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Are there state standards which assisted/personal care homes must follow when evaluating a resident's status & requiring them to seek "higher level of care".

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In my own experience: These are profit driven organizations and may intentionally cause a need for an increase in services. This of course is unethical and unconscionable but "Ends justify the means" to coerce more money from your elders funds.
Beware, keep a log and prepare to defend yourself.
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They use doctor's orders via the transmittal form.
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When I worked with adults who were physically and/or mentally disabled, I had to assist in making such determinations. It was similar in both states I worked in. While the homes can not discuss someone's situation with just anyone, they were mandated to document information obtained. The current system/s that engage the resident - doctors, nurses, home helpers of most any type, and even extended family or friends/neighbors can all be a part of the equation. If the person in question has visitors of any type - family, friends, or community advocates each can help document - directly or indirectly. A licensed home is required to document observations, discussions, and the resident's level of difficulty in achieving the Activities of Daily Living. Mobility, dressing oneself, bathing, eating, ability to communicate and comply with medical and other advice, and very importantly the ability to use the toilet. The ability to communicate his/her needs is extremely important. If there is any combativeness or wandering these are signs that a higher level of care may be necessary. To CYA, public services typically make note of any reports received from any source. They can listen and report but mostly can not discuss the problem with you unless you are legally part of their care program. Sometimes reports from the bigger community or law enforcement are very helpful. The flow of documentation went from in-home staff, families, conservators, day care programs, agency line staff supervisors, directors, and then it would get bumped up to the state level. Standards are spelled out and if you're a part of the care team, you should have access to how well the home and resident achieve this criteria. Medical, physical and mental levels of functioning, ancillary support systems in place, and observation of care are all signs of whether or not a person can function within a specific residential setting. If they appear to not be able to function, any publicly funded circles of support will typically band together to bump it up to the next level of care. If it's a private payment system, the home has more authority to make that determination. It's never easy. Publicly funded homes usually have wait-lists so can afford to let one resident go, and move in another. Finally, don't forget, if someone is not being as forth-coming as you believe they should, you can go to county welfare, AARP and other senior programs, state agencies. Often there will be many standards on their websites. Homes usually post at least some standards too. If you are employed in such settings of course do this research on your home computer. Never use your office computer if you're working in the office setting at all. The goal should always be to house the person in what is usually referred to as the "least restrictive setting". Go online to study what is meant by "least restrictive setting" if you want more detail. Let us know what you finally learn about this issue. It's a very important system that we should all be up to date on whether we are involved at a family level or official level.
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