Identifying information is obtained from the person or family.   The room assignment is made.   A nurse or social worker explains the resident’s rights to the person and family.   The person or legal representative signs admitting papers and a general consent for treatment.   The person’s photo is taken.   The person receives an ID bracelet.   Residents arrive by ambulance, wheelchair van, or car. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admission (Cont’d)   Admission is a hard time for the person and family.   Persons with dementia and their families may need extra help.   Often confusion increases in a new setting.   Fear, agitation, and wanting to leave are common.   The family also is fearful and may feel guilty.   You prepare the room before the person arrives.   A nurse usually greets and escorts the person to the room. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admission (Cont’d)   Admission is your first chance to make a good impression.   Greet the person by name and title.   Introduce yourself by name and title.   Make roommate introductions.   Act in a professional manner.   Treat the person with dignity and respect.   To help meet safety and security needs:   Do not rush into admission procedures.   Treat the person and family as guests in your home.   Introduce the roommate and residents in nearby rooms.   Help make the room as home-like as possible.   Show caring and compassion. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Admission (Cont’d)   During the admission procedure you will:   Collect some information for the admission form.   Measure the person’s weight and height.   Measure the person’s vital signs.   Complete a clothing and personal belongings list.   Orient the person to the room, the nursing unit, and the center.   Weight and height are measured on admission to the center.   Then the person is weighed daily, weekly, or monthly.   Standing, chair, bed, and lift scales are used. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Moving the Person to a New Room   Reasons for transfers include:   The person’s condition changes.   The person requests a room change.   Roommates do not get along.   The person’s care needs change.   The need for closer supervision   The doctor, nurse, or social worker explains the reasons for the transfer.   You assist with the transfer or perform the entire procedure.   Support and reassure the person.   Use good communication skills. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Transfers and Discharges   OBRA and the CMS have standards for transfers and discharges:   Protect the patient’s rights.   Reasons for the move are part of the medical record.   The person and family are informed in advance.   A procedure is followed if the person objects.   Also, an ombudsman protects the person’s interests. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Reasons for Transfer and Discharge   OBRA and the CMS reasons for transfers and discharges:   The move is necessary to meet the person’s welfare. It cannot be met in the center.   The person’s health has improved so that the center’s services are no longer needed.   The health and safety of other people in the nursing center are in danger.   The person has failed to pay for his or her stay in the nursing center.   The nursing center closes. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Discharge   Discharge is the official departure of the person from the center.   The health team:   Plans the discharge   Teaches the person and family about diet, exercise, and drugs   Teaches the person and family about procedures and treatments   Arranges for home care, equipment, and therapies as needed   Makes a doctor’s appointment 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Discharge (Cont’d)   Use good communication skills when assisting with a discharge.   Wish the person and family well as they leave the center.   A person may want to leave the center without the doctor’s permission.   Tell the nurse at once if the person expresses the wish or intent to leave. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Quality of Life   To help the person and family:   Be courteous, caring, efficient, and competent.   Be sensitive to fears and concerns.   Handle the person’s property and valuables carefully and with respect. Protect them from loss or damage.   Treat the person and family like you want your loved ones treated.   Visit new residents often.   Explain all procedures and what the various sounds mean.   Always protect the person’s rights and promote quality of life. 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.