Skilled Nursing Facilities

For Sophisticated Medical Care

Nursing facilities are the most medically sophisticated longterm care option, offering continual nursing care for residents. For many people, nursing facilities are also the most familiar option. It’s a myth, however, that everyone eventually lives in one; only about 5% of people over 65 currently do. For those older people who need the specialized medical care of a nursing facility, studies show that moving into one is a positive step for both health and wellbeing.

Nursing facilities offer the residential components of other longterm care options: a clean room,healthy food, pleasant atmosphere, and personal care services such as help with bathing, dressing and eating. But what sets SNFs apart is the onsite medical staff that provides nursing care 24 hours a day, as well as daytime access to variety of other medical professionals–such as respiratory,speech, and physical therapists. Many SNFs also have a dietician, activity director, and social worker on staff.

The Resident Community

For anyone recovering from an acute illness or injury, coping with severe disorientation or immobility, or needing frequent injections, catheterizations, or other medical care, a skilled nursing facility is likely to be the best choice. If an older adult doesn’t need the specialized care of a nursing facility, you’ll probably want to look for less medically oriented alternatives. The trend now is to move people from SNFs into more independent, cost-effective care options. It’s estimated that as many as 20% of nursing facility residents could live comfortably in a less institutionalized setting, such as congregate housing or assisted living facilities. Typical residents are women in their 80s who are coping with a chronic illness or disability but who don’t need acute hospital care.

The Unique Services of a Skilled Nursing Facility

Most residents share a double or triple room, although some single rooms may be available. While nursing facility designs vary greatly from a hospital-like to hotel-like atmosphere, most provide basic furnishings for each room. Some allow residents to bring in a few pieces of their own furniture to personalize their rooms, with the understanding that few SNF rooms have lockable doors. Staff is available 24 hours a day to help with personal care such as bathing, dressing, and eating. Nursing care is provided by registered nurses (RNs), licensed practical nurses (LPNs), and nurses’ aides, trained in the specific needs of older people.

Nearly all skilled nursing facilities have an activity director to plan a variety of recreational and social programs, both for small groups and personalized for individuals. SNFs also have a dietitian to plan healthy meals and snacks as well as any medically advised diets, and a social worker to help residents adjust to life in a nursing home and facilitate communication among residents, their families, and the staff.

In these settings, a home atmosphere is as crucial as the nursing component, since all activities–meals, bathing, socializing, recreation–take place within one facility. While personalized, one-on-one care is provided, keep in mind that a nursing facility is an institution, and that your parent’s quality of life is highly affected by the choice of a friendly, attentive one.

What Do Nursing Facilities Offer?

While each skilled nursing facility is somewhat unique in the range of services it provides, allSNFs can outline for you what’s covered in their basic fee and what services are provided for an additional fee.

Usually included in the standard day rate:

• a clean, furnished room
• housekeeping and linen service
• meals and snacks, including medically advised diets
• an emergency call system in each room
• trained nursing staff available 24 hours a day to perform IVs, catheterizations, injections, and other medical care
• trained staff to help with bathing, dressing, eating, and other daily activities
• professional services of an activity director, dietician, and a social worker

Usually provided for an extra charge:

• services of a physician who regularly reviews residents’ care and is on-call for emergencies
• licensed respiratory, speech, occupational, and physical therapists
• medications
• personal care items (combs, razors, tissue)
• personal laundry
• incontinence supplies

Philosophy

Nursing facilities are designed to offer trained nursing care 24 hours a day, and to provide for the medical, residential, and social needs of men and women with a number of different medical conditions. The nursing staff provide direct patient care at any hour of the day, in as homelike a setting as possible, while honoring each patient’s dignity and individuality.

Admission into a nursing facility is based, in part, on an exam by a physician to certify your parent’s medical condition. Many residents are admitted after being discharged on relatively short notice from a hospital, following illness or an injury such as a hip fracture, and may not have much time to plan or prepare. Upon admission, your parent is likely to find a flurry of paperwork to sign, including a resident contract and forms that outline his or her wishes regarding resuscitation in case of medical emergency. Your parent will be assigned a physician from those available to the facility for ongoing medical review, since many primary care MDs don’t typically follow their patients’ care in nursing facilities.

You may find a variety of skilled nursing facilities available in your community. Non-profit nursing facilities, typically owned and operated by religious or charitable groups, tend to put operating profits back into the facility as physical, program, and staffing improvements. For-profit nursing facilities, typically owned and operated by an individual, hotel, or hospitality corporation,try to stay current with market needs and improve their services at competitive prices. All SNFs are bound by the same licensing and regulation requirements.

The Cost of Nursing Facility Care

Most nursing facilities charge a basic fee of $150 to $400 a day–which can mean up to $146,000 a year, with the average cost about $72,000 a year–amounts that can rapidly drain a family’s savings. The basic fee may not cover everything; add-on costs are common for medications, services of a facility-assigned physician, treatment by physical and other therapists, and personal care supplies.

About 20 to 30 percent of residents are private-pay patients (they pay with personal assets).Medicare and Medicaid contribute toward other residents’ care. But be forewarned: Medicare pays for skilled nursing facilities only if the resident meets strict criteria, and then only for a limited number of days. Medicaid pays only when a resident’s personal assets are below strict criteria. For residents who enter as private-pay patients and continue to need SNF care after personal funds are depleted, Medicaid will typically pay for the minimum daily rate but not for any add-on services or luxury items.

Medicare and Medicaid Certification

To be certified by Medicare or Medicaid, a facility has to meet their additional, stringent regulations. Those facilities that are Medicare- or Medicaid-certified have beds available for residents who’ll pay with these funds, but beds are typically allocated on a first-come, first-served basis. Medicare beds, in some regions, can be hard to find.

Licensing

All skilled nursing facilities are licensed federally and by their state once they meet required regulations for the quality of care they provide and for the residence itself (such as fire protection,housekeeping, and building maintenance). Be sure that any nursing facility you consider is licensed. If you have the luxury of time to choose among facilities, you can ask to read their last licensing surveys, which are available to the public and outline any weak areas in quality of care.Back to: What’s New? on our Guided Tour.

 

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