Skilled Nursing Facilities

What is a skilled nursing facility?  Skilled nursing facilities are residential facilities that provide 24-hour medical care to senior citizens with significant health concerns.

Also referred to as nursing homes or convalescent homes, skilled nursing facilities provide high-level medical care from trained professionals. Patients may be admitted to a skilled nursing facility for a short time, or for long-term care.

Requirements for skilled nursing facilities include having an adequate number of nurses on staff, including registered nurses, licensed practical nurses and certified nurses’ aides. Keep reading to learn about the benefits of skilled nursing facilities, how to find a quality facility and how to determine if this type of care is best for you or your loved one.

Who benefits most from skilled nursing care?

People admitted into skilled nursing facilities generally fall in the middle of the health care requirement spectrum. Skilled nursing facility residents usually need a lower level of care than what hospitals provide, but require a higher level of care than what is available in an assisted living facility. Although assisted living facilities provide some aid with meals, medication and personal care, skilled nursing facilities provide more comprehensive help with these tasks of daily living.

Skilled nursing facilities also help patients who have been recently released from the hospital, but have continuing medical needs that make it difficult or impossible to return home without further rehabilitation. These temporary skilled nursing facility residents receive daily physical therapy, wound care and other medical assistance until they are well enough to return to their permanent residence.

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People who tend to benefit most from skilled nursing facilities are aging, frail or sickly senior citizens who do not have family members nearby to assist with their care. Seniors in these situations can receive the level of care they need to maintain or improve their health.

What type of care is provided at a skilled nursing facility?

Skilled nursing facilities provide around-the-clock nursing care to patients with a variety of medical concerns. As mentioned above, the skilled nursing facility staff of RNs, LPNs and CNAs help with daily tasks such as eating, toileting, bathing, getting in and out of bed and keeping medication dosages on track. Support staff assist with other aspects of custodial care, such as laundry, housekeeping and transportation. However, skilled nursing facilities provide much more complex medical care when necessary. Examples of skilled nursing facility care include the following:

  • Alzheimer’s and dementia care, including supervision to prevent wandering off
  • Stroke recovery, including speech and occupational therapy
  • Wound care, including antibiotic administration and bandage changes
  • Acute illness care, when a sudden illness or infection threatens a patient’s health
  • Acute injury care after a fall or other accident causes serious mobility issues
  • General rehabilitation services, such as physical, speech and occupational therapies needed after a serious operation or extended illness
  • Terminal illness care, including hospice services and patient comfort care

Some skilled nursing facilities also provide specific care to patients with serious chronic medical needs, such as those undergoing kidney dialysis or those with advanced Parkinson’s disease. Because this level of care is not available at all types of convalescent homes, it is important to ask before adding a facility to your list of options.

How to Get Into a Skilled Nursing Facility

To access the benefits of skilled nursing facilities, you must go through the facility’s specific admissions process. Sometimes admission is relatively easy, such as when a doctor writes an order for rehabilitation care following hospitalization for an extended illness, acute health crisis or complicated surgery. Other times, people seek skilled nursing facility admission after a slow decline in health that eliminates other, less-complex forms of care.

Many caregivers only begin to research skilled nursing facilities after caring for their aging relative becomes too much to handle alone. Although skilled nursing facility admission procedures vary by location, most follow these general steps:

  1. Obtain a doctor’s order for skilled nursing facility admission. The patient’s primary care physician must confirm that you or your loved one needs the in-depth care provided by skilled nursing facilities.
  2. Ask the primary care physician for copies of the medications and treatment plans the patient is currently on so that the facility management team can hand over these directions to their staff.
  3. Get a copy of the patient’s medical records.
  4. Complete a copy of your state’s nursing home admission form, which may be obtained from the patient’s doctor or the skilled nursing facility.
  5. Obtain proof of negative tuberculosis (TB) status via chest X-ray or TB test.
  6. Complete admissions paperwork, which can be extensive.
  7. Complete the nursing facility financial assessment, including Medicaid/Medicare information.

How to Find a Quality Skilled Nursing Facility

A simple online search should provide a skilled nursing facility directory to help you find local options for skilled nursing care. Many insurance companies, including Medicare, provide a skilled nursing facility directory that can help connect seniors and their caregivers with local nursing homes. You can also ask your doctor or hospital nurses for advice about local facilities. Medical professionals can often provide personal feedback on skilled nursing facilities and other senior care alternatives because of having patients in these facilities.

Because these skilled nursing facility lists may not include reviews from people who have used them, it is important to thoroughly research any facility that you are considering. Also, check the Better Business Bureau for skilled nursing facility lists that include consumer ratings and information about complaints filed against the facility or its employees. Social workers, ministers and other clergy members can also provide valuable insight into skilled nursing facilities.

Once you create your own skilled nursing facility list, visit each option more than once to get a feel for how well the facility is run. Observe the skilled nursing facility residents and notice how well the staff interacts with them. Consider the following factors when shopping for skilled nursing facilities:

  • Employer turnover
  • Facility cleanliness
  • Residents’ cleanliness and general mood (Do they seem happy?)
  • Indoor and outdoor social activities
  • Counseling or other social service availability
  • The quality/quantity of meals
  • Institutional vs. home-like décor
  • Ability to meet specific medical needs
  • The facility’s most recent inspection report

Skilled Nursing Facility Cost Factors

The high cost of skilled nursing facilities is understandable, given the level of care these facilities provide. However, people are sometimes surprised to learn that a skilled nursing facility can be less expensive than trying to maintain a high level of care at home by patching together home health care services, respite care and overnight nursing services.

Medicare Part A (hospital insurance) and some other health insurance plans cover care in skilled nursing facilities for certain conditions, for certain periods of time. Long-term care insurance and Medicare savings programs can help some people afford the costs of time spent in a skilled nursing facility.

Many seniors start out paying for skilled nursing facility care themselves or with the help of their family members. Seniors can increase disposable income by applying for a home equity loan or a reverse mortgage program. However, skilled nursing facilities are so expensive that many will permanently exhaust their own resources before qualifying for Medicare coverage of nursing home costs.

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