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re: How does one pick a skilled nursing/rehab facility for an elderly parent?
Posted on 6/25/25 at 8:54 pm to Slippy
Posted on 6/25/25 at 8:54 pm to Slippy
I work in a rehab hospital with a skilled nursing facility as well. It all depends on what the patient/family expectation is along with what can they actually do. A true rehab hospital has roughly 3 hrs a day of therapy 5 days a week (in general, sometimes more than that, but should not be less than that except for medical reasons). The typical length of stay on a Rehab unit is around 14 days, and the goal is to raise the patients level, meet goals, and have them ready to go home with home health or outpatient therapy. A skilled nursing facility can have patients stay from 20-100 days depending on insurance/need/progress. They typically get far less therapy than a rehab patient. Think 30 minutes at max 5 days a week at most. Therapy time includes if the therapist has to help the patient transfer to the chair to go to therapy, or if they help with anything else. If I were in your shoes, I would look at these questions to help decide:
1) what is the insurance? Medicare is the golden key, and allows for the MD to direct the care more effectively. On Rehab, you are given a projected discharge date based on the average length of stay of other Medicare patients with the same diagnosis. Managed Medicare follows the same guidelines in many cases for Rehab.
IF the patient is a skilled nursing patient, Medicare provides for 20 days of care covered completely, and starts to incur copays on day 21. The maximum amount of days a patient can stay in skilled nursing as a Medicare patient is 100 days. After day 20 you will start to incur a copay of Medicare, which varies but a good rule of thumb is about $200 a day, and facilities will want that upfront. You can dip in to "Lifetime Reserve Days" but you DON"T want to do that. IF it's a managed Medicare like Humana , UHC, WellCare, People's Health, they review records every 3-5 days and will decide if the patient still requires that level of care. They typically only approve 20-25 days. If the approve over 20 days, you still are responsible for the copay after day 20.
2) once you understand the financials, you need to decide where to go. You have to keep in mind, that your first, second, or third choice may decline due to being full, or patient needs, or even though it's not said, the payor source....if it's not a good payor, it's hard to get facilities to take patients.
3) overall , I would, working in this type of healthcare, show up unannounced for a tour. I would ask questions about nurse to patient ratios (nursing homes have high nurse to patient ratios like 1 nurse for 25 to 30 patients, same with nursing assistants). I would ask about if family could stay over. if private rooms that could be an option, if semi-private rooms it may not be. I would ask about the intensity of therapy/frequency.
4) use your senses. If you go and the place looks all great, but smells like pee and poo, that's not good.
1) what is the insurance? Medicare is the golden key, and allows for the MD to direct the care more effectively. On Rehab, you are given a projected discharge date based on the average length of stay of other Medicare patients with the same diagnosis. Managed Medicare follows the same guidelines in many cases for Rehab.
IF the patient is a skilled nursing patient, Medicare provides for 20 days of care covered completely, and starts to incur copays on day 21. The maximum amount of days a patient can stay in skilled nursing as a Medicare patient is 100 days. After day 20 you will start to incur a copay of Medicare, which varies but a good rule of thumb is about $200 a day, and facilities will want that upfront. You can dip in to "Lifetime Reserve Days" but you DON"T want to do that. IF it's a managed Medicare like Humana , UHC, WellCare, People's Health, they review records every 3-5 days and will decide if the patient still requires that level of care. They typically only approve 20-25 days. If the approve over 20 days, you still are responsible for the copay after day 20.
2) once you understand the financials, you need to decide where to go. You have to keep in mind, that your first, second, or third choice may decline due to being full, or patient needs, or even though it's not said, the payor source....if it's not a good payor, it's hard to get facilities to take patients.
3) overall , I would, working in this type of healthcare, show up unannounced for a tour. I would ask questions about nurse to patient ratios (nursing homes have high nurse to patient ratios like 1 nurse for 25 to 30 patients, same with nursing assistants). I would ask about if family could stay over. if private rooms that could be an option, if semi-private rooms it may not be. I would ask about the intensity of therapy/frequency.
4) use your senses. If you go and the place looks all great, but smells like pee and poo, that's not good.
