Suwannee Democrat

Mayo Free Press

February 14, 2013

Long term healthcare, a history of changes

Mayo — Lafayette Health Care Center Administrator Rich Wisdahl is well versed in the laws governing long term healthcare facilities and recently explained the complex process of patient admission assessment. He has been working in the nursing home administration field since 1974 and has seen a lot of changes over the years.


From about 1976 through 1988, Wisdahl said he noticed that most people entering a nursing facility did not have a complete health portfolio, which made it difficult for staff to know what to provide for the patient.

“There was no standardization to anything,” Wisdahl said. “Some facilities didn’t have anything, as far as a formalized assessment program. If an administrator or director of nursing had put something into place, it might have been a couple of pages of questions,” he added.

Since then, he said, a lot has changed, although the general public isn’t aware of just how much it has changed since the federal government stepped in around 1988 and decided a standardized admission assessment needed to be implemented for all nursing care facilities.

“So, they put in what is called an MDS, a Minimum Data Set,” he said.

Wisdahl remembers the uproar when, all of a sudden, they were forced to fill out about 10 pages worth of information for each incoming patient. He said he thought it was an okay idea, but he hoped they’d get reimbursed for their efforts.

“As time moved on, that process changed,” Wisdahl said.

Like any change, he said, things always seem to increase, including the amount of paperwork.

“For the most part it has been a very good change to have more detail,” he said.

About 10 or 15 years ago, he said, the admission assessment paperwork grew to about 30 pages.

When a new patient arrives at a nursing care facility, they are frequently unable to respond to or answer a lot of questions, he added.

“If I wanted an answer, I wouldn’t go to the individual, I’d go to the family member,” he said.

Oftentimes, he said, when you ask a family member about their parent or relative who is being admitted, they don’t know a lot of the answers because they haven’t been around the person in years.

“The accuracy to the answers probably weren’t the greatest,” said Wisdahl.

About two years ago more paperwork was added, along with a stipulation that answers needed to come from the patient, not a family member.

Once a patient is admitted another stack of papers have to be filled out identifying “triggers” for that patient. Then, as with all government paperwork, he said, there are meticulous instructions for filling out all the paperwork that can fill a four inch binder.

“You have no idea how things have changed within long term care,” he said. “It’s a much more thorough process.”

Wisdahl said probably about 99 percent of the general public doesn’t understand how much of a positive thing all these changes have been.

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