Skilled Nursing Facility (SNF) administrators are faced with some serious challenges when establishing policies for their admissions teams.
The drive to increase revenue by accepting any and all admission referrals in order to maintain census, can lead to short-term goals with serious long range consequences. Adopting a “never say no” policy regarding referrals to the SNF may make hospital discharge planners happy, but inappropriate admissions often leads to potential disaster.
The facility must be able to meet the needs of the patient and the patient. The family must accept the capabilities and resources the facility can provide. When there is a mismatch between these, prepare for rough times ahead.
For example, a 60-year-old patient is referred to the SNF status post fall and subsequent open reduction internal fixation (ORIF) of the femur. She is alert and oriented to person, place and time. Most SNFs can manage such a patient with little difficulty. However, a closer look at the referral indicates that the patient has a recent history of heroin abuse. Hospital social worker notes further indicate that family members have demanded the patient receive increasing doses of narcotics claiming that the patient is being denied the right to be free of pain. Nursing notes repeatedly refer to patient as non-compliant with safety instructions. Physician’s notes indicate a referral to psychiatry for a longstanding history of depression with multiple suicide attempts.
While every individual should be able to receive the care necessary for optimum quality of life, this patient is a ticking time bomb that places a SNF at very high risk:
The medical complexity of the average SNF patient has, and will continue to increase, placing significant demand on clinicians. Adding to the challenge by taking a “never say no” admissions policy is flirting with disaster.
Administrators, admissions teams and clinical leaders must come to an agreement as to the care they can provide and the risks they are willing to share.