1. SELECTING A FACILITY
When it comes time to choose a skilled nursing facility, either for short term rehabilitation or long-term care, there are various options available. A tour of the facility is the best way to assess the environment, culture, resident care and available services. We gladly invite you to look around our building and talk to our residents and staff.
At a minimum, you should consider the following when making your decision:
Resident Care Services
Skilled nursing facilities offer different levels of care in varying environments. Some facilities focus on long-term care, while others are geared toward post-hospital, short term care, and some provide both. When considering a facility, ask the following questions:
- Based on my condition, do I need short term rehabilitation or long-term care?
- Does the facility offer any specialty care programs or enhanced clinical capabilities?’
- Can the facility provide me with physician coverage if my doctor does not provide services at the facility?
- Will I require physical, occupational and/or speech therapy and does the center offer these services? Be sure to tour the therapy gym, especially if you will need rehab before returning home.
- Ask what types of rehab equipment will be used in your care and whether there are other advanced technologies like the Wii system, E-Stimulation, NuStep and more.
- Are patients, residents and families encouraged to participate in developing a care plan?
- Are other medical professionals (dentists, podiatrists, optometrists) available to me?
- How are prescriptions drugs ordered and administered?
- Does the facility have a special unit for residents with Alzheimer’s disease or other forms of dementia?
Licensure and Certification
While you can assume a skilled nursing center has all the appropriate licensure and certifications, you can ask:
- Is the facility licensed by the state?
- Is the facility both Medicare and Medicaid certified?
- Is the facility’s latest annual state survey report available for review?
- Does the facility have a formal quality assurance program?
- Has the facility received any awards or certifications?
CMS requires that all skilled nursing centers undergo yearly evaluations in order to be certified to receive payment from Medicare and Medicaid. At a minimum all skilled nursing facilities are surveyed at least annually. In addition, each state requires that we maintain compliance with state licensing requirements. Annual visits, complaint surveys and resurveys ensure that the facility meets federal and state regulations
Consider the following:
- See if the atmosphere is welcoming and attractive.
- Do you have private and semi-private rooms available?
- Are private telephone lines and TVs provided?
- Do you have free Internet access and/ or wireless connectivity?
- Are private areas available for family to meet outside of the resident room?
- Ask for a sample menu and gauge your ability to choose your own meals.
- Does the facility have always available meal options or snacks?
- Do residents have the ability to make special dining or menu requests?
Inquire about required staff training and qualifications. While touring a facility, observe the interactions between staff and residents. You can also ask the following:
- How many Attending Physicians/Nurse Practitioners are on staff and will they be involved in my care?
- How many RNs are on staff and what is the staff to resident ratio?
- How many days per week is therapy offered?
- Are there evening and weekend activities offered?
Cost and fees
Understand the costs and whether care will be covered by Medicare, Medicaid or private insurance. If not, you will need to pay for your care out of pocket. A facility should be able to assess your financial situation and determine your eligibility. In addition, be sure to inquire about additional fees such as TV, phone, transportation, beauty/barber, or other types of services.
2. TYPICAL SERVICES PROVIDED IN SKILLED NURSING FACILITIES:
Skilled nursing facilities provide a broad range of services customized to meet the individual needs and preferences of its residents. In general, a facility will provide the following services on a daily basis:
- Assist residents with all activities of daily living helping with mobility, walking, eating, and personal hygiene;
- Provide hours of physical therapy, occupational, and speech therapy to enable residents to gain function with daily tasks and to enable many of them to return home;
- Monitor residents’ acute medical conditions that require special attention in addition to their ongoing health concerns;
- Manage residents’ nutritional status by monitoring weights and food intake, providing assistance and special therapeutic diets when appropriate;
- Dispense numerous prescribed medications for the treatment of many of the chronic and acute medical conditions;
- Assist residents in maintaining or improving physical strength and mobility so that they can function as independently as possible;
- Observe and monitor residents’ skin integrity to prevent or treat any skin break down;
- Engage residents in therapeutic recreational activities to provide stimulation and interest, physical strengthening and socialization in the day.
