SKILLED NURSING FACILITIES

Skilled nursing facilities, commonly referred to as nursing homes, provide the highest level of care for older adults outside of a hospital, including assistance in both daily living activities and medical care. They are comprehensively regulated medical facilities.

A licensed physician supervises each resident’s care, and a nurse or other medical professional is almost always on the premises. Other medical professionals available may include licensed practical and vocational nurses, occupational and physical therapists, speech-language pathologists, and audiologists.

This type of facility is the best choice if you need:

• Both medical and professional care at a level above what can be handled at home or in another type of facility, perhaps due to recent hospitalization or progressive worsening of a chronic illness
• A temporary higher level of care after hospitalization with the expectation that the resident will be able to return home or to another type of facility after a period of time

Skilled Nursing Services Offered

Services offered by skilled nursing facilities include:

• Assessment and evaluations
• Catheter care/change
• Diabetic care
• Infusion therapies
• Lab draws/injections/IV therapies
• Medication management and administration
• Orthopedic care
• Pulmonary care
• Pre- and post-operative care
• Skilled nursing assessment with monitoring vitals
• Tube feeding, G-tube care, and teaching the patient or ultimate caregiver how to manage this once the patient leaves the facility
• Wound care/dressing change
• Wound VAC (vacuum assisted closure) competent care

Skilled Nursing Facilities Are Regulated by Law

Every aspect of the nursing home resident relationship, from admission to discharge, is regulated by law. The Nursing Home Reform Act requires nursing homes to provide certain services and establishes a set of standards for these services. Required services include:

• Access to nursing, social, and rehabilitation services
• Access to dietary and pharmaceutical services
• Periodic assessment of each resident
• A comprehensive care plan developed specially for each resident
• Access to a full-time social worker if the facility has more than 120 beds

Additionally, the following aspects of nursing home operation are covered by regulation:

• Admission, discharge, and transfer of patients
• Clinical records
• Physician services
• Rehabilitative services
• Dental services
• Podiatry services

Resident’s Bill of Rights

The Nursing Home Reform Act also sets forth a Residents’ Bill of Rights. Be aware that while working to satisfy their requirements, nursing homes do not all deliver the same quality of care. A resident has a long list of rights, but needs a patient advocate to protect and enforce those rights to good care. A patient advocate must be authorized in writing by a designation or healthcare power of attorney.

You should visit any facility you are considering and observe how residents are treated. Find out the care philosophy of the facility. Visit at least twice. One visit should be either on the weekend or in the evening when staffing is lower. Take a checklist with you. Visit the www.Medicare.gov “nursing home compare” section and review the annual state inspection report. If you are unable to do an on-site investigation, you can hire a Geriatric Care Manager to help.

Exercise Extreme Care in Signing Any Documents

Be careful what you sign. An admission agreement is an enforceable contract. Some states allow a “responsible party” to sign the contract for the patient without incurring personal financial liability. Some contracts, however, have language buried in paragraphs imposing legal obligations on the signor.

While the law in your state may forbid the requiring of a personal guarantee of payment, the law may allow a person to guarantee payment. A person who signs a contract, even as power of attorney (“POA”) Agent for another, is presumed to have read and understood what they signed.

It is best to have an elder law attorney review the contract before signing.

Other Names for Skilled Nursing Facilities

Skilled nursing facilities are also known as:

• Convalescent Care
• Nursing Center
• Nursing Home
• Long-term Care Facility