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Skilled Nursing Facilities: How to Choose the Best One

Updated on July 18, 2012

I recently had to find a skilled nursing facility for my mom for rehabilitation after a fall. I had no idea what a difficult decision this would be, or what factors I should consider. Although her stay would be short term, I wanted to make sure I chose the best facility to meet her needs.

Luckily, a social worker at the hospital where she was staying was very helpful in my search. I wanted to make sure that the facility was in my mom's insurance network, and that they had experience in working with patients with her specific needs. But there is a lot more that factors into the choice of a skilled nursing facility.

What is a Skilled Nursing Facility?

A skilled nursing facility (abbreviated "SNF") is an institution that includes rehabilitation and nursing care, on a short or long term basis, for individuals who need such care. They are sometimes called "rehabilitation centers" or "nursing homes", but many facilities fit into both of those categories and more.

A skilled nursing facility in the United States must be recognized by Medicare and Medicaid as being prepared to meet individuals' long term health care needs. Patient care is supervised by a physician, and that nursing services are available 24 hours a day. Care is provided by a diverse team, usually consisting of nurses, aides, social workers, doctors, and therapists.

Nursing staff is critical to a skilled nursing facility
Nursing staff is critical to a skilled nursing facility | Source

Medical Care

When looking for a skilled nursing facility, it is important to understand the medical needs of the person who will live there, and to determine whether the facility can meet those needs to everyone's satisfaction. Most skilled nursing facilities have full time, 24-hour nursing staff, along with nursing aides on the same schedule. Doctors often visit patients once per week, and provide consultation to the staff on other days.

Before choosing a facility, there are many questions to ask to make sure this is the right place for your loved one.

  • What are the hours of the nursing staff? How long are their shifts?
  • When do the doctors visit? Is it on a regular schedule?
  • What types of doctors or specialists visit patients? Can my doctor see me here instead?
  • What types of therapy (physical, occupational, speech, etc.) are offered? Who provides this therapy? How often does it occur?

You may also ask about medical equipment that is used in therapy and for your loved one. Walkers, wheelchairs, etc., may be the property of the facility, or you may be able to bring your own. Also, if your loved one is at risk for falls, ask whether they use bed or chair alarms that sound a loud alarm if a fall occurs.

In addition to nursing care, it is important to make sure the facility can meet the needs of your loved one. For example, if there is a chronic illness such as heart disease, be sure to ask what experience the facility has with this particular illness. If there are other special medical needs, such as hard to find prescriptions, be sure to ask about these as well. Make sure the facility can meet ALL of your needs.

Physical Therapy at a Skilled Nursing Facility
Physical Therapy at a Skilled Nursing Facility | Source
How often do doctors or nurse practitioners visit?
How often do doctors or nurse practitioners visit? | Source

Costs and Insurance

At more than $200/day, cost is obviously a factor when selecting a skilled nursing facility. In most cases, insurance will pay some portion of the costs. It is important to check with your insurance company or MediCare to determine what portion is covered, and for what duration of time.

It is also important to get pre-approval from your insurance company before being admitted to a skilled nursing facility. The facility can assist with this process, and it should be done several days before anticipated admission.

Most insurance companies have a duration of time or a maximum dollar amount that they will pay for a skilled nursing facility. Be sure to ask what happens when the end is reached. Also, insurance companies often ask for updates on progress. Be sure to ask what happens if the patient plateaus and no further progress is made. Does the insurance continue to pay?

In addition to the daily cost and the insurance coverage, you will want to find out what products and services are not covered in the daily rate. Usually, most medical necessities and therapy services are covered, but ask to confirm. Services such as laundry and meals are also generally included, as well as activities such as games and movies for the residents. Some items are not included, such as services at a salon and some extracurricular activities. Make sure you know what exactly is covered before you make a commitment.

What is the most important factor in choosing a skilled nursing facility?

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Personal Items

Residents usually live at a skilled nursing facility for a duration of time, from a few days for rehabilitation to several years for nursing care. Because they stay for some time, it is important to make sure they can have some of the comforts of home. Ask how mail and packages are handled, as well as any special dietary requirements. Also, make sure you understand the restrictions on visitors, including time and age restrictions, and how visitors get in or out of the facility. Also, ask what to do with valuables and money, and how the resident's clothing and personal items are handled.

Tips for Touring a Facility

Checklist for Touring a Facility

Before you select a skilled nursing facility, be sure to take a tour of the building. In fact, you may want to take more than one tour to see how the facility operates at different times of day. For example, the facility may be very different at night than during the day, or on weekends (when some of the management staff may not be around) versus weekdays.

When you tour a facility, do not make an appointment. Scheduled tours mean the staff has an opportunity to get ready for you. You want to see the facility as they are every day.

Below is a checklist of things to look for on your tour:

  • Is the facility clean? How does it look and smell?
  • How large are the rooms? Do residents have private rooms?
  • What are the nurses doing? Are they helping residents? Standing around talking?
  • What are the attitudes of the staff? Do they look happy or frustrated?
  • Listen to how the staff treat each other and how they treat the residents. Look for respect.
  • How quickly do staff respond to residents' call lights? Are they attentive?

Whether short or long term, a skilled nursing facility can provide excellent care for an individual's specific needs. Investigate thoroughly and you will find the right facility for your loved one.

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    • Marcy Goodfleisch profile image

      Marcy Goodfleisch 5 years ago from Planet Earth

      Such great tips here - nursing facilities are important choices, and the right choice can literally be worth life and death. Thanks for publishing this! Voted up and up!

    • Amy Gillie profile image
      Author

      Amy Gillie 5 years ago from Indiana

      Thanks Nettlemere! I wish there had been a comprehensive list when I was looking.

    • Nettlemere profile image

      Nettlemere 5 years ago from Burnley, Lancashire, UK

      Very useful advice especially when it comes from your experience being so recent Amy. I do hope your mum recuperates steadily. Very interesting comment from Peg too.

    • Amy Gillie profile image
      Author

      Amy Gillie 5 years ago from Indiana

      Peg - I'm so glad to hear that your Aunt Helen found a place that suited her needs. It's very tough, especially when you are choosing for someone who can't choose on their own. Thanks for reading!

    • PegCole17 profile image

      Peg Cole 5 years ago from Dallas, Texas

      You've identified some of the most important issues when choosing a Skilled Nursing Facility. Although no one really wants to end up in one of these places, it happens. I saw a major difference between facilities when my Aunt Helen reached her nineties and had to move into an SNF.

      At the first facility, the immediate reaction would be a response to the smell. There were residents half clothed wandering the halls lost and confused. The staff moved Helen from one room to another during her stay, failing to take many of her personal belongings to her new room. It was a disaster. She responded by assuming a fetal position and refusing to open her eyes.

      After a few more temporary places much like this one, she was moved to a nicer place where she began to respond with her eyes open, kissing our hands when we would visit. I knew immediately that despite being unable to verbalize, she was well aware of the difference in the level of care, the responsiveness of the staff and the cleanliness of the place. This is where she spent her remaining days.