3. COMMON RESIDENT HEALTH ISSUES:
Among the elderly – especially those who have reduced muscle mass and brittle bones due to osteoporosis – falls can be serious and even disabling. Falls are more common among those 65 and over, whether or not they live at a nursing home. Falls can occur for various reasons:
- A decrease in safety awareness as we age
- Changes in vision, hearing, muscle strength, coordination and reflexes
- Health disorders – diabetes, heart condition – that affect balance
In a nursing home, a fall can often result from a resident’s impatience or reluctance to ask for assistance in walking or getting up to use the restroom. While no facility can prevent all falls, our goal is to minimize the number of falls and the severity of any resulting injuries.
Although every effort is made to keep residents fed and hydrated, the ability to take nourishment is affected by the desire to eat and drink and the perception of whether someone is hungry or thirsty. Several factors can influence appetite:
- Sadness, grief or depression
- Tooth loss or ill-fitting dentures
- Reduced ability to feed oneself
- Some medications that can mask hunger or contribute to dehydration
Problems with control of one’s bowel or bladder are widespread in the elderly. The reason may be muscle weakness or a decreased awareness of bodily function.
As the body ages, it undergoes changes that affect its ability to heal. Our skin becomes drier and less elastic, and the layer of fat under the skin decreases, resulting in increased bruising or tearing. Diseases such as diabetes can increase the risk of skin problems and wounds. Pressure ulcers (bedsores) can develop, especially in elderly bed-bound people who are unable or unwilling to move. Nutrition also has an impact – without proper food and hydration, the body’s ability to heal is affected. It’s also important to remember that since older adults may suffer from multiple medical problems, they can have different types of pain.
Although many mental changes are a normal part of the aging process – including decreased memory and slower thinking – depression, dementia and Alzheimer’s disease are examples of more severe mental changes. Experts estimate that as many as two-thirds of nursing home residents have some sort of dementia. In addition, many of the medical and physical problems discussed are complicated by cognitive impairment.
Decreased bone density can lead to an increased risk of serious injuries, such as broken bones, caused even by simple movement. Bones become more porous as we age, and slower to heal in the event of an injury. Women are more likely to develop fragile bones, but men can also suffer from. Taking such steps as consuming adequate calcium and exercising can slow the loss of bone density, but the decrease is a natural effect of aging, and as bones become more porous they are more prone to breaking. Such fractures can be caused even by simple movement and can heal slowly or not at all, depending on the age and the health of the individual.
4. MEDICARE COVERAGE IN SKILLED NURSING FACILITIES
Medicare Part A & B
What is Medicare and what does it cover?
Medicare is a federal health insurance program (administered by the Centers for Medicare and Medicaid Services (CMS)) for people age 65 and over and certain disabled people under 65.
Medicare is divided into two parts:
Hospital Insurance – Part A:
- Part A covers care provided by a skilled nursing facility to help a beneficiary recover from an acute illness or injury. Medicare provides full coverage for the first 20 days of care in a skilled nursing facility and a portion of the costs for skilled nursing facility care for days 21-100. During this period, the patient pays a daily coinsurance rate.
- Any Medicare A stay requires a 3-day overnight hospital stay within 30 days of admission to a skilled nursing facility.
- The resident requires skilled nursing services or skilled rehabilitation services (requires the skills of qualified technical or professional health personal)
- The resident requires these services on a daily basis
- As a practical matter (economy and efficiency), the daily skilled service can be provided only on an inpatient basis in a skilled nursing facility
- Services must be furnished pursuant to a physician’s orders
- Services must be reasonable and necessary, as well as: consistent with nature and severity of illness, and reasonable in terms of duration and quantity
Medical Insurance – Part B:
- Part B is a supplemental program for which you must pay an annual premium and a deductible for all covered services, including physician services.
