<p>My mom just had a hip replacement this week…and I need to select a facility for her 2-week rehab stay. She has many health issues (she’s between chemo sessions, has dementia, and anxiety disorder). Her HMO sent us a list of 12 places, and I plan to check out a few tomorrow. </p>
<p>What should I look for? Ask? Considerations? I need to make a quick choice.</p>
<p>Here’s a pretty good resource from Medicare - [Medicare.gov</a> - Nursing Home Overview](<a href=“http://www.medicare.gov/nursing/overview.asp]Medicare.gov”>http://www.medicare.gov/nursing/overview.asp)</p>
<p>Make sure you tour the facilities and look for some of the more obvious things like cleanliness, in good repair, staffing level, activity, etc. Also ask around to your friends in the area since they may have experience with particular facilities for themselves or their relatives and might steer you away form or towards a particular place.</p>
<p>Usually in a situation like your mom’s the hospital discharge people will find a place and if you talk to them you can try to get a sense of which ones are the better ones depending on who the discharge person is and how open they are in this area.</p>
<p>Also, it can be helpful to try to get one that’s convenient to you if you live in the general area so you can stop in and visit frequently. Visiting is probably one of the best things you can do to ensure good care since you can keep up with what’s going on and the staff know someone’s checking on them frequently and may be more likely to do a better job as a result.</p>
<p>Sorry to hear about your mom. I am going through this exact same thing. My elderly dad is being released in the next day or day. I have found the medicare site a good place to start. It lets you compare various facilities. Once you have a sense of which facilities have ranked higher, you can go visit them. Good luck. This is not fun.</p>
<p>[Medicare.gov</a> - Nursing Home Compare](<a href=“Medicare.gov”>Medicare.gov)</p>
<p>So sorry about your mom. </p>
<p>I always tell people to first check with your NOSE. If you go to see the facility and you don’t like the smell, turn and leave.</p>
<p>Find out what is the local “Area Agency on Aging” for your mom’s area. (That’s a federal term, but your mom’s local senior center should easily be able to tell you that contact for her community/city/county.)</p>
<p>Each Area Agency on Aging has a Long Term Care Ombudsman that is available to you. You should be able to easily see deficiency reports for each of the nursing homes/rehabilitation centers in the area, and they may have other information as well. </p>
<p>One other suggestion: Do not allow your mom to be moved from the hospital to any nursing home until there is confirmation that the nursing home has – ON HAND – the specific drugs/dosages your mom requires. The hospital attempted to discharge my MIL to a nursing home on a Friday afternoon, and while many of the drugs she was on were available through the Long Term Care pharmacy they used, not all were. She spent a miserable night without her needed migraine medication because of this problem even though we had been assured that it would be “no problem” for her to have all her medications. If she’s on a cancer regimen I’d make doubly sure that everything is available. I had already stopped my MIL’s hospital discharge once (because they FAILED to contact us before trying to discharge her, which violated Medicare’s discharge planning rules) but then we were blindsided by the medication problem. </p>
<p>Good luck – and hang in there.</p>
<p>That is superb advice, arabrab!</p>
<p>My mom’s gone to 4 or 5 different skilled nursing places on discharges from the hospital and I’m pleased that all of them have been okay places and fairly comparable. These were all places the hospital arranged with me selecting the last one but the discharge person checking on it and doing the arrangements. </p>
<p>If you haven’t talked to a discharge ‘case worker’ person at the hospital yet then either they should contact you before the discharge or you can ask for them now and discuss this with them and see what the plans are and what the suggestions are. The ones I’ve dealt with have been pretty good. You shouldn’t be on your own for this.</p>
<p>Arabrab’s points are good in making sure the discharge person is aware of your mother’s needs with respect to the cancer treatment as well as the dementia. Sometimes hospitals are focused on the particular procedure and may be viewing your mom as a ‘hip’ when she needs to make sure the SNF place can adequately handle these other needs as well.</p>
<p>I had to spend some weeks in a rehab that was attached to a longterm skilled nursing home, following a back surgery. The discharging hospital was open to our suggestions, as long as a bed was available there right then. </p>
<p>We asked and got our 2nd choice, the one which, by reputation, had the best/most professional/equipped physical therapy department, since we wanted the speediest and most effective recovery while possible under their watch. True to rep, that was the strong part of the facility. Our lst choice rehab had a Warm Pool for aqua-rehab, and also great rep for Physical Therapy, but sadly had no open beds right then.</p>
<p>Unfortunately (and jym is so right about using one’s nose) the room I slept in for 2 weeks smelled intensely of urine, from the rugs. Perhaps this is because of its double use as a nursing home, I do not know. This began to really disgust and hurt my sense of well-being to breathe that in so constantly from bed. Evidently, nobody else noticed it, not even my H, as others enter and exit a room. It was a cumulative thing. Unlike me, I was simply too weak to protest and request a different room. When I finally did mention it quietly to the pastor, he just hung his head and said, “I’m sorry” which actually made me feel better. By then I was just a day from exit, so left it alone. I did mention it in my written evaluation later as the only problem, but a significant one. </p>
