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Can the family handle the mobility, medications & needs for the day?
I've seen families who do 2 x assist transfers, manage a wheelchair up & down, manage continence, empty catheter bags etc, manage meds, manage dementia symtoms & more.
I've also met many who just want to take Granny out for a meal but don't know anything about what that would entail.
Yes, and there is not enough information here. Is the person asking the question the caregiver who placed the resident and who oversees care? Just being family does not mean understanding the care responsibilities involved in a day trip.
No. Nursing homes do not charge families a fee to visit, unless you are discussing here special things like dining with your senior. You would be aware of course there would be no overnight visits without special permission. You might be asked to pay for masks if they require, gloves if you need them, small things like that.
As to whether your elder is allowed off the premises with responsible parties that is up for grabs without your giving us more info. Are you POA? Is a POA involved who may have discussed with MD and not want senior off premises without the POA for some reason, and etc etc.
You are asking a Forum of strangers from around the world questions you should better address to the care team at your loved one's facility.
No a Nursing home does not charge to visit, unless like said, u want to have a meal with the resident. They cannot keep you from taking the resident out but a POA can. They can say that no one can take the resident out without them allowing it.
BEGIN QUOTE Resident representative. Resident representative. For purposes of this subpart, the term resident representative means any of the following: (1) An individual chosen by the resident to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications; (2) A person authorized by State or Federal law (including but not limited to agents under power of attorney, representative payees, and other fiduciaries) to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications; (3) Legal representative, as used in section 712 of the Older Americans Act; or. (4) The court-appointed guardian or conservator of a resident. (5) Nothing in this rule is intended to expand the scope of authority of any resident representative beyond that authority specifically authorized by the resident, State or Federal law, or a court of competent jurisdiction. END QUOTE
Also important is to know a resident who has not been designated as incompetent (such as through a court of law) gets to make up their own mind about things unless they prefer their designee to make such a decision.
Bath, is this regarding your sister that was moved to MC in November?
Perhaps she has declined to the point that day outings are to disruptive for her and she is causing disruption in the facility because of that.
I would encourage you to speak with the facility and listen to what has prompted them to go where they have with this. It is probably time to change your expectations of what time with your sister looks like.
I am so sorry that you are losing your sister to this awful disease. May The Lord guide you in this new season.
This is what I ran into. When my mom was in AL, I took her out and about at least once a week, often more.
When we moved her to MC, I fully expected to be able to take her out often still. I mentioned it in passing to the administrators as we were moving her in and they looked at me blankly and I could tell it was going to be a problem for them. They did say I COULD take her out but that if she was disruptive because of outings, I would need to rethink taking her out.
Sure enough, the changes in her that caused us to switch from AL to MC were also enough to inhibit outings. She was wildly unstable at about that time. I was afraid to take her out because I was afraid I wouldn't be able to get her to go back in on our return and I didn't want a physical confrontation that could have resulted in my hurting her. Now, 16 months later, she is too weak for such a struggle, but also too weak for me to feel confident handling her on my own. Looking back, I realize they knew what they were talking about when they said outings were probably not very feasible.
Isthisreallyreal, your advice to change expectations is spot on. That seems to be the key to dealing with this horrible disease - constantly evaluating expectations and adjusting them to reality. Bleh.
I have seen a fee charged to use special dining facilities and for food supplied to guests. They will strongly discourage family (or anyone) from taking someone out if there is a safety issue, for example there isn't proper transit or assistive devices available or the facility is in outbreak and outside visits have been temporarily suspended. They can also exclude people who the POA has identified as known to be undesirable such those with a history of abuse.
When my father was in a nursing facility, they required the transportation for medical appointments be provided by the facility. The family was allowed to meet him at the appointment.
IMO: Everyone in or with a loved one in a nursing home should get to know the federal Laws regarding nursing homes - and also their state laws (which for the most part mirror the federal laws, and sometimes provide additional rights).
No, a nursing home cannot charge for visits by family members. Remember this is the resident's HOME (even though many "facilities" appear to strive to operate as prisons :-\)
As for exiting for a trip, this is more nuanced, but generally if the resident's health and safety are not in jeopardy it should be allowed.
