In last week’s post, I discussed how to decide where a patient should recover after a hospital stay. Often patients go home after discharge, but sometimes patients need to recover in skilled nursing facilities. Today’s post covers how to choose a skilled nursing facility so you, or your loved one, can get the best care possible and have the highest chance of a successful recovery. Before you being the process of choosing a facility, I urge you to read last week’s post to learn about quality care issues at skilled nursing facilities that can impact recovery.
If a patient needs a skilled nursing facility, it can be tough to decide which facility to choose. With expected hospitalizations, such as for a hip or knee replacement, you have plenty of time to research your options. But when a patient is hospitalized unexpectedly, due to events such as a stroke, car accident or a bad fall, your time to choose a facility is limited. But you always have time to do some research.
In all cases, regardless of how the patient arrived at the hospital, the options for skilled nursing facilities depends on which places have availability for a patient’s specific medical needs. Usually you’ll have a choice, but sometimes there is only 1 option available.
How to create your list of options?
If you have the luxury of advance notice, you can, and should, review the facilities in your area (see recommended steps for reviewing options below). Make a list of facilities you prefer, and those you want to avoid. When the time comes, ask the case manager if your preferred facilities have availability.
If you can’t get a bed in one of your preferred facilities, or if the hospitalization was unexpected, a nurse or case manager will give you a list of possible facilities a day or two before the scheduled discharge. The earlier you start these discussions, the better. Unfortunately, these lists generally don’t even include a list of services offered, never mind important quality measures and ratings. So, researching your options is invaluable.
Don’t make a rushed decision.
Research is an essential part of the decision-making process. Don’t let the case manager force you to decide before you’ve had time to research your options. A safe discharge, to an appropriate location, is a key to a smooth recovery.
How to research facilities?
First, get personal recommendations. Ask friends, neighbors and relatives if they, or people they know, have stayed in a skilled nursing facility in the past year or so. Find out what places they recommend and what places they think you should avoid. If you get a list of options from a case manager, try to find people who stayed in these facilities. Consider posting on social media to quickly and easily expand your reach.
Do some web sleuthing.
Review the websites of the facilities on your list. Additionally, conduct an online search to see if there have been complaints or articles relating to the quality of care. Type in the name of the facility with the search terms “complaint”, “quality of care” or “medication errors”.
You can also research facilities online, using these sites:
- Medicare.gov Inpatient Rehabilitation Facility Compare
- Medicare.gov Nursing Home Compare (includes some skilled nursing facilities)
- U.S. News & World Report – Best Nursing Homes (includes some skilled nursing facilities)
Additionally, I strongly encourage you to check out Medicare’s list of Special Focus Facilities (SFF) – nursing homes with a history of serious quality issues. These facilities have more problems than other nursing homes (about twice the average), have more serious problems than most others (including resident harm or injury), and have a pattern of serious problems that has persisted over at least 3 years. The May 2019 list can be found here. Additionally, CMS just published a list of facilities that are candidates for SFF classification – see that list here.
Pick up the phone.
Call facilities and ask them for information on:
- The availability of therapists on-staff to provide the specific therapy your loved one will require.
- Staffing ratios (including number of nurses and CNAs/aides per patient) and the normal number of hours each nurse, CNA and doctor work every day.
- How often a nurse and a doctor will visit the patient.
- Which doctor will oversee the care? Will the patient’s current doctor be in charge, or a doctor associated with the facility? Who will determine medication and treatment plans?
- When can family and friends visit?
- Do they have social activities for patients? What types and how often?
- How do they handle emergencies – medical and non-medical (e.g. fires)?
Visit in person.
If possible, you, a friend or a family member, should visit each facility on your list. How do the nurses and staff treat the patients? Do the patients look happy? In pain? Does the staff physically restrain patients? How does it smell? Does the food look appealing?
Most people don’t choose wisely.
Hopefully your research will lead you to the best possible facility for the patient’s needs. But it turns out that people frequently make poor decisions. The 2018 MedPAC report states that almost 84% of Medicare patients who go to a skilled nursing facility after a hospital stay could have selected a higher-rated facility within a 15-mile radius.
Don’t let feeling overwhelmed and stressed lead you to a less than optimal choice. Take the time needed to conduct appropriate research.
NOTE: I updated this post on 6-4-19.