A Guide to Choosing a Skilled Nursing/Nursing Home Facility

At one time or another, we will all be faced with choosing, or helping to choose, a Skilled Nursing Facility ( SNF) for a loved one. There are a tremendous amount of online sites that will profess to give all the stats one might think are sufficient in making a solid choice. It's not always the case. Four to five star SNF's have their share of flaws in some areas. Three- four star rated SNF's may have exactly what you are seeking, in terms of care, for your loved one and should not be negated. Inspections are done sporadically and incident report corrections are not always a continued correction.

For the most part, families are faced with having to make a SNF choice at the least convenient time. You've been told your family member is being discharged from the hospital within 48 hours and you have to give the case manger at the hospital a list of your choices of SNF's in order of preference. With more and more woman working, with less time to beat the clock SNF searching, the chances of getting your loved placed in a SNF you want is next to impossible. Keep in mind that no matter what your preferences are, the first available bed will be offered to your loved one. That SNF can be on the bottom of your preference list or not on it at all. Medicare accepts and encourages this type of action, it's widely practiced and your loved one can end up not getting the care you anticipated they would receive. After having experienced three separate SNF's that cared for one of my own parents, it was not until the third experience that I'd wish I'd known the steps that should have been taken prior to her first fall. The few simple guidelines listed below will ensure you've done the best, and will be able to continue to do the best, in getting the quality of care that is most effective for your loved one.

Don't wait. If you have a family member 50 or older begin your research now.

Do in-house, unscheduled, SNF visits. Talk with staff and family members of patients. The best advice you can get is from a family member of a long term patient even if your family member may require short term care/rehabilitation.

Believe half of what you read and forget the other 50%. Everyone is seeking a different level of care for their family members. One persons SNF's dream may be another's nightmare.

Distance. Consider how far or how close you wish your family member to be placed. There are many pluses to having your family member close to you or another family member. Family visits and contact are imperative to a healthier and faster recovery.

Diet. Talk to the dietary clinician. Ask how often the menu is changed and do they have alternative options for your family member. Losing weight due to the lack of interest in food is not a healthy scenario. Be sure, and request, additional supplements can, and will be, provided if weight loss occurs.

Rehabilitation. How often will your loved one receive rehab? Will they receive on staff occupational as well as physical therapy? Is the rehab staff part of the SNF employees or off site contracts? We have found off site contractors to be better equipped and more aggressive than in house rehab specialists. Check the rehabilitation room. Is there enough equipment available or the bare minimum?

Room size. If you have a loved one that is mobile, or is in the SNF to become mobile, make sure the rooms have ample space for walkers and wheelchairs to maneuver. Oftentimes, short term patients are place in rooms with long term patients. In this case the long term patient has acquired a good deal of the room space with personal items and the ability to move about is limited leaving your loved one playing furniture bumper cars.

Clear halls and walkways. Be sure there are little to no obstacles in the areas your loved one will be using to walk in. Most accidents within SNF's occur due to hall clutter, lack of space and unnecessary use of limited space.

On duty staff. A must in any SNF is one- two, depending on the size of the SNF, Rn's on duty per shift. Grossly understaffed facilities generate under par rehabilitation and care. In this case, less is not best.

Physician on call. Your loved ones primary care physician may not be affiliated with the SNF you choose. Be sure the assigned on staff physician is there to greet your loved on admittance and that you request a weekly to bi-weekly visit. Also request all changes in medication and or care be reported to you directly. Your loved on must sign a waiver, if you do not have a Durable Power of Attorney, in order to have this information released to you. It would be wise to set a power of attorney up anytime a loved one reaches age 50 or above, prior to an incident requiring a SNF. This is your one option that allows "you" to be charge of your loved ones care.

Consistency. There is nothing more confusing to an elderly person than to not know who is treating them, for what, as well as having to recall ten different names. Be sure there is the same RN/LPN on duty Mon-Fri., with alternatives on the weekends, per shift. SNF staff inconsistency will prolong your family members rehab, cause agitation and possible additional drug use for anxiety that can incur. Of all the measures given, I have found this to be the most effective for a healthier recovery.

Cleanliness. A clean and sanitary SNF means a healthier environment for your loved one. How often are shared bathrooms cleaned? How often are bed linens changed? Check the kitchen area. Look under the bed for discarded items from the nursing staff, rubber gloves, pill cups etc. How often are the rooms swept or vacuumed? How often are showers or bed bathes given?

Exercise. Outside of your loved ones rehab schedule how often will your loved one be moved in and out of bed? How long will they sit in a wheelchair? How often, if they are walker ready, will someone be available to walk them in the afternoon or evening? Oftentimes floor staff will not walk a patient without the patient asking. Be sure there is adequate staff on duty to keep your loved one active. To much bed rest, or sitting, can cause more damage and delay adequate rehabilitation

Know your Medicare rights. Medicare has its own set of rules in each state. Every patient on Medicare is allowed 100 days of SNF care. Your loved one may or may not receive their full 100 day allowance. Each week progression reports are sent in to Medicare from rehabilitation. As long as your loved one is showing progress Medicare wants them out of the facility and home. Speak with the rehabilitation department. Be firm and be open with what you expect from your loved one when returning home. Let them know what you are, or are not, capable of helping with so they can determine what needs to be worked on. Early dismissal from any SNF due to unknown circumstances can only lead to further complications for your loved one when returning home.

Lastly, keep in mind that any change in environment can cause undo stress or anxiety for your loved one. It's not uncommon, nor unusual, and can be dealt with. Stay on top of any changes you may see in your loved ones mood, eating habits or condition, itself, and be sure to discuss those with their assigned physician. Not catching a problem prior to its progression can also cause potential SNF release problems for the caregiver.

No matter which SNF your loved one is placed in, if you follow the guidelines presented here, you'll find your loved one receiving the care and rehabilitation needed to return home in the best physical and mental health possible.