So now what do you do? You’ve tried letting dad live by himself but he ended up with bedbugs so bad that you had to throw out most of his furniture. Then he moved into an assisted living facility; that worked for a while because he loved all the activities and he blossomed under the attention from the staff and other residents. You were happy he received three nutritional meals every day and that he was taking his medications timely.
But the other day he stumbled over his foot stool, took a fall, and broke his hip. He was rushed to the hospital where they did surgery; now they are recommending that he receive therapy for up to six weeks. Where should he get therapy? What’s involved? Who do you turn to for help?
Most often a nursing and rehab center will be recommended. For those of you who don’t know… that is a nursing home. Most nursing homes offer rehabilitation services in addition to skilled nursing care. Now before you wince and say that you will NEVEREVER put your father into a nursing home let me point out a couple of items:
First, In order to participate in Medicare and Medicaid programs, nursing homes must meet certain requirements set by Congress; every year there are more and more guidelines imposed by the federal government. Nursing homes are surveyed by their state Department of Human Services on an annual basis to insure that each facility meet those requirements.
These surveys cover everything from…
…licensure, making sure all employees, outside contractors, and vendors have all the required, up-to-date certifications and all necessary background checks have been processed…
…fire safety – surveys the physical building and environment to be sure everything meets Life Safety Code (LSC ) standards set by the National Fire Protection Agency (NFPA) – generators, elevators, electrical, plumbing, sprinkler systems, etc…
…to health surveys, where the inspectors go on rounds with staff, monitor medication passes, review charts. They interview residents and family members, as well as staff and the physicians to be sure the facility is treating each resident correctly. Surveyors have even been known to call a corporate office to request supporting documentation.
Surveys can last anywhere from a day and a half to five days or even longer depending on what conditions are found. Surveyors will show up unexpectedly even at 1 o’clock in the morning.
Second, Medicare has a website called Nursing Home Compare that contains information on every Medicare and Medicaid certified nursing home in the country.
“The nursing homes that are shown on Nursing Home Compare provide a level of care called “skilled” care. Skilled care is care given when you need skilled nursing or rehabilitation staff to manage, observe, or evaluate your care. Examples of skilled care include intravenous (IV) injections and physical therapy.”
“Nursing Home Compare includes information on:
5-star quality ratings of overall and individual star performance on health inspections, quality measures, and hours of care provided per resident by staff performing nursing care tasks.
Health and fire-safety inspections with detailed and summary information about deficiencies found during the 3 most recent comprehensive inspections (conducted annually) and the last 3 years of complaint investigations.
Nursing home staffing information about the number of registered nurses, licensed practical or vocational nurses, physical therapists and nursing assistants in each nursing home.
A set of quality measures that describe the quality of care in nursing homes including % of residents with pressure sore, % of residents with urinary incontinence and more.
Penalties against a nursing home. Penalties may be imposed on a nursing home when a serious deficiency is cited or if the nursing home fails to correct a deficiency for a long period of time.” (www.medicare.gov/nursinghomecompare)
The 5-star rating is relatively new to the industry. Nursing homes with more stars have the better rating.
“How the 5-star rating is calculated:
The overall 5 star rating is based on 3 parts: 1) Health inspections 2) Quality Measures (QMs) and 3) Staffing. Star ratings are given for each part and the overall rating range from 1 star to 5 stars, with more stars indicating better quality.
Health inspections rating: Health inspection ratings are based on the 3 most recent comprehensive (annual) inspections, and inspections due to complaints in the last 3 years. We place more emphasis on recent inspections.
Quality Measures (QM) rating: The values on eleven QMs (a subset of the 18 QMs listed on Nursing Home Compare) are combined to create the QM rating. QMs are derived from clinical data reported by the nursing home.
Staffing rating: The staffing rating is based on 2 measures: 1) Registered Nurse (RN) hours per resident per day; and 2) total staffing hours per resident per day. Total staffing includes: RNs; Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs); and Certified Nurse Aids (CNAs). Staffing data are submitted by the facility and are adjusted for the needs of the nursing home residents. The more residents a nursing home has the higher their staffing ratio should be.” (www.medicare.gov/nursinghomecompare)
There are some truly wonderful facilities out there with caring staff. So when the doctor recommends rehab, don’t sweat it! The discharge planner / social worker at the hospital will walk you through what to do. They have several nursing homes on speed dial and can help you place your father into a facility that is right for you.
To learn more about choosing the right nursing home for you, check out the CMS guide to choosing a nursing home or the Nursing Home checklist.