Angela met a case manager, a wonderful professional who also happened to be a social worker. She earns her living designing specialized plans of care for people who are being discharged from nursing homes. Angela came across this case manager, whose name is Melanie since her mother was soon to be discharged.
Because mom had some behavioral issues many small assisted living programs or group homes would not entertain the admission. This was also not a high income placement.
Finally the nursing home discharge planner indicated she had found a home who would consider the admission and mom was soon placed there. This discharge planner admitted the home who took her made it clear, "we will allow this lower paying resident to come with the expectation you will send me a higher dollar one later."
Well within 3 months Angela and Melanie crossed paths again. Melanie's help was desperately needed as the home where mom was admitted rendered shoddy care. Their staff had no experience or formal training in managing the delicate needs of the elderly including their incontinence and the wandering and agitation associated with certain levels of dementia. The experience became frustrating.
The discharge planner who recommended the home (of course Angela says "she pushed the home on us") denies coercion but did admit she promised to be on the lookout for a higher dollar referral for the home as she planned discharges and that she had never personally visited the adult foster care residence. Melanie, the case manager who helped Angela and mom find different accommodations remarked, "what a horrible circumstance to have a 'quid pro quo'. Humans are not cattle and person-centeredness is never the consideration in such arrangements."
We agree, but it continues to happen. This is not to say the independent case manager has all the answers. What it does say is that a committed, ethical professional with the required experience can help explore options objectively and often has a wider awareness of long-term care options in the community, but another caution lurks among us. What is that?
When promises or assurances are made to providers of care you will be expected to make it good and it could result in highly inappropriate expectations and divided loyalties. This behavior could also compromise the objectivity that should accompany responsibly, person-centered planned discharge arrangements.
Liability related fact: A large number of adult foster care providers went into business to serve the high-functioning mentally ill and those with developmental diagnosis and are now seeking to serve the aged without proper preparedness, just so they can replace lost revenue which dried up in public budgets. Caution is warranted. Here is an item worthy of consideration:
Have the employees been trained in:
1. Transfer and ambulation
2. Communication with dementia sufferers
3. Wound prevention
4. Definition of verbal, sexual and financial abuse
5. Avoiding the appearance of sexual impropriety when rendering care
Effective staff development practices help assure properly rendered services. It is better to find a program with these ingredients than one that simply agrees to a less than ideal placement.
Needless to say Angela has spread the word, including through the usage of social media, of how poorly she feels this nursing home chain handles discharges. All of that could have been avoided.
Better that a nursing home grant 2 days per month for social workers to spend in the field developing intense familiarities with community based care programs in your area than have these professionals recommending sub-standard, post-discharge arrangements for your patients. Of course there are no perfect circumstances, but we believe the cautions referenced herein are worth noting.
Thanks for allowing us to share.
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