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The Art of Admissions

July 1, 2004
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Today's admissions coordinator needs a broader skill set than many facilities realize by Sarah Fox, LSW

The art of admissions

The admissions coordinator plays a large role in the resident's well-being, the family's morale, and the facility's financial success The admissions department is where impressions of your nursing home are made. This department needs to shine with its presentation, knowledge, helpfulness, and understanding of all the complexities involved in the decision to place a loved one in a nursing home. Blending the emotional, financial, psychosocial, and medical aspects of an admission requires a solid knowledge of the facility's marketing, social work, nursing, and business departments.

Timing an individual's readiness for admission-usually along with the family's-with room availability in the facility often requires the proficiency of a circus juggling act. Art is defined as "requiring sensitive understanding," according to the Oxford English Dictionary. If we look at admissions to our nursing home facilities in this light, the idea of admissions strictly being about completing paperwork and obtaining specific documentation takes on a very different meaning.

The American population is aging. Baby boomers are nearing the age where long-term care becomes a possibility-and many of their parents are already there. Statistics and research show that the need for long-term care facilities and the services they provide will increase.1 Assuming that the upcoming explosions in the elder population will lead to a facility's security, though, would be premature, at best. With Medicare and Medicaid cutbacks, the changes caused by the Prospective Payment System (PPS), the nursing shortage, and the higher acuity of residents, each of these factors on its own can cause facilities to overextend themselves to the point of no return. These elements combined, if not handled with well-designed alternatives, pose a real threat to a facility's survival. In a study conducted by the American Association of Homes and Services for the Aging (AAHSA), more than 200 nursing facilities closed from 2000 to 2001. Nursing facilities must analyze how to be cost-effective in all departments throughout their organization. What better place to start than with admissions?

Get Involved Early
Advanced planning is the key to long-term care placement, which means that the admissions department's work begins long before a person even sets foot on the property. The facility needs to have early involvement with those who are just starting their research on long-term care.2 You can't wait for them to call you based solely on a few fliers or local newspaper ads. Start by making a personal care connection to show that your facility understands each applicant's unique circumstances and will honor his/her individuality. If this connection is not made prior to admission, there will be no admission.

Admissions personnel must earn individuals' or families trust to be able to convince them that your facility best meets their needs. Even a violation-free facility must show its merit and distinction and, most importantly, have someone to show it to. There are many ways to initiate this connection: offer tours and open houses, and provide facility-specific information packets and even information on specific specialized units, such as the dementia care unit, if applicable. Also, offering general information on long-term care and related topics, such as advance directives, estate planning, understanding Medicare and the Medicaid process; and health-related issues, such as Alzheimer's disease, glaucoma, or diabetes, will position your organization as a good source of information and referrals.

Admissions personnel must be knowledgeable of overall healthcare issues. Hosting informational seminars for the public is a good way of demonstrating this knowledge. Not only does it get people in the door to see your facility, but it also shows you are concerned about matters of interest to them. When administrative staff are present at the event, it connects faces to the organization-happy, supportive faces who are there to listen to the needs of the community and, let's face it, be given the once-over. Informational, supportive "meet and greets" show the public that your facility is an excellent resource center for addressing their long-term care needs.

Types of Admissions
Admissions generally fall into two distinct categories. Each requires a different approach, takes different paths to gather information, and creates different issues.

Long-term/planned admission. This admission is planned by an individual or family usually living in a private home (either alone or with relatives), or it may originate as a referral from an assisted living community, where the client now requires more care than the current facility can provide.

Families are usually involved with any type of admission, but transitioning from home to facility care requires the most serious counseling. This type of admission forces the family to face the fact that their loved one's needs are so great that he or she cannot remain at home, which is why meetings in the admissions office are regularly tearful scenes. Up to this point, placement has only been an option, but when the paperwork is actually signed, it becomes a reality. Admissions staff must be equipped with skills to handle such delicate emotional episodes.