Action Steps for Change in Condition

Assisted Living communities are at high risk when a resident has a significant change in condition.  This change could include a pressure sore, cessation or decrease in eating or drinking,  immobility or weakness, change in mental status, just to name a few.  Calling the family to notify of a change in condition is important, but not enough.

Too often staff have erred in thinking “I told the family” is enough.  Another mistake is to send a fax to the MD to notify of the change in condition.  While it is fine to notify the MD, you need your resident evaluated.

In a 2012 CNA Aging Services Report titled Data Analysis Supporting the Need for Industry Change, it is noted that gross improper care has the highest average total paid in assisted living claims ($541.000.00). These claims can include egregious deviations from the accepted quality of care and lapses in communication with physicians.

What is a community to do?  Consider these important action steps when your resident has a change in condition.

  1. Get the resident in front of a medical practitioner.  This can be an MD visit to their primary physician if that can expediently be arranged.  It could also include an urgent care visit  or a visiting physician coming to the community.
  2. Document all notifications and attempts to get the resident to the MD.
  3. Document and follow all new physician orders
  4. If resident continues to decline, seek emergency medical services.

Aggressive early interventions can prevent hospitalizations and worsening condition, which is not only appropriate for the resident, but a solid risk prevention strategy.

3 Responses to “Action Steps for Change in Condition”

  1. Wow! What a timely article. Unfortunately I have had many issues such as this this past year. The most recent just yesterday. I had a resident who is usually very high functioning have increased fatigue and weakness and mental status change (confusion, delirium, can’t follow simple instruction) over the weekend. I sent her to the ER via 911 because I went to wake her Monday am and she was 1/2 way on her bed not able to communicate with me, and when I tried to move her and help get in a more comfortable position she cried out in pain. She spent 6.5 hrs. in the ER with NO fluids given (IV or otherwise) and sent home because her tests all came back “negative”. She was worse upon arriving home and I had to stay with her all night (I don’t have an awake staff) she was confused and wanted to get up out of her bed all night and when I helped her up she would collapse into “dead weight”. I sent her again to ER (via of non-emergency ambulance) and they still could not find anything wrong with her, but decided to admit her! Why do I have to go through hoops for Dr.’s to listen to ME (the caregiver who is with the resident 24/7)! I could write a book for them to read about what is going on with the pt. and what is normal for them and what it not normal, but they ignore me and my notes and then send the pt. home for me to basically give Skilled Nursing care until they “get better”??? I lost a resident in January to this very same manner…she was very sick (suddenly with UTI, hallucinations, etc…) I sent her to ER at 10pm, she was delivered back to me at 3am (unannounced!) still hallucinating and fell and broke her arm during the early morning hours “looking for the men under her bed”. She eventually needed to have permanent Skilled Nursing! I feel like the hospitals and personnel don’t care about elderly especially if they are in an Assisted Living Facility. They act like they are all Skilled Nursing levels and should be able to handle anything that’s sent back to them. I just wish we (Dr’s, nurses, hospitals, caregivers, care homes, etc…) could all work together for the good of the residents/pt.s and do what’s best for them, especially what is safest for them.

  2. Leah,

    I could share many stories similar to yours. We’ve played the round robin with doctors/ER. It can be frustrating when we know there is something off with our residents and the medical professionals won’t properly investigate what might be going on or treat them thoroughly. The best I can do is document, document, document the steps we have taken to get medical treatment.

  3. Is it required to notify the State of any change in condition other than Hospice?

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