While we often think of a nursing home as a long-term residence, most of today’s nursing facilities also provide short-term stays for patients leaving hospitals after a health crisis or after surgery. Sometimes called a nursing home or a rehabilitation center, a skilled nursing facility (SNF) provides 24-hour skilled nursing care, and supportive related services to people who need care on a long-term basis. The typical resident is a person who is chronically ill or recuperating from an illness (such as a stroke) and needs regular nursing care and other health related services. Often hospitals discharge their patients to SNF for a temporary period of rehabilitative care (such as after a knee or hip replacement). Care is provided under the direction of a physician, and includes skilled nursing, dietary services, pharmaceutical services, and an activity program.
Other services provided in SNFs can include:
- Social services
- Dental care
- Emphasis on rehabilitation (physical, occupational, and speech therapy), such as gait training, and bowel and bladder training
- Specialized units for persons with dementia
- Medication administration including injectable and intravenous medications
In California nursing homes are licensed and regulated by various state and federal public and private agencies. The California Department of Public Health makes sure the facility meets state laws and regulations. The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services provide the regulations for facilities which accept Medicare and Medi-Cal payments. Approximately 68% of beds in SNFs are occupied by Medi-Cal beneficiaries. Some California nursing homes choose to become members of a private national accrediting organization called the Joint Commission. Facilities in California have the choice to become Medi-Cal certified.
As compared to assisted living residences, skilled nursing facilities provide higher levels of medical care. Even the smallest skilled nursing facilities are required to have at least one registered nurse or licensed vocational nurse awake and on duty during the day and night. The state also requires a minimum of 3+ nursing hours per person. So, it should not be surprising that skilled nursing facilities often have residents with higher levels of disability. According to some research, over half of skilled nursing residents use a wheelchair, have urinary incontinence, and some type of dementia diagnosis.
Sometimes a loved one needs long-term care and not rehabilitative care. Signs that a loved one may need long term care include greater dependence on caregivers to help with bathing, toileting, dressing, and eating. Other families make the decision when a chronic disease progresses in to the middle or later stages. Sometimes there is increasing need for supervision which is difficult for families to provide, due to fear of falling or other safety issues (such as wandering), or incontinence.
There are many questions to ask potential facilities. In addition to finding out about payment options and how the staff manage care, other questions to think about asking are:
- What kinds of patients do you have here? Find out if they have patients who have similar health conditions such as your loved one.
- What activities do you offer?
- What is the food like? Do the residents have food choices?
- Find out what they do to prevent falling.
- What do staffing ratios look like?
- One of the most important things to do, is talk to a couple of direct care staff and find out how long they have been with the facility. If too many have only been there for a short while, that may indicate staffing inconsistency.
- Use your nose and eyes- what does the facility smell like, what does the food smell like, do the residents and staff look happy? Do people say ‘hello’ to you?
The Centers for Medicare and Medicaid rate skilled nursing facilities. You can find the ratings for facilities in Fresno here.