Nursing Home Social Services Reference/Flow of Care/Pre-Admission

Pre-Admission Prior to admission to a nursing facility, many steps are required for most residents. This assumes bed availability for the proper gender. Evaluating the level of care required for resident and acuity balance in the unit and available at the facility Obtaining order for nursing care from a prescriber Verifying benefits or wealth sufficient to meet daily fees Verifying insurance or payment for medications Assessing mental illness (if any) and its severity Evaluating behavioral issues if any Checking sexual offender registries and fit with facility or corporate policy Considering fit of prospect to the facility community The offer for admission is made to the resident if these checks return positive. Level of Care There are several components to this assessment. First, Medicaid insured residents must qualify for nursing home level of care. This is typically done by a worker from the state CMS or a contractor to this organization. The evaluation is recorded on the functional assessment form ULTC-100.2 in Colorado. In other states, other functional assessment forms are used. The functional assessment form becomes a part of the resident's chart after admission. There is a requirement of Medicaid that at resident needs assistance for at least three activities of daily living (ADLs). These ADLs include physical capabilities and mental capabilities. Deficits in these capabilities as identified by the assessor and documented on the functional assessment form. This form authorizes the nursing home to bill Medicaid for the resident's stay if they are otherwise eligible financially for Medicaid. Usually a Medicaid application must be active for this prospective resident. The functional assessment form can have an expiration date and may require reassessment and renewal until the assessor for Medicaid agrees that resident is not likely to improve enough to leave the facility. For the facility, there is a concern that the resident's medical needs could not be met by the available staff or that the care required would overtax the unit's staff. This is called balancing acuity. For mobility issues, the intention is to be sure that there are enough sling lifts, sit to stand lifts and staff to properly manage these processes. For medical acuity, those with trach tubes, feeding tubes, drains, serious wounds, ventilators, dialysis, unstable diabetes, heart instability, hemophilia, and diseases such late stages of bed sores, cancer, Huntington's Chorea, Multiple Sclerosis, ALS, dementia and other neurological and musculoskeletal issues may require more skill and treatment effort than are possible for the unit team to manage. This call is usually made by the Director of Nursing (DoN). Order from a Medical Professional Admission to the facility for insurance payments needs to be authorized by order of a medical professional. This is necessary but not sufficient for Medicaid and private insurance, but may be for Medicare payments. Verification of Benefits For those who are paying for their facility stay with cash, different facilities may use different methods to verify that the wealth is sufficient to allow admission. Check with your admissions person or billing person for this kind of resident. For those counting on Medicaid or Medicare, there is an accounting from Medicaid of the benefit that is available for the resident. The bookkeeper/accountant for the facility receives this and sets up billing and resident accounts according to this form.