When you need it. How you get it. What it involves.
A stay in Skilled Nursing often comes after a stay in the hospital for our aging parents. It can bring a lot of confusion with it. How you get it, where you go, who is eligible and more.
Jamie Smithson has worked in the senior care industry for more than ten years and knows all of the ins and outs of skilled nursing, rehab, assisted living and more. She says falls, strokes and heart problems are the most common reasons our aging parents find themselves in skilled nursing.
She talks with Kim and Mike Barnes of Parenting Aging Parents about selecting a skilled nursing facility and how to work with the staff so our parents have the best possible outcome.
Read the full transcript
Transcript of Interview: “Skilled Nursing 101”
Mike Barnes:
Yeah, I think for so many of us, when our aging parents run into a certain problem, they need some help, and it’s more than just independent living or even assisted living. That’s when skilled nursing really comes into play.
Kim Barnes:
And it can be confusing to know all the different types of care. So, we brought in Jamie Smithson. She has been in the healthcare industry and senior care specifically for more than 10 years in the Austin area. Thank you so much for being with us because I think there is a lot of confusion when it comes to skilled nursing.
Jamie Smithson:
Absolutely. If you don’t live it and go through it, it’s hard to really know what you’re looking at and what you’re facing.
Mike Barnes:
Let’s start with the basics. Where might your aging parent need skilled nursing?
Jamie Smithson:
So, skilled nursing provides two types of care. They do short-term rehab, so if your parent fell or had an infection of some type and ended up in the hospital, typically it’s a three-midnight stay that would activate the skilled nursing benefit. Then, a physician would make a referral saying they need to go to skilled nursing for short-term rehab. The average length of stay in skilled nursing for short-term rehab is about three weeks, but with traditional Medicare benefits, you have up to 100 days of therapy available. Most people do not use that 100 days unless they’ve had a severe stroke or a really traumatic event. That’s the short-term rehab element.
There’s also long-term care. Sometimes after someone goes to rehab and isn’t able to care for themselves, they need that nursing 24/7 with CNAs and nurse practitioners there to see them. Long-term care can be for people who don’t make it out of rehab or if the family is concerned and thinks they need to be in a place that’s not at home and get more care.
Mike Barnes:
I think one of the confusions is that there are so many different types of care. If someone says, “Mom’s not doing very well; I think we need skilled nursing to come into the home and take care of her,” that’s not really skilled nursing, correct?
Jamie Smithson:
Correct. You can have a skilled need which can trigger home health benefits, but a skilled nursing facility (SNF) or “sniff” is an actual facility where you go and stay for short-term rehab or long-term care. They’re set up like a wagon wheel with a big nurse’s station in the middle and hallways that feed off of it like spokes on a wheel. Facilities will have their long-term care hallways or their short-term rehab hallways, and where you stay depends on what you’re there for.
Kim Barnes:
How do you choose a skilled nursing facility?
Jamie Smithson:
For short-term rehab, location is key. You want to pick one that’s close so you can really advocate for your loved one and keep track of their progress. If your loved one had a stroke and has swallowing issues, when you tour, ask to speak to their speech therapist while you’re there. Pick based on location and the primary rehab need. If it’s a nursing need like wound care, call and ask to speak to the DON (Director of Nursing) or the wound care nurse. You want to have a connection with them because for that short period, they will be integral in your life and your loved one’s care.
Mike Barnes:
I think for so many of us, we have dollar signs in our eyes thinking about the cost. My dad lives in independent living, my mom in memory care. If anything happens where they need to go to skilled nursing, does it compound the cost because they’re still paying for their room, hoping they can go back there? How do we afford that?
Jamie Smithson:
For short-term rehab, that is covered by insurance, primarily Medicare, with the 100 days we mentioned. Skilled nursing facilities also accept Medicare replacement plans and traditional insurance for those still working. For long-term care, primarily Medicaid funds that, for those who qualify financially and physically. It’s much harder to qualify for Medicaid in a skilled nursing setting because it’s more expensive. Government funding primarily pays for skilled nursing facilities, and it’s the second-heaviest regulated industry because of that.
Kim Barnes:
What’s the best way to actually find skilled nursing facilities? Will the hospital give recommendations, or do you find a senior care advisor?
Jamie Smithson:
In the hospital, you’re often given a list. Some hospitals have shortened that list to their preferred providers. Social workers and discharge planners will talk to you about it. They might recommend options they know, but they’re on a time crunch. Pick one close to you because there might be a good one around the corner not on the list. In denser populated areas, there are plenty to choose from, so look at a few, not too many to avoid analysis paralysis. Call ahead, tell them about your loved one’s situation, and speak to the staff like the speech therapist or nurse.
Mike Barnes:
What questions should we ask when choosing a facility?
Jamie Smithson:
Feel is important; don’t dismiss it. All facilities are highly regulated and do similar things. Some have more nurse practitioner coverage. Skilled nursing is the lowest level of care because of the physician oversight. Check if they have 24-hour RN coverage—some only have LVN coverage. You can look at the Medicare.gov website, which has a star system rating from zero to five stars based on annual surveys. Use the star system, your feel, and the professionals you speak to while touring.
Kim Barnes:
Once your parent gets there, how can you work with the staff to get the best outcome?
Jamie Smithson:
Therapy usually happens five days a week, rarely on weekends. Communication is key. Send an email with things that make your mom tick to the administrator, director of nursing, and social worker. Emails are time-stamped and keep multiple eyes on the issue. If something’s wrong, let them know so they can fix it. Also, mark and label clothing, don’t bring too many items, and avoid bringing things of significant value.
Mike Barnes:
If the doctor says mom needs to go to skilled nursing for three weeks, but it’s been two weeks and there’s no improvement, what should we do?
Jamie Smithson:
You’ll have care plan meetings to discuss progress. If there are concerns, express them then. Contact the nurse practitioner or director of nursing if needed. Be realistic about recovery, especially with elderly patients. Some may take longer to bounce back or may not recover fully.
Kim Barnes:
The goal is always to get them well or rehabbed to go back to their lives, right?
Jamie Smithson:
Yes, that’s the primary goal. Skilled nursing facilities celebrate success stories of patients returning home or to their previous lives. It’s important to investigate any issues before reacting, as there’s usually a logical explanation.
Mike Barnes:
Definitely a confusing subject, but you’ve sorted through a lot of answers. Thank you so much, Jamie.
Jamie Smithson:
So happy to help.
Kim Barnes:
There is a lot to know and be aware of. The key is to get a plan, speak up, and get to know the people in skilled nursing working with your parents.
Mike Barnes
Have patience because sometimes it takes a while. If you have any topics you’d like us to discuss, let us know at Parenting Aging Parents.
*This transcript is auto-generated. Please excuse any typos or mistakes