BEGIN QUOTE Leaving for visits: If your health allows, and your doctor agrees, you can spend time away from the nursing home visiting family or friends during the day or overnight, called a “leave of absence.” Talk to the nursing home staff a few days ahead of time so the staff has time to prepare your medicines and write your instructions. Caution: If your nursing home care is covered by certain health insurance, you may not be able to leave for visits without losing your coverage. END QUOTE
When my father was in a nursing facility, Medicare was paying since it was considered rehab. Medicare had rules they had to follow... I guess if someone is able to leave maybe they don't need skilled nursing. Another resident was limited because he was on dialysis... not sure why. There are so many federal guidelines that have to be followed or a facility can face fines. Second, there may be state guidelines. Then there may be facility policies that take it to a third level. An open discussion with someone in authority facility would hopefully help you understand if that is really true or just someone's opinion. I agree with others, reasons I can think of a fee to visit may be for PPE (gloves, masks, etc.) or HPOA requiring the visit be supervised, etc. We only paid a fee to use their overnight guest room and/or meals when visiting our father. Best of luck working through this in the interest of everyone involved.
We didn't get a lot of detail from you as to what is happening so my response is all over the place with various examples....
My moms room in medicaid memory care is very small and shared with another person with only a curtain separating the beds. If your family member is in that type of situation and you are showing up with two adults and three kids, there is not enough room to accommodate the visit. I'm just throwing a scenario out there....I have no idea how many people are trying to visit at one time. If you are showing up with an entire family expecting to be fed, that is not a good idea. These places can barely do what they need to do, let alone try to cater to extended family. If you need a special room to house more than two guests, then you may need to reserve a special room ahead of time and pay a fee. If your family member requires special care, i.e... cant walk, has to be lifted onto a toilet, requires meds frequently, is a choking risk, etc... I can see where they may say it is not in their best interest to leave the facility. If you have taken your family member off site previously and they were returned with a soiled bottom and agitated for the rest of the night because of the visit, I can see where they may say this isn't a good idea. Just remember your family member is there for a reason. They need special care that no one could provide at home. They have changed and their needs have changed and decisions need to be made in their best interest and not yours. That is hard to accept sometimes because we love or family member and want to see them. It was decided not to remove my mom from the facility for holidays. I make a special trip to see her and maybe I bring a piece of cake or a special treat, but I don't make a big production out of anything because I know it is disruptive to her and others. It is not what I want, but what she needs and can handle at this stage.
If my answers are way off from what is happening, please provide more info.
James ~ long term care admissions director and certified assisted living administrator here. Thanks for posting your experiences. They are so on pointe (you can see a few of mine in my post)!! I think it is sometime difficult to view our relatives in their current state; we want them to continue eternally as the strong independent people we knew in our childhood, but unfortunately that is often not the case. Thanks for a dose of reality.
I know I, and I suspect many others, need more information in order to give you our best opinions on this situation, although I highly suggest your speak to the administrator of the facility. Some additional information would be helpful such as:, What type of nursing facility is this (skilled nursing, assisted living, memory care, personal care home, etc). What type of fee are they requesting (dining, overnight visit, special PPE)? For what reason is the facility denying the day trip ( special equipment needed for transfers to and from a vehicle, someone in the family require special training for assisting with feeding the resident)? Also who, if anyone is the Power of Attorney and what type of PoA is it? Has the resident been deemed incontinent?
I had one family want to take a resident out for a day trip saying he would enjoy the sound of the birds and the sunshine; he was comatose and on a ventilator - don't think so. Another resident was a ward of the state, her family having given up this authority by the family ( somewhat justified based on her relationship with them during their childhood and over the years). State law in NJ says the court appointed guardian has the right to determine visitations and trips. In this case, after meeting with the granddaughter (who was the one who wanted to take her out) the guardian decided no.
Neither of the above scenarios may apply to you but without more information, none of us can give you a really good answer. Again, speak to the administrator and please update us so we can help others in the future.
No. A nursing home cannot charge a fee to visit a person who is living there. The facility gets paid to care for the resident and that is all.
If they are trying to collect a fee from you or your family for visiting this should be reported immediately to the state's Attorney General's office and to the state's Ombudsman (if your state has one). You pay them nothing to visit. Not one cent.
