Senior Care Risk: Lack of Admission and Discharge Criteria or Failure to Adhere to Criteria

Susan Lucot, MSN, RN, MLT (ASCP), CPHRM

Admission and discharge criteria are a critical aspect of ensuring safety in senior care settings. Every type of senior care setting should have well-defined resident admission and discharge criteria and strictly adhere to implementing these standards. The foundation for the criteria is the organization’s business goals and mission. Fundamentally, who does your organization intend to serve and what level of care is within your capacity?

Other essential questions to consider include:

• What staffing, skills, and oversight are required to meet resident needs?
• What environmental safety measures should be in place?
• Who assesses prospective residents for admission, are they clinically trained or supported, and are these assessments conducted in person?
• Are residents monitored and evaluated on a routine basis (including subtle changes in physical condition, cognitive abilities, behavioral activities, etc.)?
• Are residents’ baseline deviations communicated to families through an ongoing process?
• Are agreements in place with residents and families to transfer residents to a higher or more specialized level of care when needed?
• Are local area senior care resources available to transfer residents who may need a higher level of care for both physical health conditions and behavioral health disorders?

Without addressing the above considerations, senior care organizations might face increased liability exposure. For example, they might be accused of “clinical creep,” which refers to admitting and/or retaining residents who require a higher level of care than the organization can provide. Clinical creep might happen if corporate leadership pressures the organization to admit and/or keep a resident. It also may occur if leadership and staff overlook admission and discharge criteria because of an emotional attachment to a resident or due to perceived pressure from the state health department in relation to transferring residents as their needs change.

Plaintiff attorneys also like to allege “profits over people” when a senior care organization admits or retains residents beyond their capacity for safe and effective care. This is demonstrated through common arguments of limited staffing, inadequate staff training and leadership oversight, little to no behavioral health services within the local area, and infrastructure challenges.

Additionally, senior care organizations are not typically licensed by states as formal behavioral health clinics or hospitals. With each behavioral health resident admission, organizations increase the possibility for resident-on-resident and/or resident-on-staff assaults as well as their risk of liability exposure.

To mitigate these safety and liability issues, senior care facilities should establish robust admission and discharge criteria based on the organization’s goals and mission. Further, they should evaluate all prospective residents for physical and cognitive needs, and compare those needs with the organization’s:

• Existing infrastructure
• Staffing (including the number of staff members as well as their experience and training)
• Leadership stability and oversight
• The availability of both medical and behavioral health services within the organization and in the local area
• The capacity of the organization to provide safe and effective care for all residents as well as the resources to provide care for patients who have specialized needs

For additional insights on providing care for residents who have behavioral health disorders and/or dementia in senior care settings, click here.

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