Caring for a Lifetime
Some of the most difficult decisions we face in life center on the care of the loved ones as they enter their later years. We struggle and anguish over taking those who have loved and cared for us from our childhood out of their lifelong homes, and moving them to a home that symbolizes more their illness than their life. But if we carefully research, we will find a home graced with caregivers who understand these struggles, and recognize that each and every resident in their trust represents a lifetime of love and a generation of experiences.
What is a Skilled Nursing Facility?
A skilled nursing facility is normally the highest level of care for older adults outside of a hospital. Skilled nursing facility provides what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing, and dressing. However, skilled nursing facilities differ from other senior housing facilities in that they also provide a high level of medical care. A licensed physician supervises each patient’s care and a nurse or other medical professional is always on the premises. Skilled nursing care is available on site, 24 hours a day. Other medical professionals such as occupational or physical therapists are also available. This allows the delivery of medical procedures and therapies on site that would not be possible in other housing.
When to consider skilled nursing facility?
- the required period of care is longer than acute care facilities provide
- alternatives to institutional care are not sufficient for proper medical care
- 24-hour licensed/registered nursing care is medically necessary and/or
- short-term or long-term rehabilitative services for injured, disabled or ill persons are needed.
- continue the recovery process
- provide hospice services for the terminally ill
- facilitate rehabilitation or
- maintain nursing care for a chronic set of medical needs.
Financial Guidance for the stay at Skilled Nursing Facility
Medicare will cover skilled care only if all of the following conditions are met:
1. You have Medicare Part A (Hospital Insurance) and have days left in your benefit period to use.
2. You have a qualifying hospital stay. This means an inpatient hospital stay of three consecutive days or more, not including the day you leave the hospital. You must enter the SNF within a short time (generally 30 days) of leaving the hospital and require skilled services related to your hospital stay. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don?t need another three-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start receiving skilled care again within 30 days.
3. Your doctor has decided that you need daily skilled care. It must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you are in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week.
4. You get these skilled services in a SNF that has been certified by Medicare.
5. You need these skilled services for a medical condition that:
- Was treated during a qualifying 3-day hospital stay, or
- Started while you were receiving Medicare-covered SNF care. For example, you are in the SNF because you had a stroke, and you develop an infection that requires I.V. antibiotics.
You pay the amounts below for each benefit period in 2011 following at least a 3-day covered hospital stay:
Days 1 - 20: $0 for each day.
Days 21 - 100: co-pay. please check with your nursing home
Days over 101: You pay 100%.
A benefit period begins the day you enter a hospital or skilled nursing facility. The benefit period ends when you have nott received any hospital care (or skilled care in a SNF) for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.
While you are in the Medicare-certified part of the facility, your therapy services (physical therapy, occupational therapy, and speech-language pathology) must be billed by the facility. No other therapy service may be billed by another setting, such as an outpatient hospital. If you leave the Medicare-certified part of the facility, your therapy services in the non-Medicare-certified part of the facility are limited by a specific dollar amount each year unless you get the services from an outpatient hospital.
For more information, you may call 1-800-MEDICARE (1-800-633-4227).
What to look for in the nursing home facility:
Cleanliness. Does the facility appear clean? Do you smell urine or strong deodorizers that may be covering up the smell of urine?
Food. What kinds of meals are normally served? Does it look nutritious and appetizing? How are special diets handled? What kind of help is available with meals, and do they have to be eaten at the same time or in a common area?
Arrangement. Traditionally, nursing homes have been run like a medical facility, including a centralized nursing station and set medication and mealtimes. Some nursing homes are now moving to a different model, with smaller communities and communal areas. If this type is available in your area, it may provide a more homely feel.
Activities. What quality of life activities are available for residents? Are outside activities also arranged, health permitting?
Experience with your condition. If a loved one has Alzheimer’s, for example, is there a special care unit or specialized staff and activities? How does staff handle behavioral problems like agitation or wandering?
A nursing facility is required to maintain interdisciplinary staffing at several levels including
- licensed nursing facility administrator
- physician medical directors as well as directors of nursing services
- nurses trained to provide skilled nursing care and
- social workers and activities director
They are also required to staff or have as consultants :
- a pharmacist
- therapists that may include physical, occupational and speech therapists
- food service personnel including a dietary supervisor (minimally a consulting dietician) and
- an interdisciplinary assessment and assurance committee.
History of Skilled Nursing Care
Nursing homes were started by a physician in France in 1881. They created little impact in the U.S. until the early 1900s when the Nurses Act of 1919 stipulated new licensing parameters for nurses. America's nursing associations expanded these licensing boundaries by detailing the capabilities level--the education necessary plus the responsibility and accountability that came with it--for carrying out a physician's orders over an extended period of time.
With the advancements in the professional recognition of nurses' capabilities, the door was opened to the development of places specific to around-the-clock nursing care and day-to-day medical care for the ill and disabled. Nurses could now take care of their patients under the orders of--but not constantly watchful eye of--a physician.
Building on this beginning, the National League for Nursing introduced the accreditation of nurses' educational programs. It was this growth of the professional credentialing of the nursing profession and the early findings of geriatric physician specialists and other medical professionals that came together to form the foundation for what we know today as nursing facilities.
Tips for loved ones
Keep in regular contact. Even if you live far away, frequent calls, letters, and emails make a big difference. Regular visits by family and friends help ease the transition. Keep your loved one in the loop about family events as much as possible.
Stay involved. Regular contact not only reassures your loved one, but allows you to serve as an advocate for your loved one’s needs. Even if you’ve chosen the finest facility, you want to make sure your loved one’s care continues to be of the highest standard, so visit at irregular hours to make spot checks, and get to know the staff. The more engaged they feel you are, the more attentive they are likely to be towards your loved one. If the nursing home has a family council, a group of relatives and friends who meet on a regular basis to discuss concerns and issues, consider joining.