As for taking your LO out for a day. Nursing homes are not prisons. The residents are not inmates doing time. You can take your LO out for the day or even overnight if the POA has given you permission. Always consider if it's safe for you to take your LO out. Also remember that what may be a policy of the nursing home may very well not be the law in your state about something.
For example, NH's do not like when a dementia resident gets taken out or kept away for any length of time because sometimes it can make them more confused and harder to take care of for a little while when they get back. That's not your problem. You should take your LO out if they enjoy it. The staff gets paid to deal with them. It's not up to you to make their jobs easier. If it gets to be too much for your family member going out, that's when you should stop.
Every state has regulations for nursing home residents and ability to go out on "pass", and these differ in each state, but they will state how many days/month, or how many hrs/day etc. Need to consider if family has been trained to provide necessary care such as incontinence care, tube feedings, medication and oxygen management, transfers and such while out on pass and whether the patient is medically stable for a leisurely trip. In my experience, it required the doctor to write an order for a day pass.
I believe you need to: 1) Ask facility for written documentation / authorizing their rules. 2) Ask Licensing Board if their procedures / rules are legally allowed.
To charge family a fee to visit sounds beyond astoundingly absurd. Why are you asking? Did they tell you this?
Every care facility gives this information to a resident, their family, their conservator, whoever is present at the pre-admissions meeting for a new resident. This packet will tell all of their rules, regulations, and policies.
You wouldn't ask a licensing board for care facility requirement if some of their policies are legal or not. That's a matter for the Ombudsman Office in that state or the office of that state's Attorney General.
When my daddy was in a facility I would take his great grands to see him and yes they were loud but the facility had a family room and we would close the door. One night a resident came in and yell at me - not the grands - but at me that they would report what was going on. I just stood up walked over to her and told her that we had the right to be in this room and I would get the kids to keep the noise down. I never heard from her again and my daddy had the best time with his grands every time we visited. Also, when I would walk the hallways with the grands I, if there was someone in the hallway they would smile and I would tell them to say hi to them. The residents loved it and the grands were accepted. As far as removing my daddy from the facility - since I was POA - I made it a rule that family could come visit but they could not take him out - not to the park next door, the store, a restaurant NO. My daddy was willful and 6'2". I wanted my family to be safe and my daddy to be safe. Taking my daddy out could be a problem, he was not steady and he was big. If he would have fallen or if he would not leave a certain place then what! I couldn't chance it. So visitors welcome, bring a treat, bring the kids but no leaving. Talk to your administrator and see what the rules, requirements and limits are. Prayers
bathjones: The nursing home cannot charge family a fee to visit. The agent in POA is the individual who makes the determination whether or not to take the patient outside for a day trip.
My neighbor was in a rehab facility post knee replacement. Her brother is a famous concert pianist. Her brother was going to be giving a local concert. Nursing home said no, that insurance would not allow the neighbor to leave the nursing home for any reason. Neighbor got doctor involved. Finally with doctor's authorization neighbor was allowed to go to the concert to hear her brother perform for several hours.
I have never heard of a fee being charged. That’s crazy to me.
I have a friend who visits her uncle every week. Her four children visit and their children visit him.
Her uncle is a very nice guy who is quite happy in his nursing home. He’s hardly ever in his room. He’s 90 years old but very active in spite of being in a wheelchair. He participates in everything!
The nursing home called my friend to invite them to eat thanksgiving dinner there and told her to bring the whole family. 15 people showed up and they were welcomed with open arms.
This particular nursing home has gone out of their way for their residents and the place is very clean.
When the person who washes the residents hair and shaves the men missed work, an aide took my friend’s uncle to a hairdresser so he would have a fresh haircut and shave before celebrating his holiday dinner with his family. Honestly, they nursing home spoils him! He’s a lucky fellow who receives a lot of attention.
Both sound odd. The only reason to deny day trips with family is if the patient needs to attend therapy sessions or there are concerns that the family is not keeping the client safe. As for a visitation fee, ask what services the fee covers.
I do have to say if on Medicaid they may not allow it. My daughter has a classmate who is in a NH. He asked if I would get him something. I have seen him get out of the facility van so ftold him maybe someone can drive him to the store to get it. He got back to me saying that his SW said if Medicaid found out he was this mobile, they may stop paying his way. Guess hecwas coming from a Dr, visit. Yes, I got him whatvhe needed.
