Resident Rights and Facility Policies
Under federal law, nursing home residents have the right to a dignified existence and self-determination, which includes the ability to interact with the community outside the facility. However, this right is not absolute and is subject to limitations based on a resident's specific health condition, safety, and care plan. Before you can take someone out of a nursing home for a day, you must understand the interplay between these resident rights and the policies of the specific nursing facility.
The process typically begins with communicating your intentions to the nursing home staff. It is important to discuss the planned outing well in advance. This gives the staff time to prepare, and it prevents misunderstandings. Key information to provide includes the date, time of departure and return, and the name of the person responsible for the resident during the outing. Forgetting to inform the facility can lead to serious issues, including potential legal or financial complications related to the resident's bed hold or care coverage.
Restrictions on a Resident's Right to Leave
While residents have broad rights, there are specific, legitimate reasons for a nursing home to restrict a temporary leave. These restrictions must be clearly documented and related to the resident's safety and well-being. Common reasons for restrictions include:
- Medical Instability: A doctor may determine that a resident's medical condition is too unstable for an outing. This must be noted in the resident's medical record.
- Cognitive Impairment: For residents with dementia or other cognitive issues, a guardian or healthcare agent may have authority to limit outings to ensure the resident does not wander or come to harm.
- Court-Ordered Guardianship: If a court-appointed guardian has control over the resident's movements, the guardian's directives must be followed by the facility.
Planning the Outing: Steps to Ensure a Smooth Trip
For a successful day trip, preparation is key. Following a clear, step-by-step process can minimize stress and ensure your loved one's needs are met.
- Start with the Resident: Always begin by talking with the resident. Their desires and comfort should be the first priority. Respect their wishes if they are not interested in the outing.
- Contact the Facility: Inform the nursing home staff, including a nurse or social worker, of your plans. Provide as much advance notice as possible.
- Consult the Physician: If there are medical concerns, seek approval from the resident's primary care physician. Their medical opinion can override a family member's or guardian's wishes if it poses a health risk.
- Discuss Medications and Care: Arrange for any medications the resident will need during the outing. The nursing home staff can prepare these with clear instructions. Discuss any special care needs, such as a specific diet or mobility assistance.
- Review Insurance and Bed Hold Policies: Understand how a temporary absence, or "therapeutic leave," affects the resident's insurance coverage, especially for Medicare or Medicaid beneficiaries. Policies on paying to hold a bed can vary by state and insurance provider.
- Pack a Bag: Prepare a small bag with essential items, including medications, a sweater or jacket, and personal items that might make them feel more comfortable.
Comparison of Temporary Leave Scenarios
| Aspect | Day Outing (Therapeutic Leave) | Overnight Leave of Absence | Hospitalization | Discharge |
|---|---|---|---|---|
| Purpose | Social engagement; family visits | Extended family visit; holidays | Medical treatment in an acute setting | Resident permanently leaving the facility |
| Approval | Doctor/guardian dependent; requires facility notification | Advance notification; physician approval for insurance | Medical emergency; transfer order | Formal discharge process |
| Bed Hold | Bed is typically held and covered by insurance | Varies by insurance and state regulations; private payment may be required | Bed is held while in the hospital | Not applicable; resident vacates the bed |
| Cost | Typically no extra cost if duration is within policy limits | Potential for out-of-pocket costs for bed hold | Covered by medical insurance | No further nursing home costs |
Potential Complications and Considerations
Even with the best planning, unforeseen issues can arise. Knowing how to handle these situations is part of being an informed caregiver. Some nursing homes may have internal policies that seem restrictive, but it is important to remember that residents' rights to leave exist. If a facility seems to be overstepping its authority, a family might need to seek external help, such as contacting a long-term care ombudsman.
Navigating the Facility’s Attitude
While most staff members are supportive of family visits, some may create unnecessary hurdles. It's crucial to approach the situation with patience and clear communication. If a staff member says no without a valid medical reason, calmly ask to speak to a supervisor or social worker. The key is to be persistent but respectful, and to refer back to the resident's rights. Being aware of CDC guidelines regarding communicable diseases is also important, as recommendations can affect visitation practices.
What to Do in Case of Emergency
Before you leave the facility, have a plan for a medical emergency. Confirm with the nursing home what protocol to follow if the resident becomes ill or injured during the outing. They may provide an emergency contact number or specific instructions. Always carry a list of the resident's current medications, a contact list for their doctors, and their insurance information.
The Emotional Impact of the Day Trip
Beyond the logistics, consider the emotional impact of the outing on the resident. For some, a day out is a joyous occasion that boosts their morale. For others, particularly those with dementia, a change in routine can cause confusion and distress. Plan activities that are familiar and comforting, and don’t overschedule the day. A quiet meal or a short drive might be more beneficial than a crowded public event. The resident's safety and emotional comfort should always be paramount. A successful outing is one where everyone feels happy and secure.
Conclusion: Prioritizing Resident Well-being
Taking a loved one out of a nursing home for a day is not only possible but can also be a vital part of maintaining their emotional well-being and connection to family. The process, however, requires careful planning, open communication with the facility, and an understanding of the resident's rights and medical needs. By navigating the logistics with patience and prioritizing the resident's emotional and physical comfort, family members can create meaningful memories and strengthen their relationships. Remember, the goal is a positive and safe experience for everyone involved. For additional legal resources, consider exploring the California Advocates for Nursing Home Reform (CANHR) website.
