What is a skilled nursing facility? How does my father get into one?

74.What is a skilled nursing facility? How
does my father get into one?

Unlike nursing homes, short-term rehabilitation
in an SNF (skill nursing facility) is a stepping stone,
a structured setting of care to help patients go home.

Skilled nursing facilities (or SNFs) are often confused
with nursing homes, both by patients and their families.
SNFs provide a higher level of shorter-term care
that aims at having patients return home or to a family
member’s home. Nursing homes, on the other hand,
provide primarily long-term, custodial care for patients
who can no longer live elsewhere on their own.

Although many SNFs began as nursing homes, or
have units in them that provide long-term care, they
also house rehabilitation units where patients can stay
temporarily to receive physical and occupational therapy
until they have regained a level of functioning that
allows them to go home. Unlike nursing homes, shortterm
rehabilitation in an SNF is a stepping stone, a
structured setting of care to help patients go home.

Once you’ve begun the process of considering having
your father go to an SNF for short-term rehabilitation,
the hospital discharge planner should be able to provide
you and your father with a list of local facilities.

The discharge planner at the hospital will probably
have brochures or even videos on hand to provide you
with some background about these places. If you or
your father is interested about the type of care provided
at an SNF, you can contact the admission office of any
facility you are considering and arrange a tour.

Your father doesn’t necessarily have to go to an SNF in
the town where he lives. If it’s more convenient, he can
go to a facility closer to you in order to make it easier for
you or other family members to visit him, provided there
aren’t any restrictions based upon his insurance. If you
know of any facilities from previous experience or have
friends who can make recommendations about places, so
much the better. Try to identify about five facilities as
potential placements for your father, as your first choice
may be full or won’t accept your father because they can’t
meet his medical needs. Consult with the hospital discharge
planner so that he or she can put in the necessary
paperwork for application to these facilities.
If your father participates in a managed care plan (see
Part 7 for insurance information), remember that these
care facilities may have to be in-network to be covered
by insurance. Most SNFs accept Medicare, but Medicare
will cover only the first 20 days of a stay at an SNF.
After that, there is a co-payment ($133.50 per day for
the year 2009) for days 21 through 100, after which
patients are financially responsible for the costs of their
stay. For this reason, some facilities require some kind of
financial review as part of the application, in case the
patient stays at the SNF longer than anticipated.
Once your father is medically cleared and ready for
transfer to an SNF, hopefully you will have already visited
your five choices and decided upon your preferences.

Sometimes, though, your first choice for placement does
not have a bed available, even though they’ve medically
accepted the patient. If you’re comfortable going with a
second choice facility that does have a bed ready, fine;
keep in mind also that it’s always possible to transfer
later to another facility if the care provided is not adequate.

If there are facilities willing and able to accept
your father, but you or your father insists on one in particular,
his health insurer may inform you that it will no
longer pay for his current hospitalization while waiting
for a bed at your first choice SNF. Things don’t often
reach this impasse as long as you’ve been working in
conjunction with the medical team and discharge planner
and have made a good faith effort to look at
options and consider alternatives.

Another obstacle that can arise is when the SNFs
refuse to accept a patient on medical grounds, either
because the patient is too high-functioning to require
rehabilitation in a facility or has other nursing care
needs that the facility is unable to provide. In the latter
case, you need to go back to the discharge planner to
find other facilities capable of providing the specialized
care your father needs. If, on the other hand, your
father is now getting out of bed independently, walking
without assistance, and meeting other goals, SNF
placement may, in fact, not be needed, and going home
may be the appropriate plan.