Bay Pines VA Healthcare System
In-Patient Services — Geriatrics and Extended Care
Community Living Center (Nursing Home Care Unit)
The Community Living Center (NHCU) is a specialized nursing facility designed to care for patients who require rehabilitation and restorative care focused on Discharge planning to least restrictive environment, supportive health services which promote decreasing dependence and maximizing independence, respite care and/or palliative/hospice care.
Veterans admitted to this program require care which is planned and coordinated by an interdisciplinary team and require the services of a hospital-based skilled nursing home.
A veteran must meet all of the following criteria:
- Requires skilled nursing care, rehabilitative or supportive health services, and intermittent services of a physician.
- Is medically stable and no longer in need of hospital care.
- If terminally ill, requires palliative or hospice care.
- Be in need of comprehensive interdisciplinary team assessment.
- Veterans with palliative care needs that exceed the Community Living Center (NHCU) programs capacity, e.g., patients needing intravenous analgesics/therapies.
- Veterans with behavioral problems that have the potential to harm themselves or others, or who wander.
- Veterans in need of permanent placement.
Hospice and Palliative Care
Inpatient hospice provides compassionate, specialized care for patients with life-limiting illnesses in the final weeks of life. Care is provided by an interdisciplinary team which includes nurses, physician, social worker, chaplain, pharmacist, dietitian, and volunteers. Priority for admission will be given to patients occupying acute, or extended care beds within Bay Pines VAHCS.
- The patient has a life-limiting illness as determined by the patient's attending physician and with the concurrence of the Hospice physician who will receive the patient in transfer.
- The estimated survival of the patient is less than 2 months. Patients with a longer estimated survival may be considered if complex comfort care measures are needed that are beyond scope of current environment or have caused frequent recent hospitalizations.
- The patient requires treatment of pain and symptoms related to the life-limiting illness and/or be in need of emotional, spiritual, physical, or social support rather than curative measures.
- The patient has agreed to a "Do Not Resuscitate" (DNR) order and the advance directive decisions for care contained in the consent.
- The patient or patient's surrogate understands that no further medical intervention will be planned except for those measures focusing on physical, social, emotional or spiritual comfort for patients and significant others.
- The patient may elect to withdraw from Inpatient Hospice care or to revoke the DNR status at any time. In this situation, the Hospice physician will consult the most appropriate bed service for admission or transfer based on the patient's needs at the time of withdrawal from Hospice care. The patient may also be Discharged to the community. The Hospice team will work with community hospices to provide support in the environment of Discharge.
- The patient may be withdrawn from Hospice care if the patient's condition significantly improves so that death is no longer imminent, i.e., survival is expected to be greater than 2 months or patient is not benefiting from Hospice care.
Respite care provides temporary relief to 24-hour unpaid caregivers from routine tasks and supports the caregiver in maintaining the chronically ill veteran. Care may be provided as an in-patient in the Community Living Center (NHCU) or as an out-patient (See Geriatrics and Extended Care out-patient section for additional information). Alternative sources of care, providing longer lengths of stay, should be pursued if the caregiver is unable to provide care during personal emergencies or illness. Respite care provided in the Community Living Center (NHCU) may not exceed 13 days per episode, twice per calendar year.
- Veteran is enrolled in the VA and has a Primary Care provider.
- The veteran has a diagnosed chronic disabling illness or condition and needs assistance bathing, dressing, mobility or behavior management.
- 30 days must elapse between the veteran's discharge from the hospital or institution to his/her admission date for respite care. If 30 days have not elapsed, respite admission will be canceled and new dates can be requested. Discharge plan is to return veteran to his residence; this is agreed upon by all parties prior to admission.
- The need for relief by caregiver is expressed with medical documentation to support activities of daily living (bathing, dressing, mobility) deficits or behavioral management difficulties.
- The veteran lives at home and requires substantial assistance in activities of daily living in order to continue to reside safely in the home.
- Veteran's medical, psychiatric and behavioral problems can be safely managed by specific respite program.
Veterans who require enhanced safety observation (ESO) or one-to-one care (i.e. veterans who wander and/or those who are agitated) can not receive Respite in the Community Living Center (NHCU), but may be eligible for community respite care in an appropriate facility under VA Fee Services.