<p>Something I found very favorable was a policy in their kitchen that allowed for great flexibility/substitutions, as long as the dietition approved. For example, while the facility only served white bread, they let my H bring in a big hearty loaf of whole wheat. They kept it back in the kitchen with my name, and just sliced it for me with each meal. Similarly, they stashed my favorite (healthier) jam and applesauce jars, and a good box of my favorite cereal. They’d serve me from those boxes/jars, although most of the meal was hospital-issue of course. Perhaps you can ask how that works at each kitchen, if you think your Mom would notice or brighten to have a familiar brand of some favorite staple foods. I don’t know how unusual this is. This was for when I was well enough to wheel into the common dining room, so basically after around 4 days of tray-eating.</p>
<p>The actual surgeon who did the hip replacement might have some experience-based opinions about which of the area rehabs does well for a hip rehab. Our surgeon sure had strong opinions, couched professionally but we figured it out. Can you phone that office and get the surgeon’s suggestion? If you hear, “they’re all good” you can try pressing, “if this was your mother, where would you send her?”</p>
<p>But since you also mention dementia, anxiety disorders and the chemo inbetween time, I’m wondering if a rehab that is attached to a skilled longterm nursing home might actually be helpful, providing it passes the smell test. Do you feel that she might do better to live for the 2 weeks among other longterm care patients of a dementia unit (with nursing keyed into that) and wheeled from there into the physical therapy work? It depends perhaps on how advanced you understand her dementia/anxiety to be. Everyone’s a little bit loopy after major surgery for awhile, so nurses and aides expect some disorientation/worries normally. BUt if you know she might get extremely frightened or always has very advanced needs for dementia, that’s a bigger concern so might weigh more heavily than “just a hip.” as a poster above said.</p>
<p>…and if your mom is in the throes of chemo and has had a hip replacement, the facility needs to especially careful about her lowered immune status and potential infections. Be aware of any early symptoms and speak up.</p>
<p>All the above suggestions are great.</p>
<p>I want to share my experiences from my mom. My mom had Parkinson’s and dementia and did fall and broke her hip at the age of 84. In addition, she has movement problems before the fall. Her surgen strongly suggested a hip replacement, but after discussed the situation with doctors in my family who know her conditions for a long time, we decided not to perform a hip replacement surgery and opt to secure her broken hip with screws. </p>
<p>Now with the rehab. Medicare will only pay for a multi-tenant quard room in a rehab center. You do have a choice from few, but none of them is ideal. We choose the one closest(walking distance) to her home. The noise in the room is high and the rehab center is understaffed. We hired extra private help to take care of mom 9~9, even that, lots of problems resulted from the staying:</p>
<ol>
<li>PT comes once or twice a day… not nearly enough</li>
<li>Because her laying in the bed most of the time, OT could not observe her normal drinking habits, as a result, her Dysphagia was never diagnosed.</li>
<li>Laying in the the bed for long time causes her ski breakdown and because the understaff, they did not change her diper often enough and causes diper rashes. Our private help did not want to interfer the Rehab Center’s operation, so the problems were not discovered until after her returning home.</li>
</ol>
<p>Just a quick note to say thanks! The link someone posted last night</p>
<p>Medicare.gov - Nursing Home Compare</p>
<p>was perfect for narrowing down my visits this morning (and smell test complete!). My mom will be moved on Saturday to what appears to be a decent nursing home (the local rehab hospital can’t meet her non-hip needs adequately). Tomorrow I will check out whether her meds will be available at the chosen facility–thanks for that tip.</p>
<p>Gotta love CC. Where else can one get this type of speedy advice!</p>
<p>ps. the surgeon did recommend a facility where he had an affiliation…but we went with another that can meet her holistic needs better, and the chemo therapy has been placed on hold (or ended) unless she becomes well enough to continue that fight.</p>
<p>Sorry for being so late chiming in, but just returned from getting my mom settled in at a new skilled nursing facility, that also has assisted living, where she will move once she reaches that status. She was previously in an assisted living only facility, but with two trips to the hospital, followed by skilled nursing, in less than a year, we finally had to move her.</p>
<p>One thing I do want you to be sure to talk to the administration is about what happens on Day 21. Medicare only covers Day 1 through 20 at 100 percent. Unless you have a Medicare Supplement that covers skilled nursing care, many facilities will move you because you’re no longer covered. You will pay a copay of about 145/day after Day 20, but for some reason, some facilities don’t even want to bother with that.</p>
<p>My first experience last year with the SNF was that at Day 20, when they found out she didn’t have coverage, they deemed her well enough to go back to assisted living. </p>
<p>With this illness, she not only was in long term acute care, but had already been in skilled nursing for almost 20 days, when it was clear she was nowhere near assisted living status. I don’t know why this facility treated us different than the other, perhaps because we told them we want her to stay there permanently, but she has a place to stay, whether we’re paying for it or Medicare is paying for it.</p>