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Can the family handle the mobility, medications & needs for the day?
I've seen families who do 2 x assist transfers, manage a wheelchair up & down, manage continence, empty catheter bags etc, manage meds, manage dementia symtoms & more.
I've also met many who just want to take Granny out for a meal but don't know anything about what that would entail.
As to whether your elder is allowed off the premises with responsible parties that is up for grabs without your giving us more info. Are you POA? Is a POA involved who may have discussed with MD and not want senior off premises without the POA for some reason, and etc etc.
You are asking a Forum of strangers from around the world questions you should better address to the care team at your loved one's facility.
42 CFR § 483.10 - Resident rights.
https://www.law.cornell.edu/cfr/text/42/483.10
BEGIN QUOTE
Resident representative.
Resident representative. For purposes of this subpart, the term resident representative means any of the following:
(1) An individual chosen by the resident to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications;
(2) A person authorized by State or Federal law (including but not limited to agents under power of attorney, representative payees, and other fiduciaries) to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications;
(3) Legal representative, as used in section 712 of the Older Americans Act; or.
(4) The court-appointed guardian or conservator of a resident.
(5) Nothing in this rule is intended to expand the scope of authority of any resident representative beyond that authority specifically authorized by the resident, State or Federal law, or a court of competent jurisdiction.
END QUOTE
Also important is to know a resident who has not been designated as incompetent (such as through a court of law) gets to make up their own mind about things unless they prefer their designee to make such a decision.
Perhaps she has declined to the point that day outings are to disruptive for her and she is causing disruption in the facility because of that.
I would encourage you to speak with the facility and listen to what has prompted them to go where they have with this. It is probably time to change your expectations of what time with your sister looks like.
I am so sorry that you are losing your sister to this awful disease.
May The Lord guide you in this new season.
When we moved her to MC, I fully expected to be able to take her out often still. I mentioned it in passing to the administrators as we were moving her in and they looked at me blankly and I could tell it was going to be a problem for them. They did say I COULD take her out but that if she was disruptive because of outings, I would need to rethink taking her out.
Sure enough, the changes in her that caused us to switch from AL to MC were also enough to inhibit outings. She was wildly unstable at about that time. I was afraid to take her out because I was afraid I wouldn't be able to get her to go back in on our return and I didn't want a physical confrontation that could have resulted in my hurting her. Now, 16 months later, she is too weak for such a struggle, but also too weak for me to feel confident handling her on my own. Looking back, I realize they knew what they were talking about when they said outings were probably not very feasible.
Isthisreallyreal, your advice to change expectations is spot on. That seems to be the key to dealing with this horrible disease - constantly evaluating expectations and adjusting them to reality. Bleh.
42 CFR Subpart B - Subpart B—Requirements for Long Term Care Facilities
https://www.law.cornell.edu/cfr/text/42/part-483/subpart-B
No, a nursing home cannot charge for visits by family members. Remember this is the resident's HOME (even though many "facilities" appear to strive to operate as prisons :-\)
As for exiting for a trip, this is more nuanced, but generally if the resident's health and safety are not in jeopardy it should be allowed.
Quote below is from:
https://downloads.cms.gov/medicare/your_resident_rights_and_protections_section.pdf
BEGIN QUOTE
Leaving for visits: If your health allows, and your doctor agrees, you can spend time away from the nursing home visiting family or friends during the day or overnight, called a “leave of absence.” Talk to the nursing home staff a few days ahead of time so the staff has time to prepare your medicines and write your instructions. Caution: If your nursing home care is covered by certain health insurance, you may not be able to leave for visits without losing your coverage.
