Long-Term Care Survey Alert

Implement these strategies before residents leave.

The two cardinal rules for ensuring a resident's off-premise visit with his family goes well: Assess and educate.

As a matter of policy, conduct a pre-visit interview with a family member taking a resident home or for an outing, suggests forensic nurse expert William Sheridan, RN, PhD, FAAN, FND-A, a nursing professor at Johns Hopkins University.

Diplomatic approach: As part of the interview, find out what the family intends to do during the visit offsite, suggests Francis Battisti, a social worker and nursing home consultant in Binghamton, NY. "You can frame that with the family in the context of how the facility wants the resident's visits to be part of the overall care plan...," Battisti suggests.

You also want to assess whether the family members can take care of the person without staff being present, advises Gail Robison, RN, RAC-C, a consultant with Boyer and Associates in Brookfield, WI. "Anytime you take a resident out of his usual environment and disrupt his normal routine, you have to expect some atypical results," says Robison. And "it doesn't take much for a frail elder to go into crisis."

A red flag for problems with a home visit: "A caregiver who is cognitively or physically challenged," cautions Sheridan. "The home visit might go OK if there were someone there who is strong and competent to take care of the family member."

To give family members the information they need to succeed in their temporary caregiving role and enjoy the visit, make sure a responsible person will be available to:

Administer medications safely. Typically, facilities give the family a list of medications and the times to administer them, says Robison. But you also have to teach the family which meds the resident should take with food -- and how much fluid to drink with the meds, she adds.

Medication tip: Each medication has manufacturer's guidelines for how much water the patient has to take the dose with, advises Joseph Gruber, RPH, CGP, FASCP, director of medication therapy management programs for Omnicare Inc.

Skin sensitivity to sunlight is also an issue for people taking certain medications, adds Robison (for details, see "Protect Residents From Drug-Photo Reactions").

Meet the resident's fluid requirements and dietary restrictions. The resident's fluid needs will be higher if the person is attending a picnic or outing in the hot weather, Robison points out. "If the person has pureed, or mechanical soft diet, does the family really understand what that means?" To ensure the resident gets the right diet, some facilities provide a meal and drinks for the resident when he goes with the family for an outing, she notes. A diabetic's energy requirements will increase when he goes on a family visit or outing, Robison adds.

Address the resident's toileting issues and routines. These are "huge," says Robison. Park Place Nursing and Rehabilitation Center staff teach families to take the resident to the restroom or offer to based on the person's individualized schedule or at least every three hours, says Rebekha Grigsby, RN, director of nursing for the facility in Selma, AL. "We also advise them to make sure that the pathway to the bathroom" is free of fall hazards, such as a rug.