Can 2 registered nurses (RNs) sign admission papers for a dementia patient in a nursing home?

Nursing Home Admission Authorization for Dementia Patients

Two registered nurses cannot legally sign admission papers for a dementia patient in a nursing home—this is a legal and regulatory matter that requires proper legal authority, typically through a healthcare proxy, power of attorney, legal guardian, or the patient themselves if they retain decision-making capacity.

Legal Authority Requirements

The question of who can sign nursing home admission papers is fundamentally a matter of legal authorization and consent, not clinical nursing practice. The provided evidence addresses clinical care, advance care planning, and nursing interventions for dementia patients, but does not establish that nurses have legal authority to consent to admission on behalf of patients 1.

Who Can Legally Authorize Admission

• The patient themselves if they retain sufficient cognitive capacity to understand and consent to the admission decision
• Legal guardian or conservator appointed by a court
• Healthcare proxy or agent designated through advance directives or durable power of attorney for healthcare
• Family members in jurisdictions where state law establishes a hierarchy of surrogate decision-makers when no formal designation exists

The Nurse's Role in Admission

Nurses play critical supportive roles but do not serve as legal decision-makers 1:

• Facilitate advance care planning conversations by providing information and guidance to people with dementia and their families about care preferences 1
• Document wishes clearly in transferable files that should be accessible at all times for different care agencies 1
• Advocate for person-centered care and ensure that admission decisions align with the patient's goals of care 1
• Provide clinical assessment regarding the appropriateness of nursing home placement based on the patient's needs 1

Critical Distinction: Clinical vs. Legal Authority

The evidence emphasizes that complex decisions should be discussed jointly within the interprofessional care team (including nurses, family doctors, elderly care physicians, and specialists) and must involve the patient's family or surrogate decision-maker 1. This underscores that nurses participate in the decision-making process but do not unilaterally authorize admissions.

Common Pitfalls to Avoid

• Confusing clinical assessment with legal consent: Nurses can assess whether nursing home care is clinically appropriate, but this does not grant them authority to consent on behalf of the patient 1
• Proceeding without proper legal authorization: Admission without valid consent exposes the facility and staff to legal liability
• Assuming family presence equals consent: Even when family members are involved, formal legal authority must be established 1

State-Specific Regulatory Considerations

While the evidence does not provide state-specific regulations for admission authorization, it notes that states vary significantly in their regulatory approaches for dementia care in residential settings 2. Federal regulations under OBRA 87 establish quality standards but do not address who may legally consent to admission 3.

Action Steps for Proper Admission Authorization

1. Verify the patient's decision-making capacity through clinical assessment
2. If the patient lacks capacity, identify the legally authorized surrogate decision-maker (healthcare proxy, guardian, or family member per state law)
3. Obtain consent from the authorized individual, not from nursing staff
4. Document the authorization clearly with the identity and legal relationship of the person providing consent 1
5. Ensure advance care planning discussions have occurred or are initiated promptly after admission 1

Quality of Life and Person-Centered Care

Once proper legal authorization is obtained, nurses are essential in ensuring person-centered care that maximizes quality of life for residents with dementia 1. This includes individualized care adapted to changing preferences and needs, adequate staffing, and staff training in dementia care 1. However, these clinical responsibilities are separate from the legal authority to consent to admission.