UM Guidelines

Clinical Indications for Admission to Residential Care

• Admission to Respite Care for Adults[A](1) is judged appropriate as indicated by ALL of the following:
  • Member is at least 18 years old
  • Patient must meet ALL of the following:
    • Demonstrates an incapacitating or debilitating disturbance in mood, thought and/or behavior that is consistent with a DSM-IV or DSM-5 diagnosis that interferes with functioning in any domain to the extent that immediate stabilization is required
    • Member is likely to require hospitalization without de-escalation of the mental health symptoms and living environment stressors
    • Symptoms can be expected to respond to intensive, short-term structured intervention such that the safety issue will be resolved
    • Individual is in active outpatient services and the individual or family has an identified, time-limited need for respite from the current living situation
  • Absence of ALL the following exclusions:
    • Manifests behavioral and/or psychiatric symptoms that require a more intensive level of care
    • Can be safely maintained and effectively treated at a less intensive level of care
    • Symptoms are a result of a medical condition that warrants a medical setting for treatment
    • Individual or individual’s conservator does not voluntarily consent to treatment and there is no court order requiring such treatment
    • Has a sole presenting diagnosis of Substance Abuse

References

1. Edgar, M, Uhl, M. National Respite Guidelines: Guiding principles for respite models and services. ARCH National Resource Center 2011; retrieved from http://www.lifespanrespite.memberlodge.org/Resources/Documents/NationalRespite_Guidelines%20Final%20October%202011%201MB.pdf.
2. Elmore, D. Respite for caregivers of adults with mental disorders. The Technical Assistance Center for Lifespan Respite September 2011; fact sheet number 57: 1-19, ARCH National Respite Network and Resource Center. Retrieved from http://archrespite.org/productspublications/arch-fact-sheets#MentalHealth.
3. Jeon, YH, Brodaty, H, Chesterson, J. Respite care for caregivers and people with severe mental illness: literature review. Journal of Advanced Nursing 2005; 49(3):297-306.

Footnotes

[A] Program Definition: This level of care is a short-term crisis stabilization response that provides stabilization and safety in a licensed facility or licensed home for a maximum of three calendar days. Respite Care provides breaks for caregivers and gives an option to de-escalate a situation while avoiding hospitalization. It is designed to relieve stress and provide a safe environment for the member while assessing the member’s treatment needs. It can be provided in a variety of settings depending on facility. The purpose is to stabilize the member within the three-day period and prepare him/her for reintegration back into the living environment from which he/she came. If the member is unable to return home within three days, the member will be referred to a clinically-determined level of care. This intervention provides a safe, controlled environment with a high degree of supervision and structure in which the member receives therapeutic assessment and intervention.