Family FAQ: Skilled Nursing and Rehabilitation Facilities

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After a senior has been hospitalized due to a serious health setback, such as a fall, a stroke or even a nasty bout of the flu, they are commonly transferred from the hospital to a skilled nursing facility (SNF). While patients typically wish to return to their homes, a safe discharge to home usually isn’t possible without 24/7 home health care, which is costly and not covered by Medicare.

Understanding the Transition from Hospital to SNF

A hospital discharge planner will determine if a patient requires a high level of ongoing care that necessitates a short-term stay in a rehab facility for a few days, weeks or even months. There, they will be able to receive around-the-clock skilled nursing care (IV therapy, wound care, injections, etc.) as well as rehabilitative services, such as physical therapy, occupational therapy and speech therapy. These services are aimed at helping patients recover as much of their physical and functional abilities as possible.

Such care transitions are critical and often confusing times for patients and their family members. A smooth hospital discharge to a quality senior rehabilitation facility will help ensure that recovery goes as quickly and easily as possible. An uncomplicated healing process not only allows a senior to return to their familiar home environment to resume their normal day-to-day activities, but also helps minimize care costs and prevent hospital readmissions. Currently, Medicare only covers skilled nursing care provided in a certified SNF on a short-term basis. After a senior has been recuperating in a skilled nursing facility for 100 days, all costs must be paid for out of pocket.

Read: Does Medicare Cover Stays in Skilled Nursing Facilities?

Choosing the Right Skilled Nursing Facility

There is a lot of information available to help you choose the right skilled nursing facility for yourself or a loved one. With such a big decision, it is natural to have a lot of questions and it’s important that you get answers to them. You need to be confident that the skilled nursing facility you choose can provide a level of care and therapy that wouldn't be possible to receive at home.

So, how can you be certain you are choosing the right SNF? There are several factors that should guide this decision, such as specific precautions taken to protect patients with dementia and how often family can visit. The following questions will help you understand how a rehab facility functions and what your loved one’s stay will be like.

Questions to Ask a Senior Rehabilitation Facility

What precautions are taken to ensure residents’ safety?

Patient safety is the top priority in both short-term and long-term care facilities. High-quality SNFs recognize that it is their responsibility to provide the safe and caring atmosphere that patients need to thrive. When it comes to helping seniors with Alzheimer’s disease and other forms of dementia recuperate, additional safety measures are essential. It is crucial that the rehab facility uses an interdisciplinary approach to understanding and accommodating each patient’s unique needs.

One way that facilities ensure patient safety is through close supervision. Jessica Lynne White, rehabilitation director at Beachwood Post-Acute and Rehab in Santa Monica, Calif., explains, “The number one priority is paying attention to patients’ basic needs. We need to know when they are hungry, when they have to go to the bathroom, and respond in a timely manner and in a dignified way. If staff are not constantly aware and alert, patients might try to get up and meet their own needs—that’s when further injury can occur.”

One way to ensure a facility provides close supervision and attentive care is to ask questions about its staffing procedures. Find out what the legal staffing requirement is for skilled nursing facilities in your state (if there is one) and then ask representatives at prospective SNFs what their nurse-to-patient ratios are. You want the facility to meet the legally mandated staffing requirements but exceeding these is ideal. Lower patient ratios mean more nurses are available to care for fewer patients, decreasing the likelihood that personal and medical needs will be overlooked.

How involved should family members be during rehab therapy sessions?

Concerned family members frequently want to know how involved they can or should be during their loved ones’ inpatient rehabilitation. Understanding how therapy services work and your role in a loved one’s recovery will help you provide the best support. According to Mary Ann Mullane, director of rehabilitation at Linda Mar Rehabilitation in Pacifica, Calif., skilled nursing facilities typically make recommendations for family involvement on an individual basis.

