STEP 4:  

WHAT TO EXPECT

Upon arrival, you will be escorted or given directions to the assigned room.  Expect to see the nurse aide and/or nurse first however therapist  and other members of the team will need to complete admission assessment or evaluations.  If arrival is after business hours  or over the weekend  some of the ancillary assessments may be completed on the next business day. Each discipline including Nurses, physical therapists, occupational therapists, speech therapy, social work, dietary, etc work together to create the interdisciplinary  team (IDT). The interdisciplinary team develops a baseline care plan  within 24-48 hours of admission  and a comprehensive care plan within 21 days.   The resident and/or the power of attorney or resident representative should expect an invitation to this care plan meeting.  Attempt to be present for this meeting and request a different time if the proposed time does not fit your schedule.  

 

As you get settled into the room don't forget to acclimate to call bell system or nurse call system.  There are different types of call bells (punch, pancake, etc).  If your loved one can not physically activate the current call bell, ask for a different style. 

The Nurse will complete a full-body skin assessment.  Yes, it may feel awkward but necessary.

Many facilities are now offering  a quick get to know you meeting within the first 72 hours or initial care plan meetings to meet management staff and address any early questions or concerns. 

 

Staffing- each resident has an assigned nurse and CNA (Certified Nurses' Aide). The nurse's typical role is to pass medications & oversee aides while monitoring status of each resident assigned.  The role of CNA is to assist with activities of daily living (bathing, dressing, eating, etc) and report any changes to the nurse.  

The federal guidelines do not state a specific staff requirement however it is  indicated there should be adequate staff to care for the needs of the residents.   Remember unless you have hired your own private duty care (not all facilities allow sitters), the facility is unable to offer 1:1 care. Staff ratios will vary among facilities and typically based on acuity (how sick residents are or care needs required) Estimated CNA staffing range for day shift is 1:8-13, evening shift is 1:10-20, and night shift 1:20-35.  Nurse (RN/LPN) ratio is  more variable  however an estimated  range would be 1:20-30 on the day and/or evening shift and 1:30-45 on the night shift.

 

Rehab services- therapy staff typically attempt to evaluate those who may be eligible within 24 hours of admission. 

 

Concerns- discuss concerns with staff or the management team.  Facilities have policies in place to address grievances. 

Meet and get to know the Administrator  and Director of Nursing, as well as the shift supervisors.  They will be able assist with concerns and answer questions you may have.

 

Medications- Upon admission nurses must order medications from their contracted pharmacy.  Many pharmacies have a  order cut off time of  4 -5pm for  same day delivery.  Orders after the cut off time arrive the following day.  Delivery is typically late evening to midnight depending on  the delivery route.   There is a system in place to get medication prior to arrival from the pharmacy if needed.  Most skilled facilities have an emergency kit with a number of frequently used medications for a wide range of ailments including pain.