How to Choose a Skilled Nursing Facility
How to Choose a Skilled Nursing Facility
As the Medical Director of several Skilled Nursing Facilities (SNF’s) in the area and the Director of the Heritage Health Post Acute Care (PAC) Team, my team and I work closely with all of these facilities that strive to bring quality care to some of our most vulnerable patients in our community. The PAC team works diligently to care for the medical needs of these residents while supporting the facilities in any way we can to ensure compassionate and timely care. We do not specifically recommend one facility over the other, but I have been asked to review some of the key features which might assist patients and families to make good choices and find the right match based on the medical needs and acuity of the illness once these patients leave the hospital or other levels of care.
For some, medical care may lead to a Skilled Nursing Facility (SNF), frequently referred to as a “Nursing Home.” Although located in the same building, many of these facilities have two different opportunities to care for you or your family members. Many of you are familiar with the Long Term Care side frequently associated with the care of the elderly. This would be for those who require much assistance for many of their Activities of Daily Living (ADL’s) such as dressing, showering, toileting and/or eating. Some of you may not be as familiar with the short term Rehabilitation side that offers multiple Therapies such as Physical, Occupational and Speech. This short-term care could offer Rehab treatment after a major illness, surgery, care for complex wounds, provide intravenous antibiotics or other care needs unavailable in a home setting even with Home Health.
With all those healthcare needs, how does one determine the best SNF for them or their family members? It can be a difficult and stressful task, especially if the decision is needed before leaving the hospital. Fortunately there will be many resources available to assist you. Hospital Discharge Planners include a team of Nursing staff and Social Workers who will be ready to help you through this healthcare maze. They will be able to offer you a list of appropriate services available in the community. They will work hand-in-hand with representatives from these facilities, but it will be up to you to make the final decision in a timely fashion.
It is best to begin the journey as soon as possible. If you know ahead of time that SNF services will be needed, take the time to do your research. The location of the facility may facilitate more frequent visits from family members, but beyond that consider visiting some of the facilities, with the understanding that this type of care may be very new to you and staff members work incredibly hard to maintain the safety of all residents under their care. Get to know who will be caring for you or your family member. Call and arrange for a tour well before admission is needed. Feel free to ask questions not only of the tour guide, but any employee you come in contact with. Go beyond looking at the paint on the walls and see how staff members are interacting with the patients/residents for whom they are caring.
If available, ask to speak with the Director of Nurses. Ask about the average census (number of patients) for the building. Ask how many Registered Nurses (RN’s) or Licensed Practical Nurses (LPN’s) are on duty for both day and night shifts and use these numbers to divide the average census and see how busy these nurses will be throughout the day and night. The LPN’s will be responsible for oversight of the CNA’s, as well as providing medication in a timely fashion. Also ask the same about the Certified Nursing Assistant (CNA’s). This will be especially important as they provide the hands-on care for many of the ADL’s. They are one of the hardest workers in the building and deserve much more for all the love and care they provide. More specifically, ask about “Call Light times.” Each facility should have a goal for the average time it takes to answer a Call Light. We never want to keep a resident waiting longer then absolutely necessary, but when staff is short or other residents require additional assistance and care, this “time to respond” goal could be missed.
If a change in condition occurs in any patient, it would be good to know how rapid is the response of their medical team. All facilities offer 24/7 on-call phone services and many have providers inside the building four to five days a week. Remember, each facility must do all it can to avoid a return trip to the Emergency Room and risk re-hospitalization. Resources are frequently available to help avoid these readmissions. Are there access to Lab and X-ray services if needed? What is the turn around time for urgent medications, especially antibiotics? How often is Intravenous access initiated in the facility?
Also ask to speak to the Activities Director, especially for long-term care. What in-house and out-of-facility events are planned and what is the participation level? Ask about housekeeping and general maintenance staff. Also ask about employee turnover, as this can give you an idea of stability in the facility.
If time does not allow for a tour, other information may be obtained through local services or the internet, but remember this data may not be as accurate or up-to-date as we would like to see. Visit medicare.gov/nursinghomecompare. Look for the Star rating system, but I would advise you not to make a decision solely based on this information. One must take into consideration the various levels of acuity (how sick is the average patient) and how this relates to the state surveys, which generate the data. Ask your neighbors and friends who may have had personal experiences in these settings.
For additional information, consider calling the Area Agency on Aging (AAA). Also consider talking to private companies who can help you locate the right facility for your loved ones. Remember, if time allows, do your research and make an effort to learn as much as you can about the Post Acute Care world and the Skilled Nursing Facilities in your area.
by Michael Meza, M.D., Medical Director, Life Care Center of Post Falls
Dr. Meza graduated medical school from the University of Texas Southwestern in Dallas, Texas in 1993, followed by Family Practice residency at John Peter Smith Hospital in Forth Worth. After graduation he moved to Orofino, Idaho and enjoyed 16 years practicing full spectrum family medicine, providing care in the clinic, hospital, emergency department and Skilled Nursing Facility. He also provided obstetrical care, including cesarean sections, and performed colonoscopies and EGDs for his patients.
He and his wife Casey moved to Coeur d’Alene in January 2012 and began focusing on care for the elderly. He enjoys seeing residents of “the greatest generation” in the Post Acute Care facilities, Skilled Nursing facilities, and Assisted Living facilities where they live, and building a health care team to support their needs. He works collaboratively with Kootenai Health through the Community Partners group to insure a smooth transition of care for patients discharged from the hospital to these types of facilities.