1
Posted on 6/25/25 at 9:04 pm to MagZilla
Sorry, was long winded. If it looks great but smells bad, chances are care is bad. If it's is older/ not modern, but smells good, and in touring people look well cared for and happy, then it's a good facility. You can look on CMS compare for nursing homes/skilled nursing to get ratings from the state based off of surveys they conduct.
At the end of the day, know the insurance, question the nurse to patient ratio, trust your senses, have reasonable expectations ( if your loved one was bed bound before this event, don't expect that this stay will make them walk, that is unrealistic. If the patient was independent before the incident, know that them getting moderately independent is great progress and a realistic goal).
The biggest advice I can give after all of this, is to BE PRESENT. Families that visit frequently pick up on any issues and let it be known so it can be addressed. Your loved one needs to know you are there for them and not abandoning them (even though they are aware, being around reinforces that). I wish you tons of luck!
At the end of the day, know the insurance, question the nurse to patient ratio, trust your senses, have reasonable expectations ( if your loved one was bed bound before this event, don't expect that this stay will make them walk, that is unrealistic. If the patient was independent before the incident, know that them getting moderately independent is great progress and a realistic goal).
The biggest advice I can give after all of this, is to BE PRESENT. Families that visit frequently pick up on any issues and let it be known so it can be addressed. Your loved one needs to know you are there for them and not abandoning them (even though they are aware, being around reinforces that). I wish you tons of luck!
Posted on 6/25/25 at 9:32 pm to Slippy
When we were looking for an assisted living place for my mom last year, her doctor directed me to a company called Right Move. I think they only cover Georgia and Florida but you may be able to find something similar where you are.
The way it worked with them was they assigned us one of their people and built a profile of my mom (likes, dislikes, eating habits, socialization habits, etc.) They then put together a list of facilities within a specific distance of us and then arranged tours. The Right Move rep went on each tour and helped with questions, advice, etc.
It didn't cost us anything. Their business model is they get a finders fee from the facility after the resident has been there for a month.
The way it worked with them was they assigned us one of their people and built a profile of my mom (likes, dislikes, eating habits, socialization habits, etc.) They then put together a list of facilities within a specific distance of us and then arranged tours. The Right Move rep went on each tour and helped with questions, advice, etc.
It didn't cost us anything. Their business model is they get a finders fee from the facility after the resident has been there for a month.
Posted on 6/25/25 at 9:41 pm to Slippy
quote:
Word of mouth?
Word of mouth is always the best. Also make sure you really read the contract. Some places have in the contract that they basically get the estate once your love one passes. And you can’t just transfer everything to yourself first, it normally has to be done 4 or 5 years ahead of time.
If your parent can still get around then look into in home care. They have it so nursing care can come once a day, or two or three times a week, or whatever you want to pay for.
They also have adult sitters (normally retirees) that will stay at your loved ones home and helps with basic stuff. It ends up being much cheaper than you expect paying them like $15/hr to just hang at the house.
Posted on 6/25/25 at 10:14 pm to Lsukinesalum2001
Ok, thanks. Good to know. We tried to get my mom in there but that’s what we were told (I don’t remember who), but they were full anyway. Ended up at a SNF (Sage) near the Lake and once we got things handled with the conference, it worked out and the 2 or 3 weeks went well.
Posted on 6/25/25 at 10:30 pm to Slippy
I work at the Oaks of Louisiana off of Flournoy Lucas Rd. Its a retirement community that also has skilled nursing. I take care of the Campus and Grounds so am not actively involved in the day to day activities of the Skilled Nursing side. Before I worked there, I retired from the Bossier City Fire Dept, did 26 years there and I can attest that I have been in every nursing home in Bossier and they all smelled terrible, The Oaks is the cleanest Nursing Home I've ever been in, and ive been in a lot if them. Depending on the financial situation, they have a side for Medicare and Medicade patients and a self pay side. The self pay is relatively new and you get your own room. If at all possible and you can afford it, go there. If I had to put a relative in one, I wouldn't hesitate to send them there. Come by and check it out for yourself, the Campus is beautiful.
Posted on 6/25/25 at 10:34 pm to UptownJoeBrown
quote:
Have someone check on her every day. They know who comes to check every day.
We carefully chose a highly rated facility in BR area for my father (who was a WWII naval veteran) to stay in. Either myself or one of my siblings, or one of dad's grandkids always took time to go spend a couple of hours there each and every day. We wanted him to know how much his family loved him.