- In general, Part B coverage relates to ancillary services such as physician services, lab work, x-rays, routine foot care, hearing and eye exams, immunizations, and therapy.
- After meeting the deductible, Part B pays 80 percent of the reasonable charges for covered services only.
- Part B may pay for covered services you receive from your doctor while in a skilled nursing facility from the time of admission.
Medicare Covered Services:
- A semi-private room
- Meals, including special diets
- Regular skilled nursing services
- Rehabilitation services (Physical, Occupational, and Speech Therapy)
- Drugs furnished by the facility
- Medical supplies
- Oxygen administration
- Treatment for pressure ulcers
- Observation and assessment of unstable and post-operate residents
- Development, management and evaluation of the resident care plan
- Nursing rehabilitation activities
For more information about the Medicare program, please call 1-800-MEDICARE (1-800-633-4227).
5. OTHER CONSIDERATIONS:
An independent physician provides services as a medical director to offer guidance and oversee the provision of resident care. Specialty services may include consultations by a geriatrician, rehabilitation specialist, cardiologist, orthopedist or pulmonologist. Your personal physician or assigned physician will attend to your medical needs during your stay.
We can work with your personal physician to arrange for continued care when the time comes for you to be discharged home.
If an outside medical appointment or test is necessary during your stay, transportation can be arranged by our staff. These services may not be part of the daily room rate. The cost involved with transportation depends on medical needs and your insurance coverage. A family member may also transport you after receiving education from our therapy department about how to safely transfer you in and out of a car.
THE THERAPY TEAM
Therapy professionals are on site to assist with your therapy needs. Physical therapists are available to help you work towards increased strength, endurance and mobility.
Occupational therapists can help patients learn to care for themselves, focusing on activities of daily living, such as dressing, bathing and meal preparation. Speech pathologists are involved with cognitive training and re-education, as well as with swallowing and speech disorders. Respiratory therapists can work with patients to promote better breathing.
There are no restrictions on visiting hours as long as this is not disruptive to other residents. Our visiting hours are flexible to accommodate the varying schedules of families. Well-behaved and leashed pets are welcome.
PLAN OF CARE
An individualized comprehensive care plan is developed by our team of healthcare professionals that include nursing, dietary, social service, recreation therapy, and physical, occupational and/or speech therapy. This team identifies specific concerns and writes plans designed to help maintain current health status and to address health problems. We encourage you and/or your responsible party to participate in the development of the care plan at the resident care plan meeting.
Audiology, dental, optometry and podiatry consultants are available to meet your needs.
Available to you as prescribed by your attending physician, this additional service is provided by a consulting group.
A consulting pharmacy provides service for all residents. You may use our pharmacy or another, provided they can also meet the facility’s service requirements, such as specialized safety packaging.
We employ activity directors who coordinate activities throughout the week, which also includes some evenings. These activities vary from large to small groups and also include one-on-one projects. In addition to our regular activities, special events are also scheduled throughout the month. A monthly calendar of all of these events is posted in the center.
BEAUTY& BARBER SERVICE
A licensed beautician is available for your hair care. To make an appointment, please speak to the receptionist or the beautician.
You are provided with a well-balanced selection of meals that are individually planned according to specific diet needs or restrictions.
HOUSEKEEPING & LAUNDRY
Complete housekeeping and laundry services are provided for you.
Our facility has lounge areas for you and your family to gather for visits, recreation or to watch television.
Mail is distributed daily to you. If you need assistance in writing or mailing letters you may contact activities or social services.
Account statements are mailed to you or your responsible party each month and include any ancillary charges accrued along with charges for the following month’s care. These bills are payable upon receipt. The business office or social service department will also assist families in filing for medical assistance (Medicaid) as needed.
RESIDENT FUND ACCOUNT
The facility maintains a resident fund account for you if you choose to have us manage your funds. Payment for beauty or barber services, clothing, and incidentals may be made through this account.