Saturday, March 22, 2014

Contingencies Part 2 - Picking a SNF

Good morning and welcome. Laura here to continue yesterday's blog on contingency planning. I discussed how a fiduciary can benefit but not many people do advance planing in the event they need skilled nursing or caregiver services. Today we'll discuss what to look for in a skilled nursing facility (SNF).

You may ask, "Why should I worry about finding a SNF now?  I will probably never need one."

And my hope is that you are right--that you will never need to be in a SNF. But, in case you do need that service, what are some of the reasons that you might suddenly find yourself in a SNF?
  • You have a hip or knee replacement and need recovery and rehab support. 
  • You have surgery and need a higher level of support for a few days or more post-op.
  • You develop a urinary tract infection (UTI), become very weak, and are not steady enough at home until you recover and get your strength back.
  • You have been experiencing a lot of falls and, at least for now, are not safe living at home until you have physical therapy and get stronger. 
  • You have fallen and broken a hip or shoulder and need 24-hour care until you recover.
These are just a few examples but all are realistic.  Some of the issues that cause an admittance to the hospital or SNF are avoidable with a little vigilance and perhaps caregiver support if the older adult is in a weakened state.  The priority is to do whatever is needed to prevent hospitalizations and falls. This frequently involves family members monitoring their loved one's status and calling the doc or getting a caregiver in place as a preventive measure.  (Future blogs will include guest inputs from the medical community).

When admittance to a SNF becomes necessary it is good to have that advance planing in place. So, how do you select the best SNF for you.  There are many options so how do you choose?  The first thing I recommend is to create a list of what is important to you.  I gave a presentation this past Friday to a group of women from the AAUW and we were discussing some of the local facilities. For one of facilities I mentioned that the services were great but the food was not.  One of the women immediately chimed in that this facility would therefore not be an option for her. While everyone laughed at the comment, it was an important criteria to consider. Here are some of the items I think are important:
  • Food! Yes, I agree that quality of food is important.  You need to eat to regain strength and you want the quality of food to be healthy as well as tasty. 
  • Physical therapy department.  What is the PT department like, do they have adequate equipment and trained staff, what is their PT schedule? Do they have staff that will take you for extra walks outside of PT visits?
  • Response times.  What is their response time policy vs their actual documented response times? When you are ringing the buzzer for bathroom assistance you want to know they will respond within 3-5 minutes. As we al know, when nature calls she isn't always patient!
  • Smells. What does a facility smell like?  Does it smell fresh and clean or is there a smell of urine, chemicals, or mustiness?
  • People parking. When you walk down the halls, are people parked in wheelchairs in the hallway or are they engaged in activities?  An activities program isn't offered at all facilities but I feel it is important to engage someone socially and cognitively throughout recovery. 
  • Animal therapy. Is there an animal therapy program or 'Love on a Leash' visits?
  • Attractiveness and cleanliness. What does the facility look like?  Is it a place you don't mind being in?  No one wants to be in a SNF but, when it is a necessity, it should be a facility that you at least consider tolerable.
So, where do you start?  My recommendation is it start on the Medicare website. You can do a search of all SNFs in your area and see the ratings based on various criteria such as PT, quality of service, and quality of the facility. A good facility can make all thee difference.

A quick example and I'll close out for the day. A few years ago we had a client on MEDICAL come to us because she needed help writing checks to pay her bills and going shopping.  While she had her own apartment, she had been living for the prior 18 months in a SNF and she wanted to go home; but she had not been receiving any PT or OT at the facility that would allow her to get stronger and leave. I took her to visit a few other local facilities and she chose a nice quality facility with a good PT program. Within a few months she was able to go home and lived in her apartment until she passed.  She was 87 when I met her and she lived into her 90s.

That's it for today.  A bit of a lengthy discussion but hopefully valuable. Tomorrow I'll discuss in-home caregiver services, how to structure what you need, and, of course, brag about AltaGolden (that is, after all, my job!). 

Ta Ta for now (TTFN). Visit me at or call any time for assistance at 858-779-9254.  Have a wonderful, joyous day and be well!