Soon it became apparent that some of the workers and the owner / supervisor (same person) resented us for visiting him daily.
Basically they moved us out as quickly as they could because we saw neglect due to laziness, and outright cruelty. The staff and management exaggerated problems with my dad and were constantly whining to us about him every day when one of us showed up for a visit.
We searched and found a fantastic facility on the second try. All the problems the first place had with him magically did not occur at the second facility. The entire staff was great and the love they showed him until he passed away was both refreshing and amazing. Many of the nurses and aids showed up for his funeral, and were very saddened by his passing.
My point is, be careful about your decision, and be involved at the facility after you make a decision where your parents should go. Some highly rated facilities turn out to be, in fact, terrible. Good places are out there, you just have to be vigilant.
Posted on 6/25/25 at 10:44 pm to dek81572
quote:
I work at the Oaks of Louisiana off of Flournoy Lucas Rd
Based on Dek’s post, I wouldn’t miss this one. Hell, he had me wanting to move there!
Posted on 6/25/25 at 11:21 pm to Slippy
Check with the insurance you will be using first, they will give you a list of ones you can use.
Take your time, I was in the same boat and picked the wrong one. We picked it based on being in a good area. We didn’t have time to research due to a broken hip.
Take your time, I was in the same boat and picked the wrong one. We picked it based on being in a good area. We didn’t have time to research due to a broken hip.
Posted on 6/25/25 at 11:32 pm to Slippy
quote:
How does one pick a skilled nursing/rehab facility
Just don't.
Posted on 6/25/25 at 11:35 pm to Slippy
quote:
Should have said I need a place in Shreveport.
My Grandmother was at Brookdale and it was good. Started in the regular portion and ended up in the Memory Care wing.
By the time she went in, at 95, something like The Oaks didn't make much sense for her.
Posted on 6/26/25 at 5:08 am to Slippy
Look closely at the BACKGROUND of images posted on the website.
Mom had to go for a month after a fall. Never alone in her life she had fits and tantrums to the point they were about to discharge her so I started looking at her alternatives.
The photos showed neglect, disrepair, and plain dirt. These were the “best “ photos the facility could offer and the background was bad.
Then visit the site and see how it smells.
Mom had to go for a month after a fall. Never alone in her life she had fits and tantrums to the point they were about to discharge her so I started looking at her alternatives.
The photos showed neglect, disrepair, and plain dirt. These were the “best “ photos the facility could offer and the background was bad.
Then visit the site and see how it smells.
Posted on 6/26/25 at 5:13 am to Slippy
Word of mouth, and visit them at various hours. If there is a lot of activity, that is good. If the old people are just sitting in the halls with no one around them, run away. If it's clean, smells decent most all the time, and there is a lot of activity, it should be okay.
Posted on 6/26/25 at 5:29 am to Slippy
This is a generalization but for simplicity’s sake, there are two types of patients in the nursing home, short term, which is a rehab & the patient coming from the hospital after a minimum of three days stay. Many of those patients return from where they came, their home, an assisted living facility or even a long-term stay in a nursing home. Then there are long-term patients who will be staying the rest of their life.
How do you pick? The first place you go is to this website, it is run by CMS (Feds) and it scores the Nursing Homes based on various metrics.
LINK
Keep in mind, even if it is a five star facility bad things can happen. Old people fall down, you could end up with a bad CNA on her or his first day.
Look at the staffing, look at the quality measures, long and short term. The facility could be good at one and suck at the other.
Look at Google reviews. Look at yelp. Look at Facebook reviews. Yes all can be worked, but how do they respond to the bad reviews?
I partially agree with the smell test, but the uninformed, you could walk past the room just after, or during an incontinent Resident is being changed. Does a facility only do short term patients? If so the smell factor should be much lower, but if they do short-term and long-term they could be very good at short term and they are dealing with the burden of long-term patients.
Look at the tenure of the director of nursing, the administrator and the director of rehab. Is the rehab done in house or are they using a 3rd party. I prefer house therapy. If the administrator gives a tour how did the CNA react to that person? Do they smile? Are they engaging?
