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
When a patient’s care team has determined that they cannot safely be discharged home, even with intermittent home health care and outpatient physical therapy, the hospital discharge planner will determine the level of care they need and the setting that is the best fit (typically a SNF, which is also commonly referred to as a subacute rehabilitation facility).
Read: Senior Rehabilitation Settings and Levels of Care Explained
While the exact offerings may vary slightly from setting to setting, generally a senior will be able to receive around-the-clock skilled nursing care (e.g., IV therapy, wound care, injections) 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, cognitive 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: Senior Rehab: Medicare Coverage of Skilled Nursing Facility Stays
Questions to Ask When Choosing a Rehab Facility
There is a lot of information available to help you choose the right skilled nursing facility for a short-term rehabilitative stay. With such a big decision, it is natural to have a lot of questions. Working closely with the hospital discharge planner and contacting local providers for detailed information about their services will ensure that the skilled nursing facility you select can provide a level of care and therapy that wouldn’t be possible in a home setting.
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 since stays can last anywhere from a few days to a few months. The following questions will help you understand how a senior rehab facility functions and what your loved one’s stay will be like.
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 recover as fully as possible. When it comes to helping seniors with Alzheimer’s disease or other forms of dementia recuperate, additional training and safety measures are essential. It is crucial that the subacute rehab facility uses an interdisciplinary approach to understanding and accommodating each patient’s unique needs.
Facilities ensure patient safety through close supervision explains Jessica Lynne White, a licensed physical therapist who has spent more than a decade serving as the director of rehabilitation at several SNFs in Santa Monica, Calif. “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, etc., and respond in a timely manner and in a dignified way,” White continues. “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 a loved one’s stay. Understanding how therapy services work and your role in a senior’s recovery will help you provide the best support. According to MaryAnn Mullane, former 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 clarifies. “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. It is also wise for family members to participate in any care plan meetings (covered in greater detail below) to keep track of the senior’s progress.
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/or 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 verbal communication. Together, these therapies help seniors live as independently as possible.
Some facilities specialize in certain injuries or health conditions, such as stroke rehabilitation, amputee rehabilitation, brain injury rehabilitation, or orthopedic rehabilitation to name a few. Be sure that the SNF you choose offers care and services that match your loved one’s unique medical needs.
How long does a senior rehab stay last?
This is one question every patient and family member wants answered when making this decision. Unfortunately, it’s difficult to estimate since there are so many factors at play. For example, slow healing, refusal to participate, and pain (or fear of pain) are a few common reasons that could delay a senior’s progress and their discharge home.
Kit Quan, director of rehabilitation at Pacifica Nursing and Rehab Center in Pacifica, Calif., takes care to fully assess every patient’s initial condition 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.
While it’s impossible to accurately predict how long a senior will need SNF care, it helps to ask potential facilities what the average length of stay is for their patients—especially those with the same (or similar) medical issues as your loved one.
How does the facility define “progress”?
Gauging progress is different for every patient and largely depends on the type and severity of medical setback they have experienced and any other comorbid conditions they may have. However, the goal for each patient is regaining 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 independently.
“If a patient comes to us with very little prior function, then the goals are radically different,” notes 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 notify you of any plateaus or declines observed in a loved one’s health or abilities.
What are the facility’s patient discharge procedures?
Skilled nursing facilities conduct intake assessments for new patients to evaluate their medical needs and personal care needs, set a baseline for functionality, and create a rehabilitation plan of care. Carina Arceo-Vergara, director of nursing at Berkley Post-Acute in Van Nuys, Calif., explains that careful preparation of a customized care plan will ensure patient safety upon admission, during rehab 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,” Arceo-Vergara says. “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.
What percentage of patients return to their homes?
One indicator of effective rehabilitation is how successful a facility is in returning patients to their previous homes, which may or may not be in the community. (Some patients may already be living in assisted living facilities or other senior living settings before they require an SNF stay.) If a large percentage are unable to return to their prior residences because they now require a higher level of long-term care, then it may be a red flag. However, make sure your expectations are realistic. The truth is that a full recovery simply isn’t possible in some cases. Instead of returning “home,” permanent placement in an assisted living facility, a memory care unit or a nursing home may be the best option for some older adults whose needs and abilities have changed significantly and permanently.
If a senior’s family or caregiver is not yet ready to receive them home, then the social worker and/or discharge planner will offer resources and supports to help them prepare, such as education opportunities, referrals for in-home care services, adult day care, or senior living, or recommendations for home modifications or durable medical equipment. “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.”
Choosing a skilled nursing facility can be a daunting task for patients and their family caregivers. 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.
