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Skilled Nursing Facilities

  • Skilled Nursing Defined
  • What to Look For In a Skilled Nursing Facility
  • Additional Resources
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    Skilled Nursing Defined

    Skilled Nursing Facilities may be freestanding, or part of a seniors community offering any or all of the following:

    • Congregate or "Independent Living"
    • Assisted Living
    • A continuum of care.

    The type of care that may be administered ONLY BY A NURSING HOME in your state, is defined by state regulations. Generally "medical proceedures" and assistive acts requiring a nurse to physically "handle" a patient are limited to nursing home providers, when not in a hospital. Changing bandages deep wounds is often only permitted in Nursing Homes as is turning a patient in bed, who cannot turn themselves. To learn where the line between a Nursing Home and Assisted Living is drawn in your state, see regulations in your state at seniorresource.com state resources. Also speak with the discharge planner at the hospital because they deal with the fine line between levels of care needed on a regular basis. They will know if a patient needs a Nursing Home, or can receive the care they require in Assisted Living.
    Both freestanding and senior multi-level campuses (those which offer different lifestyles and/or levels of care to meet resident's needs) with a nursing facility affiliated, generally accept residents for long term stays, as well as for short term recovery. Acceptance is based on availability, the nature of care needed, and ability to pay or their acceptance of Medicaid.

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    A Nursing Home may not accept an Alzheimer's patient, whose illness is too advanced for them to be safely accommodated in a an Assisted Living setting. If their behavior is disruptive to other nursing home patients, who do not have Alzheimer's, they may need to move into a specific Alzheimer's Nursing Home. The physical structure and layout of a home specific to Alzheimer's patients should better meet their needs, and staff training will better be able to deal with erratic or dangerous behavior.

    An Alzheimer's patient may be discharged post-surgery to a nursing home which accepts reimbursement from Medicare. As they recover and regain mobility they may exhibit inappropriate behavior for that nursing home. There may be no near-by nursing home that accepts Medicare reimbursement that is also prepared to accept and care for an Alzheimer's patient.

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    What to Look For In a Skilled Nursing Facility

    When difficult situations arise families may need to turn to social workers, case workers, hospital discharge planners, and yes, the internet to help them become educated about the options appropriate for their loved one. They may also need guidance to identify specific choices in their area. Unfortunately, choices for selecting a nursing home are often made in haste and under stressful situations.

    Don't just accept the recommedation of a professional. They may mean well and understand the level of care needed, but do not know your family, or your family member. They will know which homes will take Medicare, Medicaid, and which ones only take private pay patients. But must be comfortable with the care that will be, or is being provided for your loved one. So plan to do some of your own Nursing Home shopping. Ask around. Plan to visit and see how different homes "feel", "smell" and look for those who have happier residents. Follow the guidelines below to help you shop. Try to start shopping as soon as it seems you may need to place a loved one in a nursing home. That way you will be less stressed when you have to make the decision. If you make it in haste, it is possible to have to remake the decision later and relocate a loved one. If the first placement is hard, the second one is harder!

    There is no substitue for visiting the home in person!

    Federal regulations require any long-term care home or facility to provide 30 days written notice and an appropriate discharge plan if they determine a patient is inapporpriateto remain with them. They may not just tell you verbally "you have to relocate a loved one"!

    Your Nursing Home Check List

    • Is it well maintained inside and out?
    • Is the decor pleasing and warm?
    • Is the facility free from odors?
    • If there are odors, are they handled quickly?
    • Do all rooms have private bathrooms?
    • Are there electric beds?
    • Is the attitude of the nursing staff caring and friendly?
    • Are meals nutritious and appealing?
    • Is the kitchen clean and orderly?
    • Does a registered dietician, or professional service, plan meals?
    • Are there individual and group activities and a monthly calendar?
    • Are arts and crafts offered?
    • Are there special outings?
    • Are non Medicare patients allowed to visit home?
    • Do they have an active volunteer visiting program?
    • Do they provide in-house physical therapy?
    • Is speech and occupational therapy available?
    • Are therapists licensed?
    • Are religious services, or transportation to churches offered?
    • If privately owned, is the owner available?
    • If managed by an outside service, how do their other facilities compare?
    • What is the reputation in the surrounding community?
    • How does the facility treat residents with similar needs?
  • How do reports issued by state and watchdog organizations rate and rank the home you are considering? What do the state or county obmudsmen say? Check Medicare's Nursing Home comparison site and the resources listed below for additional evaluations. The expense that may be incurred could be well worth the aggravation of later moving a loved one from a poor quality home.
  • After placing someone in a nursing home, remember "the squeaky wheel gets the oil". By trying to be an ally of the staff, advocate for the needs of your loved one. Show up often, not necessarily on "schedule". Catch staff unexpectedly - hopefully doing their job well. Remember the cute sweet girl in grammar school who was always teachers pet? Well it works the same when we are elderly - the sweet, charming patients are better candidates to be well liked by staff.
    br /> "My father was angry and disruptive when a child in school, and again as an Alzheimer's patient of 83. Someone from the outside needed to be his advocate, show up often and assure that he got the care he needed when family could not be there to provide care."

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    Additional Resources

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    Medical Informational Record Services

      Is your medical information

      available to your caregiver??

    • A Personal Health Record for Caregivers
    • Keep track of all your medications and allergies
    • Carry your legal directives such as DNR, living will with you!
    • Attach your x-rays, test results and more!
    • Keep track of all your insurance claims in one place
    • Here is how you can make it happen!

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    Other Resources

    • Nursing Home Reports provides ratings on nursing homes across the country and offers a book of the same for sale. Web site includes related articles of interest.
    • CareScout offers ratings for Nursing homes throughout the USA. Registration and a fee are required for specific home rating reports.
    • MyZiva.Net - The Complete Nursing Home Guide - is a completely free, objective resource for healthcare professionals, caregivers and prospective residents and their loved ones to find, evaluate and compare Nursing Homes across the nation. Search results contain government Survey (inspection) reports, Quality Measure rankings and Nurse Staffing Level ratios (including County averages). The unique MyZiva Comparison Tool also empowers users to easily create and print a comparison chart containing selected facilities.

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