The Importance of a Thorough Admission Process in Long-Term Care

Yesterday, I shared an unfortunate experience involving a loved one’s admission to a nursing home facility. 

It was a difficult moment for me—not just as a nurse leader and advocate for healthcare professionals, but as a concerned family member who simply wanted the best care for their loved one.

As I reflected on the situation, one key thought kept running through my mind:

🔹 How important is the admission process?

🔹 How does poor communication impact patient care?

🔹 What systems need to be in place to ensure no resident is forgotten?

When No One Knew He Was Coming…

My family member was told no one knew he was coming—that hospitals “dump” patients on weekends when administration isn’t around.

I sat there quietly, processing that statement.

💡 I’ve been in long-term care for two decades. I know firsthand that while hospitals do discharge on weekends, it’s never truly a surprise.

In most facilities, the Admissions Director or Liaison is the first point of contact for any new admission.

They coordinate directly with hospitals case managers and social workers to verify patient details, and relay information to nursing leadership.

But here’s the reality—even when an admission happens on a weekend or outside of administrative hours, a facility should NEVER be caught off guard.

 The care team should always be informed, prepared, and ready.

If the Admissions Director isn’t communicating effectively, or if there’s no structured process in place, this leads to staff confusion, poor preparation, and compromised patient care.

The Breakdown in the Admission Process

In a well-run facility, weekend admissions should never be a mystery.

Here’s what should happen:

✅ Hospitals notify the Admissions Director/ Designee about a potential admission.

✅ The Admissions Director confirms the details and notifies the DON or administrator. (Most often, the DON does not have say if the patient should be accepted or not especially if you have a low census.)

✅ Managers on duty and nursing supervisors are informed.

✅ The admission is discussed in daily stand-up meetings until the patient arrives.

✅ A preliminary care plan (simply on paper) is established to ensure proper care from Day 1.

✅ The facility ensures they have the necessary equipment, supplies, and staffing to accommodate the resident’s needs.

What Does a Proper Admission Process Look Like?

Before the resident even arrives, the facility should have the following information:

✔️ Diagnosis & Medical History: Does the patient have any special medical needs or monitoring requirements?

✔️ Transfer & Mobility Needs: Can the patient walk, or do they require a Hoyer lift, stand lift, or transfer assistance?

✔️ Dietary Restrictions: Does the dietary department need to modify meals or textures?

✔️ DME (Durable Medical Equipment): Does the facility have the necessary wheelchair, bedside commode, or specialty mattress?

✔️ Fall Risk Assessment: Has the patient had previous falls? What interventions should be in place?

✔️ Cognition & Behavioral Concerns: Is the patient at risk for wandering, elopement, or agitation?

✔️ Family Notification & Emergency Contacts: Who is the primary decision-maker? Are advanced directives in place?

This information must be communicated to the team BEFORE the patient arrives. It should never be a case where staff walks into a room and says,

"Who is this?"

The Role of Communication in Admission Success

Whether a resident is arriving in two hours or two days, they should be a part of the facility’s daily discussion until they officially arrive.

Why? Because awareness creates preparedness.

👩🏽‍⚕️ When staff knows an admission is coming, they prepare.

📋 When leadership communicates effectively, teams stay informed.

🏥 When facilities follow a structured process, residents receive better care.

A strong admission process ensures that no resident goes unseen, unheard, or uncared for.

A Challenge for Nurse Leaders: How Are You Managing Your Admissions?

This experience made me evaluate my own practices as a leader.

Now, I want to ask you: What are some processes you’ve implemented to ensure smooth admissions?

💬 Drop a comment and share your best practices. Let’s build stronger systems together.

🔹 If you’re a DON, Admissions Director, or nurse leader looking to improve your facility’s processes, let’s connect.

📥 Need tools to organize your admissions process? [Check out my DON Planner]Bilquis Ali RN FACDONA, CDONA (@bilquisbali) | Stan

💡 Want guidance on improving leadership & operations? [Join my DON Leadership Program]Bilquis Ali RN FACDONA, CDONA (@bilquisbali) | Stan

📧 Need personalized coaching? Contact me for mentorship & consulting Bilquis Ali RN FACDONA, CDONA (@bilquisbali) | Stan