Here’s something to pay attention to, what is the parent’s payer source? Coming from the hospital it will generally be, Medicare or Medicare advantage, a federal, but managed care product. Most facilities will kill for that. They are both the most profitable payers in the Nursing Home but if your parent is going long term what is the plan? Will the resident pay privately or be Medicaid? If the resident has even six months of Private pay funds almost all will accept. If the patient has to apply for Medicaid, then the facility will be worried. Start doing your homework on that right now.
The last thing I will focus on, who will be the primary caregiver, ie who will be visiting daily? His not as big a factor in a short term decision, but a big one if your parent is going long-term.
I hope that helps. I’ll say a prayer for your family.
How do you pick? The first place you go is to this website, it is run by CMS (Feds) and it scores the Nursing Homes based on various metrics.
LINK
Keep in mind, even if it is a five star facility bad things can happen. Old people fall down, you could end up with a bad CNA on her or his first day.
Look at the staffing, look at the quality measures, long and short term. The facility could be good at one and suck at the other.
Look at Google reviews. Look at yelp. Look at Facebook reviews. Yes all can be worked, but how do they respond to the bad reviews?
I partially agree with the smell test, but the uninformed, you could walk past the room just after, or during an incontinent Resident is being changed. Does a facility only do short term patients? If so the smell factor should be much lower, but if they do short-term and long-term they could be very good at short term and they are dealing with the burden of long-term patients.
Look at the tenure of the director of nursing, the administrator and the director of rehab. Is the rehab done in house or are they using a 3rd party. I prefer house therapy. If the administrator gives a tour how did the CNA react to that person? Do they smile? Are they engaging?
Here’s something to pay attention to, what is the parent’s payer source? Coming from the hospital it will generally be, Medicare or Medicare advantage, a federal, but managed care product. Most facilities will kill for that. They are both the most profitable payers in the Nursing Home but if your parent is going long term what is the plan? Will the resident pay privately or be Medicaid? If the resident has even six months of Private pay funds almost all will accept. If the patient has to apply for Medicaid, then the facility will be worried. Start doing your homework on that right now.
The last thing I will focus on, who will be the primary caregiver, ie who will be visiting daily? His not as big a factor in a short term decision, but a big one if your parent is going long-term.
I hope that helps. I’ll say a prayer for your family.
Posted on 6/26/25 at 6:30 am to Slippy
For both my grandparents who recently went through this, my parents chose a facility as close as possible to our houses. That means that between us, if they weren't being visited daily, they were being visited 6x a week.
Once you have your basic health and cleanliness standards, that seems like the most important factor. Somewhere you will actually go.
Once you have your basic health and cleanliness standards, that seems like the most important factor. Somewhere you will actually go.
Posted on 6/26/25 at 7:00 am to Slippy
Whatever one you choose(and do choose wisely) you must MUST advocate for your loved one.
- they must know you could show up at any time.
- bring good treats/snacks for the staff and on a regular basis.
- reinforce to your loved one that they will generally only get out of rehab what they put INTO it.
- Ask PT/OT there for exercises that your loved one can perform while in bed or chair and make sure they are performed regularly - may only get an hour if that a day in actual gym unless it’s an acute rehab.
- they must know you could show up at any time.
- bring good treats/snacks for the staff and on a regular basis.
- reinforce to your loved one that they will generally only get out of rehab what they put INTO it.
- Ask PT/OT there for exercises that your loved one can perform while in bed or chair and make sure they are performed regularly - may only get an hour if that a day in actual gym unless it’s an acute rehab.
This post was edited on 6/26/25 at 7:01 am
Posted on 6/26/25 at 7:23 am to Slippy
serious answer....
Take a personal tour, look around and observe staff. Ask around the community for their experiences.
Take a personal tour, look around and observe staff. Ask around the community for their experiences.
Posted on 6/26/25 at 7:29 am to Slippy
Depends on whatever your Medicare advantage plan will cover boomer
Posted on 6/26/25 at 7:36 am to Major Dutch Schaefer
Go visit places you are interested in sending your mom. After working for one and seeing several others in action my mom is at home with me. Thank you Lord.
Posted on 6/26/25 at 7:54 am to Slippy
Like many on here are saying, go visit several. Notice cleanliness and smell of course. Pay attention to the residents, how they are dressed, clothes clean etc. Notice grooming, as in hair and fingernails. Finally, watch the interaction between staff and residents.
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