END QUOTE
My moms room in medicaid memory care is very small and shared with another person with only a curtain separating the beds. If your family member is in that type of situation and you are showing up with two adults and three kids, there is not enough room to accommodate the visit. I'm just throwing a scenario out there....I have no idea how many people are trying to visit at one time. If you are showing up with an entire family expecting to be fed, that is not a good idea. These places can barely do what they need to do, let alone try to cater to extended family. If you need a special room to house more than two guests, then you may need to reserve a special room ahead of time and pay a fee. If your family member requires special care, i.e... cant walk, has to be lifted onto a toilet, requires meds frequently, is a choking risk, etc... I can see where they may say it is not in their best interest to leave the facility. If you have taken your family member off site previously and they were returned with a soiled bottom and agitated for the rest of the night because of the visit, I can see where they may say this isn't a good idea. Just remember your family member is there for a reason. They need special care that no one could provide at home. They have changed and their needs have changed and decisions need to be made in their best interest and not yours. That is hard to accept sometimes because we love or family member and want to see them. It was decided not to remove my mom from the facility for holidays. I make a special trip to see her and maybe I bring a piece of cake or a special treat, but I don't make a big production out of anything because I know it is disruptive to her and others. It is not what I want, but what she needs and can handle at this stage.
If my answers are way off from what is happening, please provide more info.
Take care.
I think it is sometime difficult to view our relatives in their current state; we want them to continue eternally as the strong independent people we knew in our childhood, but unfortunately that is often not the case. Thanks for a dose of reality.
Some additional information would be helpful such as:, What type of nursing facility is this (skilled nursing, assisted living, memory care, personal care home, etc). What type of fee are they requesting (dining, overnight visit, special PPE)? For what reason is the facility denying the day trip ( special equipment needed for transfers to and from a vehicle, someone in the family require special training for assisting with feeding the resident)? Also who, if anyone is the Power of Attorney and what type of PoA is it? Has the resident been deemed incontinent?
I had one family want to take a resident out for a day trip saying he would enjoy the sound of the birds and the sunshine; he was comatose and on a ventilator - don't think so.
Another resident was a ward of the state, her family having given up this authority by the family ( somewhat justified based on her relationship with them during their childhood and over the years). State law in NJ says the court appointed guardian has the right to determine visitations and trips. In this case, after meeting with the granddaughter (who was the one who wanted to take her out) the guardian decided no.
Neither of the above scenarios may apply to you but without more information, none of us can give you a really good answer. Again, speak to the administrator and please update us so we can help others in the future.
If they are trying to collect a fee from you or your family for visiting this should be reported immediately to the state's Attorney General's office and to the state's Ombudsman (if your state has one). You pay them nothing to visit. Not one cent.
As for taking your LO out for a day. Nursing homes are not prisons. The residents are not inmates doing time. You can take your LO out for the day or even overnight if the POA has given you permission. Always consider if it's safe for you to take your LO out. Also remember that what may be a policy of the nursing home may very well not be the law in your state about something.
For example, NH's do not like when a dementia resident gets taken out or kept away for any length of time because sometimes it can make them more confused and harder to take care of for a little while when they get back. That's not your problem. You should take your LO out if they enjoy it. The staff gets paid to deal with them. It's not up to you to make their jobs easier.
If it gets to be too much for your family member going out, that's when you should stop.
Every state has regulations for nursing home residents and ability to go out on "pass", and these differ in each state, but they will state how many days/month, or how many hrs/day etc. Need to consider if family has been trained to provide necessary care such as incontinence care, tube feedings, medication and oxygen management, transfers and such while out on pass and whether the patient is medically stable for a leisurely trip. In my experience, it required the doctor to write an order for a day pass.
1) Ask facility for written documentation / authorizing their rules.
2) Ask Licensing Board if their procedures / rules are legally allowed.
To charge family a fee to visit sounds beyond astoundingly absurd.
Why are you asking? Did they tell you this?
Gena / Touch Matters
You wouldn't ask a licensing board for care facility requirement if some of their policies are legal or not. That's a matter for the Ombudsman Office in that state or the office of that state's Attorney General.
I have a friend who visits her uncle every week. Her four children visit and their children visit him.
Her uncle is a very nice guy who is quite happy in his nursing home. He’s hardly ever in his room. He’s 90 years old but very active in spite of being in a wheelchair. He participates in everything!
The nursing home called my friend to invite them to eat thanksgiving dinner there and told her to bring the whole family. 15 people showed up and they were welcomed with open arms.
This particular nursing home has gone out of their way for their residents and the place is very clean.
When the person who washes the residents hair and shaves the men missed work, an aide took my friend’s uncle to a hairdresser so he would have a fresh haircut and shave before celebrating his holiday dinner with his family. Honestly, they nursing home spoils him! He’s a lucky fellow who receives a lot of attention.