My 79-year-old dad has been in the hospital and now the discharge planner is talking about sending him to an SNF. What is an SNF? How will this be paid for? How do I know if he will receive good quality of care?
— N.S., Concord
Dear N.S.: I’m glad you’re asking. Sometimes medical personnel toss around jargon without explanation, making it hard for families to make informed decisions. An SNF (usually pronounced sniff, so read it that way in your mind through the rest of this article) is a skilled nursing facility, or what you probably refer to as a nursing home or rehab center.
SNFs vary wildly, so it is extremely important to understand what your dad needs and what each facility offers. In many ways, your dad’s successful recovery is dependent on the care he will receive during this period of healing. We’re seeing more and more that hospitals are discharging patients earlier, which means that often families must rely on a SNF to help their loved one through to complete recovery.
All SNFs are state-licensed and inspected by the health department. They are places for people who no longer need hospital care but are not well enough to be independent at home. This can include a rehabilitation stay after surgery or illness, and may require the services of licensed professionals such as medical providers, physical therapists, speech therapists and occupational therapists to help patients get back on their feet. In addition, patients receive assistance with activities of daily living, personal hygiene, dental care, nutrition and mental health.
Hospital discharge planners usually have a list of SNFs to which they refer patients, and managed health care plans have contracts with certain centers. However, before your dad is transferred, it’s important that you review nursing home ratings and any consumer complaints. Nursing Home Compare (www.tinyurl.com/SNF-compare) provides valuable information such as quality of care and staffing at each nursing home you may be considering. California Advocates for Nursing Home Reform (www.canhr.org) also has important information about nursing homes.
The next step is visiting nursing homes you are considering and meeting with the chief administrator and the nursing director. It’s also important to observe how the residents look and interactions between staff and residents. This will give you a feel for the kind of care your dad will be receiving.
You also need to understand what will and won’t be covered by Medicare. Medicare covers stays in SNFs for patients who have spent three nights in the hospital, are admitted within 30 days of hospitalization, and require skilled nursing services from licensed nurses and therapists. If your dad was not admitted to the hospital, but was in the emergency area for “observational care,” he will not be eligible for Medicare coverage even if he needs skilled nursing care. In this case, he will have to pay out of pocket.
If your dad’s care falls under the Medicare benefit, then it will cover a maximum of 100 days per benefit period. Only the first 20 days are covered 100 percent by Medicare; starting at day 21, Medicare coverage drops to 80 percent of the cost. Your dad will then be responsible for the co-pay, which may be covered by a Medigap policy if he has one.
In any case, your dad has guaranteed rights while in a SNF. These include dignity, respect and freedom from any abuse or neglect; the right to privacy; and the right to participate in decision-making about his care plan. The facility is obligated to provide each resident with a care plan within 14 days of admission.
You, your dad and his geriatric care manager (if you have one) should be part of this multi-disciplinary meeting. The care plan will be an invaluable tool to address your dad’s individual needs and preferences. The care plan should address the goals of care, the activities to achieve those goals and the plan for your dad’s eventual discharge home.
Also, your dad’s SNF should make every reasonable effort to accommodate his personal needs and preferences; in general, care should be resident-centered. For example, he should not have to get up at a set time or be showered only at certain times. Having a healthy sense of expectation that he will receive high-quality care is essential.
A nursing home is paid thousands of dollars monthly for each resident, and they are obligated by law to provide individualized care. If something is not right, bring it to the staff’s attention as soon as possible. And showing appreciation to the hard-working staff is also important. The stronger the relationship is between your family and the staff, the more your dad is likely to get the attention and quality of care he needs.
If you see a significant breach of conduct or care at the SNF, a good source of advocacy assistance is the long-term care ombudsman program that exists in each state. The office is funded by the state and provides free advocacy for every SNF patient if needed. A list of ombudsman offices in California is available at www.tinyurl.com/ca-ombudsman.
Though SNFs are highly regulated and must provide certain standards of care, there can be variance in quality, which leads some families to determine that their loved one requires additional support during the facility stay. In these cases, families hire a home care agency to provide one-on-one care, often temporarily overseen by a care manager. This personal attention can help ensure that your dad is hydrated properly and receives the social engagement that he needs. This may prevent complications and result in quicker healing. Busy and often short-staffed, the nursing staff can only do so much, but we have seen a lack of close care result in dehydration, bedsores, and falls.
A stay in a SNF can provide just the right amount of rehabilitation your dad needs to transition safely back home. However, it’s important to understand his rights and to monitor the quality of care to give everyone peace of mind and the interventions needed for healing.
Rita Clancy, LCSW, is director of adult services at Jewish Family & Community Services East Bay. Her columns appear regularly in J.’s Seniors sections. Have questions about your aging parents? Email email@example.com or call (510) 558-7800, ext. 257.