Procedure No. I.C.3.PR.001.d
Subject:  Family Respite Center Admission and Visitation
Section:  Services and Supports: Family Supports
Issue Date:  April 2006
Effective Date:  Upon Release
  1. Purpose
    To establish a standard process for admission to and activities available at the Family Respite Centers.

  2. Applicability
    This procedure shall apply  to all individuals who use DMR Family Respite Centers and their families/caregivers who access this resource.  This procedure shall apply to all DMR staff  responsible for admission and visitation to or operations of Family Respite Centers.

  3. Definitions
    Family Respite Center - homes or residential units operated by DMR which provide planned, temporary supports to individuals who reside with their families, community training home providers or DCF foster families and who are eligible to receive services from DMR.


    Respite Guest - the individual who receives supports at a Family Respite Center.


    Travel Packet - information which accompanies each individual when they are away from the Family Respite Center.  Packet includes: Guest Profile, Physician's Orders, Emergency and Authorization Form, and Respite Center Guest Permissions Form.

  4. Implementation
    1. At the time of admission to a Family Respite Center
      1. A family member/caregiver should accompany the guest to his/her scheduled visits unless other arrangements have been coordinated.
      2. The Family Respite Center admitting nurse or designee shall examine the guest and may refuse a planned respite admission to include but not limited to the following:
        1. The individual presents with cold/flu symptoms or does not appear to be in good health
        2. The individual presents with a contagious disease
        3. The pharmacy-labeled container does not match doctor's orders
        4. The individual presents with a body temperature of 100 degrees or higher
        5. The individual does not have required doctor's orders
        6. The individual lacks sufficient medication or other medically necessary items for the length of the stay.
      3. The Family Respite Center staff ,which may include the Nurse, shall complete the Admissions Assessment Form.  Following admission and prior to discharge, a body check will be completed and documented accordingly. The Discharge Assessment Form will be completed prior to discharge.
      4. The Family Respite Center Nurse, shall complete the Evaluation for Bathing and Personal Care Safety Supervision Form.
      5. The Family Respite Center nurse or medication administration certified staff will ensure compliance with the following:
        • Physician's Orders are current, match the prescription label on bottle, and adhere to the following:
          • The medication name, dose, route, and time of administration instructions on the pharmacy-labeled container must agree with the physician's order or prescription.
          • If there has been a recent change, the current physician's orders must be on file and a change in direction sticker must be placed on the prescription bottle by a nurse.
          • A physician's order is necessary each time there is a medication change.
          • Physician's orders must be updated annually if there are no ordered medications.
          • Physician's orders must be updated semi-annually (every 6 months) if routine or PRN medications (other than psychotropics) are ordered.
          • Physician's orders must be updated every 3 months if psychotropic medication is ordered.
          • Controlled medications must be only the amount needed for the duration of the respite visit two additional doses.
          • Formulas and special diets are considered prescriptions and must be included in the physician's orders. These include restricted calorie and diabetic diets and dietary supplements.
          • Orders for tube feeding must include type and amount of supplement and how often it is given. If a feeding pump is used, the infusion rate, time infused, and flushing instructions need to specify the agent used, time, and amount.
          • Other treatments, such as suctioning and nebulizer treatments, must have physician's orders and must include an order for special equipment needed.
          • Physical or occupational therapy programs must have a physician's order. Family Respite Center staff must receive an in-service by the family or by appropriate Family Respite Center staff prior to implementation of these programs.
          • Written/verbal instructions or video tape should accompany any adaptive equipment.
        • Medication count shall be completed and documented on the Admission Assessment Form.
      6. Family Respite Center staff shall ensure completion of the following:
        1. Leisure Interest Survey
        2. Personal Item Inventory
        3. Personal Spending Sheet
        4. Travel Packet.
      7. Family Respite Center supervisor/ designee shall ensure that the guest is introduced to staff and other guests and made welcome.
    2. During the respite visit a variety of programs and activities will be offered based on the individual's preferences and abilities.  Specific activities will be selected based on the Leisure Interest Survey, family recommendations, and staff availability.
    3. In the event of a medical emergency during the respite visit:
      1. Family Respite Center staff will call 911 immediately.
      2. Family Respite Center staff will accompany the individual on 911 calls. Whenever possible, the preferred hospital will be used as indicated on the Emergency and Medical Authorization form.
      3. Families/caregivers or their designated emergency contact person will be notified to meet the individual and the Family Respite Center staff at the hospital.
      4. The Family Respite Center staff will bring the individual’s Travel Packet to the hospital.
      5. Family Respite Center staff may return to the Family Respite Center when the individual’s family/caregiver or designated emergency contact person arrives at the hospital.
    4. If a respite center guest develops symptoms of a communicable disease during their visit, the Family Respite Center staff shall call the family/caregiver or the designated emergency contact person to take the individual home.
    5. G-Tube/J-Tube Replacement
      1. The respite center guest’s family/caregiver will bring a replacement tube to the Family Respite Center when the individual is admitted.
      2. Replacement of the G-tube or J- tube will be done at the preferred hospital as indicated on the Emergency and Medical Authorization form, whenever possible.
      3. The Family Respite Center staff will contact the family/caregiver or designated emergency contact person to bring the individual to the hospital for the replacement procedure.
      4. If the family/caregiver or designated emergency contact person cannot be contacted in a timely manner, the Family Respite Center staff will accompany the individual to the hospital.
      5. The individual will be readmitted to the Family Respite Center after the G-Tube/J-Tube has been reinserted and working.

  5. References
    1. Guest Profile
    2. Emergency and Authorization Form
    3. Physician's Orders
    4. Respite Center Permissions Form
    5. Leisure Interest Survey Form
    6. Evaluation for Bathing and Personal Care Safety Supervision Form
    7. Pre-admission Health Checklist
    8. Admission Assessment Form
    9. Discharge Assessment Form
    10. Personal Spending Sheet
    11. DDS-Family Respite Center Personal Items Inventory
    12. PICA Information for Respite Center Visits

  6. Attachments
          None

Connecticut Developmental Services

460 Capitol Avenue
Hartford Connecticut 06106