When exteded care is needed- how to choose

Your loved one needs more care

Your loved one is hospitalized for what everyone thought was routine. A hip or knee replacement, or a recent bought of pneumonia. Yet, in comes the Case Manager or Discharge Planner who states that the patient needs “more “care but at a lower level. This person also states that the patient must be moved today and that you (the family) must find a place to go or if you are lucky they have found a facility that is willing to accept.

What does this mean? Most important, the patient and the family have the right to ask for more information. It is important for everyone involved to have correct information about the extended care being proposed because it could be as little 1 week or it could be a month or longer.

Next, be aware that the patient has every right to make his/her needs known and has the right to choose where they want to go. If the patient does not have the capacity to make their own decisions then the family will have to make these choices for them. In all cases, the family has the right to ask for a list of all the facilities in the area especially for the facility that has accepted the patient. The family should take the time to tour. Please do not leave this decision to the hospital personnel.The hospital personnel is not allowed to make recommendations, however,they are allowed to give the family facilities to choose from. The right facility will make a difference in the patients recovery.

What kind of care is needed?

Usually, when it comes to extended care the case manager or discharge planner is referring to a Long Term Care Facility that offers rehabilitation services. There are times where a lower level of care such as an Assisted Living is more appropriate.

An Assisted Living Facility does not normally offer extensive rehabilitation services nor do they offer 24 hours nursing care. This type of facility is great for the patient who needs minimal assistant with ADLS (Activities for Daily Living) such as dressing, eating, and taking their own medications. Most of these patients need only reminders and are able to make all their needs known. There are specialized Assisted Living Facilities that have memory units for Alzheimer patients. Even patients at this stage can make most of their needs known and still do most things for themselves like brushing their teeth and feeding themselves.

If the patient needs “more” care, which may require things such as I.V. antibiotics, physical therapy, occupational therapy, and/or speech therapy then a Long Term Care Facility that offers rehabilitation is appropriate. These facilities are often referred to as Nursing Homes, Long Term Care Facilities, or 24 hour nursing facilities. These types of facilities assist the patients with all medication needs including pain management as well as with their ADLS. They help the patient recover and regain their strength.

Who can reside in a LTC (Long-term Care)

Long Term Care Facilities are no longer just for the elderly. Patients of different ages may reside in the same facility as long as everyone’s nursing needs are met. Nursing Homes may only take patients that they can provide adequate care for. Adequate care refers to providing all necessary nursing care that are ordered by the attending physician. This would include their medications, therapy, and assisting the patient their ADLS (i.e. going to the bathroom/getting dressed). It does not refer to their age.

The age of the patient can be as young as 21, but the facility must make sure that the patient is compatible with the other patient(s). For example, a 21-year-old cannot share a room with a 76-year-old (unless both patients can make their needs known and have chosen to be in the same room). Typically younger patients share a room with other young patients or reside/ in a private room. Also, the facility must ensure that there is age appropriate activities for everyone. For example, providing video games or movies, such as Fast and the Furious, for the younger patient is great, but these same items would not be age appropriate for the elder patient. Activities for all age groups must be provided.

Long Term Care facilities in California must follow Title 22 regulations as well as Federal regulations.

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