<p>When interviewing places last month for her to move from long term acute care to skilled nurse, I was honestly told by one facility that at Day 20, she would be out. I thanked the staff member for their honesty, and my family hoped that she would be accepted at the facility where she is now, and thank goodness, she was.</p>
<p>Last year, in interviewing SNFs, we found a wonderful, glamorous, clean facility, that had plenty of beds available. However, they would not take my mom. We don’t know whether it was because of her obesity, her mental meds, what the reason was. We were lucky to get into the facility that was associated with the hospital she was in, the doctor she was treating with there, but it wound up being a nightmare for our family. It was two hours away, they did not do her laundry, and although she got excellent rehab care, it was not a good choice since I live out of town, and my brother, who was local, was not able to keep up with things like laundry. </p>
<p>I’m sharing this not to seem selfish, but to educate you on how at this time, your primary focus is getting your mom the best care. And indeed, that is what you should be looking for. But, unless you plan to be there every day and take care of her dirty clothes, you have to think of the practical, logistical things. </p>
<p>And another warning: Even though you will be told, she’ll only be there for a few days, you can count on her being there at least 20 days. Medicare pays 100 percent for 20 days, and you can bet the facility is going to get as much reimbursement as they can.</p>
<p>Good luck with your search and I hope your mom has a speedy and uneventful recovery.</p>
<p>
I’m not sure it’s even legal for the SNF to operate that way. </p>
<p>Medicare covers up through day 20 at 100% and days 21 through 100 at a reduced rate that requires the $145 co-pay like you indicated. The number of days they’re permitted to stay and be paid by Medicare is strictly regulated according to Medicare guidelines - i.e. they don’t have a right to be there the full 100 days or even the 20 days if it’s deemed that the reason they’re in the SNF to begin with is something the SNF can no longer help with. For example, if someone was admitted for rehab purposes and it’s deemed at day 15 (or 32 or 58, etc.) that they’re no longer making reasonable progress then they’ll be done with it.</p>
<p>Whenever the SNF says they’ll no longer be covered there under Medicare the patient has a right to appeal the decision if they disagree with the conclusion of the SNF.</p>
<p>After day 100 then the person is on their own for paying for it even if they still have issues. The ones I’ve experienced seem to permit people to stay there longer term but it’s very expensive. If one has Long Term Care it usually can be used to cover part of the cost.</p>
<p>Montegut - if you ever run into this kicking out at day 20 issue again you might want to contact Medicare and discuss it with them because it doesn’t sound legal for them to do this to me (but maybe I’m wrong on this). Of course, the other point is that if the SNF couldn’t be bothered to go past day 20 even though they get paid just as much, especially regardless of the resident’s condition, that’s probably a facility to avoid.</p>
<p>I guess collection is the main concern of SNF operators. Once it reaches co-pay state, they do not like to be bothered with collection and may patients do not have assets to pay for it and creates problems.</p>
<p>I was observing at the SNF my mom was at, it is scary how they treat the patients. Not sure if other SNFs are the same, but I would NOT want to be in the facility even you pay me.</p>
<p>btw, we have supplemental insurance for snf co-pay coverage up to 100 days. But we were told to discharge her after 15 days. So, not every SNF will milk that 20 days or beyond.</p>
<p>
I don’t think anyone enjoys being in an SNF any more than they enjoy being in a hospital but there are times it’s the best choice for the person. </p>
<p>It sounds as if you’ve had some bad experiences at an SNF but really, after having experiences at a number of them, they’ve been what I’ve expected and have done their job. If you have a need for a family member to use an SNF again make sure you investigate other ones since they’re not all horrible.</p>
<p>It was her supplemental HMO care coordinator that provided the list of covered facilities so we are good for a longer stay if needed. </p>
<p>Laundry! I didn’t even think of that …will pack LOTS of my mom’s comfy clothes so I can wash them every 5 days or so.</p>
<p>^^ The rehab centers have their own clothings, don’t worry about it until she is ready to be discharged.</p>
<p>My mom’s first SNF stay was mostly a mobility issue. Although she did mostly stay in the hospital gowns, she did have to wear a top and pants every day for therapy. Last year, she just wore the same outfit every day, then back into the hospital gown when she was done.</p>
<p>This year, mom is also going to physical therapy in tops and pants, but she is also eating dinner with the other residents in a dining room, so wears her dresses there. She unfortunately is always in a diaper now, as she is a long way from transferring from bed to wheelchair to get to the bathroom on her own. She’s having some incontinence issues as well and has soiled herself many times, so the laundry issue was a concern.</p>
<p>We were told, like art said, that clothing wouldn’t be a concern, but in reality, it was. Just passing this on to you, so you’re prepared.</p>
<p>Wishing the OP lots of luck. It is a learning process, and one that I’m sure will continue on.</p>
<p>As to SNF coverage, please, please, anyone out there with an elderly relative, make sure they have SNF full coverage to Day 100. It will make your life a lot easier. I applied with my Mom’s Medicare supplement for a higher plan and was denied, mainly because she had a recent hospital stay. So, before you are faced with your parent/spouse having this situation, apply and get coverage while they’re healthy!</p>