As a whole we remain healthier longer and most of us will never need to reside in a skilled nursing facility. However, skilled nursing facilities provide short-term, subacute care and long-term skilled nursing care for those who need help attaining or maintaining their highest physical, social, and emotional well-being.

Choosing a skilled nursing facility is an emotionally challenging time in an individual's or family member's life. For most of us, as we grow older, we recognize the need to plan for the future but we often neglect to prepare for the possible need for skilled nursing. We would like to encourage you to spend a little time thinking about your wishes and preferences. When you make the plan, it’s your plan and not someone else’s.

Do I need a skilled nursing facility? Are there other options?

Skilled nursing facilities provide both short and long-term nursing and rehabilitative care. Individuals who require skilled nursing usually have difficulty completing daily activities independently such as taking medications, walking, completing grooming tasks like brushing their hair and teeth, taking a bath or shower, and using the toilet.

Skilled nursing facilities can be a place for someone who needs brief rehabilitation; it is no longer true that a skilled nursing facility placement is “forever.” Hospitals tend to discharge people sooner than they have in the past. Often a brief stay in a skilled nursing facility allows an individual to recuperate prior to returning to her/his previous lifestyle. Whether choosing a skilled nursing facility for a short-term or long-term stay, the first step is to have a physician evaluate your needs. The physician will determine the services you will need and make a recommendation for the length of your stay.

It is important to remember that skilled nursing facilities provide a high level of supervision and resident interaction. Some medical conditions require this intense type of monitoring. However, not all medical conditions require this skilled level of care. Some individuals can benefit from less stringent monitoring and assistance. Options for this type of care can vary widely including personal care homes, assisted living, boarding homes, and continuous care retirement communities (commonly referred to as CCRC’s).

Selecting a Skilled nursing facility

It is often best to research as many skilled nursing facilities as possible prior to making your selection. By going to the Pennsylvania Department of Health web site you can print an alphabetical list of all the skilled nursing facilities in the area that you select.

It is important to determine whether the skilled nursing facility accepts insurance coverage, Medicare, Medical Assistance, or is private pay. It is important to consider whether a skilled nursing facility will be able to continue providing service if you run out of financial resources necessary for private pay placements. You may wish to discuss this with a financial advisor familiar with long-term care issues.

Consider whether the skilled nursing facility offers services in-house such as physical and occupational therapies, counseling, activities and recreation, pharmacy, podiatry, specialized medicine, etc. Research which hospitals are nearby and with whom the skilled nursing facility has transfer agreements. Again, it is important to ask what services will be covered by insurance and what is paid for privately. For instance, television cable services, hairdressing, and telephone service charges often vary widely.

Use a Checklist when Selecting a Skilled Nursing Facility.

It is time to visit the skilled nursing facilities that you are interested in. Most facilities have admissions workers who will be happy to schedule a tour for you. Be sure that you are also welcome to drop in after your tour to review your first impressions. It is often helpful to visit in early evening so that you can observe the care-giving activities on both daylight and evening shifts. Checklists are a recommended way of recording your observations when you visit a skilled nursing facility. The following are suggestions for items that you may wish to include on your checklist.

• Will you have to move to a different part of the facility based on your financial resources?
• Is there a waiting list?
• Does the facility have a license?
• Is there a licensed skilled nursing facility administrator?
• When you enter the skilled nursing facility, what is your first impression?
• Is it a warm and inviting environment?
• Is it odor free?
• Is the temperature comfortable?
• Is it clean?
• Is it quiet?
• Do staff and residents appear to interact with ease?
• Are there regular staff or does the facility depend on Agency or contracted employees?
• Are there special care units designed to meet specific resident needs such as Alzheimer’s/Dementia Units, Ventilator Units, etc.
• Is there sufficient staff on evenings and weekends?
• Are requests for assistance by residents/families responded to in a timely manner? For example, how long does it take staff to answer a call bell or light?
• Are care planning meetings held at times that are convenient for residents and family members? Are the meeting times flexible?
• Are meals attractive, nutritious, and varied?
• Does the facility have a dietary/nutrition specialist who monitors the menus?
• Is the facility able to provide specialized or therapeutic diets when necessary?
• Do residents routinely have input into the menu selections?
• Is cold food cold and hot food hot?
• Are dining rooms attractive and conducive to eating?
• Is assistance offered to residents as needed?
• Are fluids readily available to residents in the dining areas, common areas, and in their rooms?
• Are resident’s weights monitored regularly?
• Are snacks available at all times even when the kitchen is not open?
• Does the facility appear to be safe and hazard free?
• Are carts routinely stored in hallways/corridors where residents must walk?
• Is carpet or tile in good repair to prevent tripping hazards?
• Are walking areas well lit without shine or glare?
• Are there wander protection devices in areas where confused residents reside or visit?
• Are exits clearly marked and visible to residents and visitors?
• Are spills cleaned up quickly and thoroughly?
• Are handrails stable, clean and hazard free?
• Are handrails available everywhere that residents go without interruption?
• Do you notice any residents in physical restraints (devices that prevent the resident from moving freely) that seem inappropriate?
• Are there smoke detectors and fire escape plans?
• Are there regular fire drills?

All of the time you spend in the planning process will make moving to a skilled nursing facility a decision in which you feel confident.