“There is no straightforward answer to this question, because patients are so different and come into our care in different scenarios,” Mullane explains. “Sometimes the patients need support in the beginning so they can get comfortable. But other times a patient can get overstimulated or distracted by visitors.”

Although the staff at Linda Mar is careful to consider each case separately, Mullane believes that family presence generally helps patients keep their spirits up and improves their rehab outcomes. “Sometimes patients only respond to someone they know,” she adds. As long as visitors do not interfere with therapy sessions or a patient’s ability to get the rest they need, family members are welcome to bring encouragement and treats during regular visiting hours.

What types of therapy does the SNF provide?

Patient care plans are customized to fit individual needs and may include physical therapy, occupational therapy and speech therapy. Physical therapy services address disease or injury through methods such as massage, exercise and heat treatment. Occupational therapy helps patients regain the ability to perform activities of daily living (ADLs), such as bathing and dressing, and instrumental activities of daily living (IADLs), such as pushing a shopping cart or cooking dinner. Speech therapy generally helps individuals with swallowing issues and speaking clarity. Together, these therapies help seniors live as independently as possible.

Kit Quan, director of rehabilitation at Pacifica Nursing and Rehab Center in Pacifica, Calif., takes care to fully assess every patient’s progress to individualize treatment. Rehab schedules can then be prepared and followed, assuming the patient is able to participate and progresses as expected. “However, we can’t tell you exactly how long anything will take because we don’t have a crystal ball,” Quan acknowledges.


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How does the facility define “progress”?

Gauging progress is different for every patient and largely depends on the type and severity of medical setback that led to their hospitalization and any other comorbid conditions they may have. However, the goal for each patient is to try and get them back to their previous level of ability. Signs of improvement include improved health as determined by the medical director and the ability to accomplish activities of daily living (ADLs) independently.

“If a patient comes to us with very little prior function, then the goals are radically different,” explains Alyssa Higgins, a traveling physical therapist and former director of rehabilitation at a SNF in Scottsdale, Ariz. “A lot of patients live alone or with only one other person, so progress is also defined by how easily they can integrate back into their specific home setting. We’ve found that patients with a lot of family support typically do better.”

A quality facility will chart a patient’s progress daily and communicate effectively with family members about their expected recovery time. Similarly, the facility should communicate clearly about any decline that they observe in the patient’s health or abilities.

What are the facility’s patient discharge procedures?

Skilled nursing facilities conduct intake assessments on new patients to evaluate their medical needs and personal care needs, set a baseline for functionality, and create a comprehensive plan of care. Carina Arceo-Vergara, director of nursing at Lake Balboa Care Center in Van Nuys, Calif., explains that careful preparation of a customized care plan will ensure patient safety upon admission, during rehabilitation and following discharge. “We try to have the care plan meeting immediately to discuss the patient’s anticipated progress and put together a time frame for their recovery. After therapy, we have another care plan meeting—this one with doctors, social services and any other care team members—to make sure the patient is ready to be discharged.”

A reputable SNF will discharge patients as soon as they are no longer in need of around-the-clock medical care and intensive therapy. Be wary of any skilled nursing facility that offers to keep patients longer than needed for skilled care.

If a senior’s family or caregiver is not yet ready to receive them home, then the social services discharge planner will help make alternative accommodations. “Sometimes all the family needs is a bit of training, which we can provide,” Arceo-Vergara assures. “And if the patient needs to be transferred to a long-term care facility, then we work together with social services to help them in that process.” In some cases, a full recovery may not be possible. Instead of returning home, permanent placement in an assisted living facility, memory care unit or nursing home may better suit a senior's needs.

Choosing a skilled nursing facility can be a daunting task for patients and their loved ones. But, by asking the right questions, you will be able to assess which facilities offer the highest quality restorative nursing care and rehabilitative care programs that are the best fit for your loved one.

Sources: Home health services (https://www.medicare.gov/coverage/home-health-services); Skilled nursing facility (SNF) care (https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care)

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