Leave of Absence (LOA)

Leave of Absence (LOA) 

Effective Date: [Original NPP Date] 
Revised Date: [Current Date] 

Goal: 

To provide for continuity of care and resident safety when a resident is out on a leave of absence. 

Policy: 

A physician’s order stating the resident may have a leave of absence (LOA) is required. The physician’s order must specify: 

• Whether the LOA includes medications, including controlled drugs. 

• Whether the resident may go on LOA independently or must be accompanied, and if so, by whom. 

The resident or person taking the resident on LOA will be responsible for administering medications and providing any needed care as instructed. Staff will be responsible for instructing the resident or the person taking the resident on LOA regarding medications to take and care routines to follow. 

The resident or person taking the resident on LOA will be provided with supplies, medications, and/or equipment as needed to meet the resident’s care needs while on LOA. They will also be informed that medications will be given in non-child-proof containers. 

Procedure: 

1. Physician's Order: 

• Obtain a physician’s order specifying the details of the LOA, including medications and accompaniment requirements. 

2. Preparation for LOA: 

• Notify the pharmacy in advance, if possible, of an impending LOA so that medications can be packaged. If the pharmacy cannot send pre-packaged LOA medications, the nurse will place the resident’s medications in unit-of-use medication packages. 

• Prepare supplies, medications, and/or equipment needed for the resident’s care while on LOA. 

• Inform the resident or person taking the resident on LOA that medications will be provided in non-child-proof containers. 

3. Instruction: 

• Staff will instruct the resident or person taking the resident on LOA regarding: 

• The medications to be taken. 

• The care routines to follow. 

• Ensure the resident or the responsible person understands the care plan and medication administration. 

4. Documentation: 

• Complete the LOA log when the resident is leaving the facility, acknowledging that the resident or person taking the resident on LOA accepts responsibility for the resident’s well-being and has been educated on the resident’s care needs. 

• Document in the resident's medical record the details of the LOA, including the instructions given and supplies provided. 

5. Communication: 

• Request the resident or person taking the resident out to contact the facility if there is a delay in returning. 

Name of Facility 

Release from Responsibility for Leave of Absence (LOA) 

Resident Name:______________________________________________ 

Resident/Responsible Party Signature:__________________________________________ 

This is to acknowledge that I (or my family/responsible party) am taking a leave of absence.  I acknowledge that I take full responsibility for my well-being outside of these premises.  I have received and understand education that has been provided to me about any medications and or care needed during my leave of absence.  I agreed to accept medications in “non-child proof containers” for medications provided.  I will inform the facility if I will not be returning at the anticipated time.  I hereby release the attending physician, the facility, its administration, staff and employees  from any claims, demands, grievances, and causes of action of every kind whatsoever arising from or out of any accident to me or by reason of any mishap or deterioration of my condition while on a leave of absence. 

References: 

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM] 

• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]