Admissions and Discharge Policies
Guide to Admission Agreements for Residential Care Facilities
- Choosing an Assisted Living Facility
- - Checklist for Visiting Assisted Living Facilities
- - Admissions and Discharge Policies
- - Waiting Lists
- - Resident Turnover
- - Pets
- - Assisted Living Facility Violations
- - Assisted Living Facility Licenses
- - Choosing Assisted Living in a Healthy County
- - Making Sense of Assisted Living Ratings
Thinking of Moving to an Assisted Living Residence?
The assisted living facility model has no federal regulations. Instead, regulations are left to each state to ensure the standards are met. It's highly advisable that family members get involved and advocate for a loved one living in a facility.
When a potential resident evaluates an assisted living facility, it's necessary to carefully read the admissions and discharge agreement. By state law, the documents be written in a language and format that is clear, easily understandable, and uses words with common and everyday meaning. It must include the discharge policy and define its steps taken during the discharge process.
All states have their own set of regulations:
- Types of assisted living,
- Physical and mental status of a person,
- When the facility must discharge a resident.
Types of Facilities
The following types are not clear-cut and followed by all states. Be sure to check with your state regulatory office for details.
Type A Facility - a resident be physically and mentally capable of evacuating the facility unassisted. This may include mobile, non-ambulatory persons like people in wheelchairs or electric carts; people who do not require routine care during sleeping hours and are able to follow directions under emergency conditions.
Type B Facility - a resident may require staff assistance to evacuate; yet capable of following directions under emergency conditions; may require attendance during nighttime sleeping hours; or not be permanently bedridden but require assistance in transferring to and from a wheelchair.
Type C Facility - facilities are four-bed facilities that contract with the state and provide adult foster care. They must meet specific contracting requirements.
Type E Facility limits the number of residents and each are physically and mentally capable of evacuating the facility unassisted. This may include persons who are mobile, although non-ambulatory, such as persons in wheelchairs or electric carts with the capacity to transfer and evacuate themselves in an emergency; not require routine attendance during nighttime sleeping hours; be capable of following directions under emergency conditions.
Assisted living facilities do not require a doctor's orders for admission or to create the care plan. Some states require that a resident have a medical history and physical completed thirty days before admission or within fourteen days after admission.
Typical Admission and Discharge Policies
In a national survey of Residential Care Facilities in 2010, The Center for Disease Control reported the following admissions and discharge terms in assisted living policies.
Do you admit a resident who is Unable To Leave The Facility In An Emergency Without Help? 56% of the facilities do allow residents unable to leave the facility in an emergency without help, while 29% do not.
Do you admit a resident who Has Moderate To Severe Cognitive Impairment--The Resident Does Not Know Who They Are? 55% of the assisted living facilities admit residents with moderate to severe cognitive impairment, while 33% of the facilities do not.
Do you admit a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents? 35% do admit residents exhibiting problematic behavior, while 49% do not.
71% of the facilities do not admit residents who require Nursing Home Level of Care on a regular basis, while 20% do admit them.
81% of the facilities admit residents who Need Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar, while 12% do not.
82% of the facilities admit residents who are Regularly Incontinent Of Urine, while 10% do not.
69% of the facilities admit residents who are Regularly Incontinent Of Feces, while 20% do not.
33% of the facilities admit a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed, while 59% do not.
45% admit a resident who Has A History Of Drug or Alcohol Abuse, while 26% do not.
61% admit residents who Requires End Of Life Care, while 26% do not.
42% of the facilities said there are "other reasons" for refusal.
Resident agreements cover all the terms that a resident and the assisted living provider agree to, such as:
Grievance Procedure and
The Rights and Obligations as a Resident.
TIP: Remember, what you read in brochures and other advertising information from the assisted living provider may not show up in your contract. Check them against each other to ensure that any and all advertised services that you want to have--be in the actual Resident Agreement.
TIP: Be certain that the contract covers refunds or adjustments made when the assisted living changes owners, or when it closes down. You should insist that your contract includes a statement about when any refunds or adjustments in your bill, especially if discharged.
In a national survey of Residential Care Facilities in 2010, The Center for Disease Control reported the following discharge terms in assisted living policies.
15% of the facilities discharge residents Unable To Leave The Facility In An Emergency Without Help, while 71% do not.
18% of the facilities discharge a resident who Has Moderate To Severe Cognitive Impairment--The Resident Does Not Know Who They Are, while 65% do not.
43% of the facilities discharge a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents, while 40% do not.
57% of the facilities discharge a resident who Needs Skilled Nursing Care On A Regular Basis, while 28% do not.
8% of the facilities discharge a resident who Needs Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar, while 86% do not.
5% of the facilities discharge a resident who is Regularly Incontinent Of Urine, while 87% do not.
12% of the facilities discharge a resident who is Regularly Incontinent Of Feces, while 75% do not.
44% of the facilities discharge a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed, while 41% do not.
34% of the facilities discharge a resident who Abuses Drugs or Alcohol, while 50% do not.
9% of the facilities discharge a resident who Requires End Of Life Care, while 75% do not.
38% say there other reasons for discharge.
TIP: Use your state Ombudsman to help negotiate problems between residents and the facility or between individual residents if needed. This is the most successful approach to resolve issues with agreement or otherwise. However, if you want to consult with others about concerns or problems before actually filing a grievance, the residents' rights include the right to confidentiality and access to writing instruments, postage, and reasonable access to the private use of a telephone within the facility. Residents also have to right to have an attorney and to meet in privacy with visitors of their choice.
After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.
- What is Assisted Living?
- Who Lives in Assisted Living?
- Services Provided
- Staff and Administration
- Quiz: What type of care is right for me?
- Talking to a Parent
- Assisted Living Costs
- Ways to Pay for Assisted Living
- Putting Together a Financial Plan
- If You Can't Afford Assisted Living
- Planning Your Social Security to Better Pay for Retirement
- Prescription Drug Assistance
- Choosing an Assisted Living Facility
- Moving Out of the Family Home
- Moving Into an Assisted Living Community
- Resident Activities
- Resident Health
- Medication Management and Adherence Education
- How Tech Advanced are Facilities?