What is a physician's order for admission to a nursing home?

According to the Centers for Disease Control and Prevention, approximately 1.3 million Americans reside in nursing homes. A critical and mandatory step for each of these admissions is obtaining a physician's order for admission to a nursing home, which authorizes the patient's care and residence.

Quick Summary

A physician's order for admission is a mandatory medical directive confirming that a patient requires a skilled level of care, authorizing their placement in a long-term care facility, and certifying eligibility for insurance coverage such as Medicare or Medicaid.

Key Points

• Medical Authorization: A physician's order is a formal, written directive from a doctor authorizing a patient's admission to a nursing home.

• Ensures Payment: The order is a mandatory condition for payment from insurance programs like Medicare and Medicaid, confirming the care is medically necessary.

• Details Patient Care: Beyond admission, the order details specific medical treatments, medications, therapies, and dietary requirements for the resident.

• Part of a Larger Package: It is one of several critical documents, alongside financial forms and advance directives, that are necessary for admission.

• Potential for Delays: Failure to provide a properly signed and dated order can cause delays in admission or lead to serious billing issues.

• Establishes Care Standards: The order dictates the care that the nursing home must provide, with the physician continuing to supervise the resident's medical treatment.

What Exactly is a Physician's Order?

A physician's order for admission to a nursing home is a formal, written medical directive provided by a qualified physician. This document confirms the medical necessity of a patient's placement in a skilled nursing facility. It's more than just a simple request; it serves as a legal and administrative cornerstone that validates the patient's need for the specific level of care and services that a nursing home provides. This order is a crucial part of the comprehensive admissions package required by all licensed nursing facilities and is a prerequisite for initiating patient care and securing insurance payments.

The Critical Role in Admissions and Finances

Without a valid physician's order for admission, a nursing home cannot legally or ethically admit a new resident for medically necessary care. This directive serves several vital functions:

• Establishes Medical Necessity: It provides the documented medical justification for why a patient can no longer be safely or effectively cared for at home or in a less intensive setting. The order is based on a physician's assessment of the patient's condition, including their functional abilities, medical needs, and cognitive status.
• Authorizes Care and Services: It gives the nursing home the authority to initiate and provide the necessary medical treatments, therapies, and day-to-day care. This includes everything from medication management to specialized wound care.
• Ensures Insurance Coverage: For payment from Medicare, Medicaid, and many private insurance plans, the physician's order is a mandatory condition. It certifies that the care is not merely custodial but medically required. A missing or unauthenticated order can lead to payment denials, leaving families responsible for substantial costs.

What Information is Included?

While the specific forms and formats can vary by state and facility, a physician's order for admission typically includes several key pieces of information to guide the resident's care:

• Patient's full name, date of birth, and identifying information
• The physician's name, signature, and license information
• The date the order was written
• The admitting diagnosis and any co-morbidities
• A certification that the patient requires a skilled nursing level of care
• Specific orders for medications, including dosages and frequency
• Details on required treatments, such as wound care, IV therapy, or respiratory treatments
• Instructions for physical, occupational, or speech therapies
• Dietary requirements and restrictions
• Any special precautions, such as fall prevention or wandering alerts
• A list of contact information for key healthcare providers and emergency contacts

The Process of Obtaining the Order

The process of securing a physician's order for admission to a nursing home usually involves a medical evaluation and subsequent paperwork. Here's a typical flow:

1. Medical Evaluation: A physician, often a hospital doctor or the patient's primary care provider, performs a comprehensive evaluation to determine if the patient meets the criteria for nursing facility care. This assessment covers physical abilities, functional decline, medical needs, and cognitive or behavioral status.
2. Certification of Need: If the patient meets the criteria, the physician will sign and date the necessary paperwork, often including a state-mandated form that certifies the patient meets the requirements for a nursing home level of care.
3. Submission to Facility: The hospital discharge planner or family member then provides this signed order to the nursing home's admissions department as part of the total admissions packet.
4. Ongoing Supervision: Federal regulations require that a physician must personally approve the admission in writing and continue to supervise the resident's medical care throughout their stay. This includes regular reviews of the patient's care plan and progress notes.

Physician's Order vs. Other Admissions Paperwork

It is easy to confuse the physician's order with other essential documents required for nursing home admission. The table below helps clarify the distinction.

Document	Primary Purpose	Who Completes It	When Needed
Physician's Order for Admission	Certifies medical necessity for nursing home care and authorizes admission.	The attending physician or primary care provider.	Required before or at the time of admission for medically necessary care.
Admission Agreements	Legal contract between the resident/family and the facility covering terms of residency.	The resident or their legal representative (e.g., Power of Attorney).	Part of the formal admissions paperwork, signed upon entry.
Advance Directives	Expresses a person's wishes for end-of-life medical care (e.g., Living Will, DNR).	The resident while of sound mind.	Should be available at the time of admission to guide care decisions.
Financial Documentation	Assesses and arranges payment for care, including Medicare, Medicaid, or private pay information.	The resident, their family, or legal representative.	Required during the financial assessment portion of admissions.

Potential Challenges and Pitfalls

Navigating the admissions process requires diligence, and problems can arise if the physician's order is not handled correctly. Common issues include:

• Delays in Care: If the order is delayed or incomplete, it can hold up a planned admission, especially for patients transitioning from a hospital.
• Payment Denials: If the order is missing or not properly authenticated before discharge, Medicare or other insurers can deny payment, leading to significant financial stress for the family.
• Following Orders: It is a legal and ethical requirement for nursing homes to follow the physician's orders. A failure to do so can constitute negligence and result in severe harm to the resident. It's important for family members to stay vigilant about the care being provided.

Conclusion

A physician's order for admission to a nursing home is a foundational document that triggers the formal care process. It serves as the medical and financial green light for a resident's stay, ensuring that the care is both medically necessary and properly funded. For families, understanding this crucial document and its requirements is essential for navigating the complex admissions process smoothly. For further guidance on long-term care options and documentation, visit the US Department of Health & Human Services website.

Frequently Asked Questions

Is a physician's order for admission always required for a nursing home?

Yes, a physician's order is almost always required for medically necessary care in a skilled nursing facility, especially for those who need to use Medicare or Medicaid for payment. It validates the need for skilled, long-term care.

Who is responsible for getting the physician's order?

The physician, typically the patient's primary care provider or a hospital doctor, is responsible for writing and signing the order. However, a patient's family or a hospital discharge planner will often manage the process of obtaining and delivering the document to the facility.

What happens if we forget to get the order before admission?

Failure to have a valid physician's order can cause significant delays in the admissions process. In some cases, if the patient is admitted, it could lead to the denial of insurance coverage for the stay, resulting in unexpected and expensive bills for the family.

Can any doctor write the admission order?

The order must be written and signed by a physician who is licensed to admit patients and who has evaluated the patient's condition. The physician must also have admitting privileges at the facility or be part of the care team.

Is the admission order the same as a Power of Attorney (POA) or Living Will?

No, a physician's order is a medical directive for admission, while a POA and Living Will are legal documents. A POA grants decision-making authority to a representative, and a Living Will states a person's wishes regarding end-of-life care.

How long is a physician's order for admission valid?

The initial order is valid for a specific period, and regulations often require ongoing physician supervision and re-certification of the need for care. For example, federal rules mandate physician visits and reviews at specific intervals after admission.

What is the difference between an admission order and treatment orders?

The admission order is the initial directive authorizing placement. Treatment orders are specific instructions from the physician detailing the medications, therapies, and other care the resident will receive while in the facility. Both are necessary parts of the resident's medical record.