A Closer Look: Skilled Nursing Care

Skilled nursing care offers care for people who require nursing services on a 24-hour basis. At one time, nursing home services bore the bad reputation of long term care. Due to poor practices at certain homes, many ugly truths unearthed about substandard care and resident abuses. However, due to increasing federal regulation and pressure from the competing assisted living industry, nursing homes have turned a corner. Nursing homes are reinventing themselves, eliminating the institutional environment and implementing unique practices, and in doing so, vastly improving the quality of life for their residents. This is good news because nursing services provide a key component in the continuum of healthcare of our seniors. The nursing, medical and support staff who provide care can attend to pretty much any level of need. For people who do not need hospital care but are not yet able to go home, specialized nursing and rehabilitation found in these settings can provide a safe transitional stay. For people who need 24 hour nursing care on a long-term basis, skilled nursing care can be a welcomed, nurturing environment.

As with any senior care home, quality of care and services are best evaluated firsthand. Be sure to ask direct questions about the types of services you or your loved one require. Conduct some background checking with state regulatory agencies and voluntary accreditation boards. Be familiar with who owns or manages the nursing home and the medical and nursing staff. In this type of setting, residents have a high level of dependence on staff. Family and/or the responsible party involvement is important to resident success and happiness every step of the way.

To take a closer look at Skilled Nursing care, choose a category below:

Services
Accommodations
Staff
Building/Environment
Security
Cost
Checklist
More Information

Services:
Skilled nursing services can be classified as either post-acute care or long term care.

‘Post-acute’ care requires a previous hospital stay to qualify for Medicare-covered skilled nursing services in a Medicare-licensed facility. A physician would write an order for skilled nursing services based on certain patient care requirements. ‘Patient’ is used here because the services are provided on a temporary basis and for medical needs. Medicare would cover skilled nursing services for 100 days. For those first 20 days, Medicare would pay for 100% of all covered charges. On days 21 through 100, Medicare would cover skilled care at a certain rate, and the patient would be responsible for the remainder of all charges, also called the coinsurance portion. Supplemental insurance or Medicaid could also pay the coinsurance amount. Medicare rates change annually. For an update on Medicare coinsurance rates and other information for Medicare beneficiaries, go to the Medicare website.

Skilled nursing services can typically include personal care (bathing, dressing, incontinent care), meals, medications, physical/occupational/speech therapy, and nursing services for medication administration, intravenous care, feeding tubes, catheter care, or wound care. The skilled nursing facility’s care plan team creates a care plan. The care plan demonstrates the skilled needs of the patient by which patient progress is measured. The patient must make gains within the areas of skilled need in order for Medicare to continue covering the stay. The staff of the skilled nursing unit will work with the hospital to determine the patient’s need for skilled nursing services.

Long term care in a skilled nursing home provides for the ‘custodial’ needs of the resident. Custodial services are those that provide for the basic personal care needs of the resident. These may include personal care (dressing, bathing, incontinent care), meals, medication administration, room & board, and assistance with mobility. The nursing home should also have an activity program and social service staff to assist with the social aspects of the residents. Housekeeping, laundry and maintenance are also provided. Transportation and any services beyond those listed may require additional expenses. Long term care is not covered by Medicare. However, the resident may still have a feeding tube or wound care or rehabilitation that may be covered under Medicare Part B. To find out more about Medicare Part B services, go to the Medicare website.

Accommodations:
Nursing care can offer private or semi-private accommodations. Typically, a room will be furnished with a chair, bedside table, dresser and mechanical bed similar to that found in a hospital. You may be encouraged to bring things in from the home, but nursing homes usually provide bedding and towels that are changed and washed regularly. Meals are provided in a common dining room unless the resident prefers or needs meals in their rooms. There are common rooms for socialization and group activities.

If a nursing home provides Medicare or Medicaid services, they designate specific beds for those patients qualifying for each service. The home may not accept patients over the number of beds designated for that coverage. For example, if a home has 12 Medicare-licensed beds, they can only have 12 Medicare residents at a time. Therefore, it is helpful to ask if any beds are available when looking for a Medicare or Medicaid licensed facility.

Staff:
Because of the higher level of care required by most nursing home residents, staff members are licensed professionals who register with the state to provide their specialized services. They must undergo annual training to maintain their license and the nursing facility’s license.

Staff members can include:
-registered or licensed vocational nurses (RNs or LVNs) who provide nursing services;
-certified nurse aides (CNAs) who provide personal care;
-dietary staff who oversee nutritional services;
-housekeeping staff
-building maintenance
-medical director, who oversees all clinical needs and requirements and medical staff; and
-administrative staff, who run the operational aspects from day to day.

Other people who provide or oversee care may include physical therapists, occupational therapists and speech therapists, nutritionists, and pharmacists. They may only operate, however, on a contractual basis to ensure that patient needs are met.

Building/ Physical Environment:
A nursing home can be housed in a single or multilevel building that can accommodate disabilities and improve resident safety. The building should have wide doorways and halls, access ramps, and elevators for those residents using wheelchairs or walkers. Bathrooms should have safety grab bars in the shower and by the toilet. Fire exits, interior fire sprinklers, and fire-rated doors should be found throughout the building. Rooms in a skilled nursing facility are situated around a nurses’ station. Residents can call for help through a pull cord by the bedside in rooms and by the toilet in bathrooms. Again, nursing facilities are reinventing their image to appeal to contemporary demands in style and function. While they must be able to maintain an environment that sustains the scuffs of heavy equipment and constant use, they incorporate elements to also maintain a homey, non-institutional feel.

Security:
Nursing homes are busy places. Family members, friends, vendors, contract services, volunteers and staff are constantly coming in and going out to provide 24 hour care. There is usually a main entry or reception area where guests and residents sign in and out. The entry may be locked after business hours and require staff members to allow visitors entry. Cameras may monitor the common areas, although residents may request an electronic monitoring device for their room to provide additional surveillance. For more information on electronic monitoring devices in Texas, download the form on the Texas DADS website.

Cost:
$120 (shared room) to over $230 (private room) a day. If eligible, Medicaid may cover nursing care on a long-term basis, and Medicare may cover temporary skilled nursing care after a hospital stay.

Checklists:

Does your loved one require Skilled Nursing care?
- Identifying immediate and long-term needs and gettting recommedations through a primary healthcare provider can help determine if skilled nursing care is the right solution.
- Find a healthcare provider in your area
Do you know your choice of providers available in your desired area?
- Providers can be classified by your preferences to narrow your choices. Identify what's important to you and your loved one.
- Search for skilled nursing care providers in your area
- View your state's department of aging website for inspection records on licensed skilled nursing facilities. View Texas' Department of Aging Website.
- Need personal assistance? Contact the experts at www.seniorsperfectsolution.com for a customized list of providers.
- Top 10 ways to pay for senior care
Have you visited the communities you are interested in?
- Taking a personal tour gives you a sense of the environment, staff and residents so you know whether it's a fit.
- Top 10 touring tips to make the most of your personal tour.
Are you ready for move-in day?
- Get all your facts in line to avoid feeling overwhelmed when the day arrives.
- Top 10 must-haves for move-in
What can you do to ease the transition of move-in?
- The first few weeks after move-in determine the resident's happiness with their new home.
- Top 10 ideas about easing the transition into senior housing
What can you do to make the stay a success?
- It takes a team approach to caregiving
- Top 10 people to know in your skilled nursing facility

Learn more:
A Perfect Solution...Senior Care Locators
Monitoring Devices: Request in the state of Texas





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