One thing I have noticed during this experience is that facilities (whether they be a hospital or a rehab center) seem to think that 48 hours is enough to make a major decision. That is the amount of time they are required to give you to determine where you’d like your loved one to be transferred to next, once they are ready for discharge.
TRUST ME. IT’S NOT ENOUGH TIME. Be proactive. Start your research the minute your parent goes into the hospital or into rehab, NOT when they are about to be discharged.
Here is a list of things to keep in mind when looking for a rehab facility. Wish I’d had this list.
Questions you should be asking of the facility:
- What is the number of aides to patient ratio? Look for a 6:1 ratio or better. Anything fewer, your mom or dad will be waiting a long time to be helped to the bathroom. Remember, it’s not the number of nurses, or med tech’s you are looking at…it’s the number of direct service aides. These are the people who are on the front line for taking care of your mom or dad.
- This may be a silly question to have to ask of a nursing home, but trust me ASK IT. You’ll want to confirm that all the bathrooms in the rooms are handicapped accessible. I found out the hard way. The nursing home where my dad is does not have wall mounted handrails. They only have “handlebars” attached to the toilet. That is not sufficient for my dad’s needs. I never in a million years thought I’d find a nursing home without handicapped-accessible wall-mounted rails. I did. Lucky me.
- Will my parent have to share a room? Again, don’t assume he/she will have a private room. I did and found out that not all nursing homes have private rooms. If they have shared rooms available, that is what Medicare will cover. In our case, we have to pay $40 to upgrade to a private room. In the last two places he received skilled rehab, he had a private room, for which Medicare paid. I assumed (wrongly) that this place would be the same. The way it works is that if the facility ONLY offers private rooms, then Medicare will pay for the room. If the facility offers an option of a shared room, then they will only pay for a shared room. If it is important to you for your parent to have the privacy of a private room (it was for me), know that you may be charged a fee.
- Ask if there is a walking path or sidewalk outside the facility that is wheelchair friendly (if your parent is chair-bound) so you can get your mom or dad outside for fresh air. Again, I assumed there would be because the last place my dad was had many different outside areas I could walk him to get some Vitamin D and fresh air. This cannot be underestimated. When a person is confined to a nursing home, it can be a very dreary existence. Having the opportunity to get outside is liberating for both your parent and for you.
- If, your parent has had more than one hospitalization in recent months, make sure to get the hospital discharge papers from each facility and hand deliver them to the nursing home. It is the protocol for the referring hospital (meaning only the last one your parent was admitted to) to send over discharge papers. In the case of my dad, I found out THREE days into his stay at the rehab facility that they had NO IDEA that he had had hip replacement surgery 2 weeks prior. They thought the patient they were receiving was there after hospitalization for GI ulcer (the side effect to the blood thinners he was put on after his hip surgery). You can imagine the type of treatment he was receiving at the rehab center. They were asking him to do things that he physically could not do; they were roughly handling transfers from the chair to the bed, etc. It was only when I started complaining about the treatment, that it surfaced that they had a major whole in the information they were operating on.
- Don’t rely solely on the Medicare.gov site and their nursing home compare tool. And don’t rely on US News and World Report’s Best Nursing Homes issue. Look at those resources but also talk with local doctors who have patients in rehab facilities. The most important thing you want to ascertain is how good is the therapy your parent will receive. That single thing represents the direct correlation to shortened stays in skilled nursing. Remember, the hospital social worker is not allowed by law to endorse a particular facility, so although they will help you find out if there is a bed available and to get all the paperwork transferred, they are not a good source for where to send your parent.
And finally, visit your mom or dad often. It is a proven fact that residents whose family visit often get better treatment in these types of facilities. Visit at different times in the day. Speak up if you see your parent (or even another resident) not being attended to. At the end of the day, this is a very tough job these people do day after day. They want to do what is right but sometimes they are overwhelmed by the needs of the residents.
Thank them often.
And then thank them again.
It will make a difference in their lives and in your mom or dad’s life.