Last week's column described life-threatening issues that one patient, Joan, experienced in a short-term rehabilitation facility.
How can you select a short-term non-hospital rehabilitation facility to get better results? In the hospital, discharge planners will provide a list of all licensed facilities in the area. Typically, they are not permitted to steer you towards or away from any specific site, so you will need to get more information.
You might start with federal and state online databases of nursing/skilled nursing facilities, within which such short-term rehab units are often based. One is Medicare's Nursing Home Compare at http://www.medicare.gov/nursinghomecompare/. In Arizona, at http://hsapps.azdhs.gov/ls/sod/SearchProv.aspx?type=LTC, type the facility's name in the "Provider Name" field and select "Start Search." In my experience, though, neither site adequately distinguishes facilities that provide great care from those that don't.
Check with your primary care doctor or nurse, and seek out family or friends who have experience with one or more facilities. Also realize that, anywhere in the country, the quality of other services provided on the campus (such as assisted living or independent living) may not tell you anything at all about the quality of services in skilled nursing/nursing/short-term rehab. The different units are often managed quite independently, and it is possible to have a great experience in one and a sub-par experience in another.
How can you get more insight? Show up - unannounced. While a visit at 3 a.m. is not likely to tell you much, seeing the place during normal waking hours may help you get a feel for how it operates. Nothing substitutes for your own assessment of what you see, hear, smell and touch. (Unless eating a meal there, omit the sense of taste!)
To find out how care can be planned to safeguard patients, I spoke with Allene Young, Social Services/Marketing Director at Good Samaritan's skilled nursing facility in Prescott, which includes a short-term rehab wing. To be clear, this facility was NOT involved in the care of Joan, the patient mentioned above.
Young explained that the rehab facility and the hospital start talking as soon as plans start to be made to transfer a patient to rehab. Generally, patient records and doctors' orders for drugs and for care are received well in advance. A staff member scrutinizes the patient's records to identify any omissions. For example, if someone has a significant wound but the orders don't include specific instructions for wound care, the rehab facility will follow up.
Typically, there are no surprises when a patient shows up. For example, if a potential patient is extremely obese, the care facility learns this fact ahead of time. If they do not have the proper equipment on hand to provide needed care (e.g., perhaps a heavy-duty hoist to lift him out of bed), they will not agree to admit him.
In addition, Young explained, "If possible, we always have a conversation with a designated family member ahead of time, especially if we have any questions about the patient's needs."
When patients arrive, they undergo a complete nursing assessment to make sure that nothing is missed. And if the patient arrives at night or during the weekend? "The process is exactly the same. Usually, if we have an admission on the weekend, I come in myself to make sure that everything is covered." Typically, advance planning makes off-hours admissions run smoothly.
Many different staff members may be involved in the individual's care. How can residents know who to talk with if they have an unresolved problem? One way is by reading the (large-print!) resident handbook Good Samaritan gives them when they arrive. It notes, "The nursing staff is available to care for you 24 hours a day.
If you have any questions or concerns regarding nursing services, please see the Charge Nurse, Director of Nursing Services or the Administrator."
If the resident or family member has a significant concern, even in the middle of the night, Young added, "They can request a phone call to a higher-level staff member. A nursing manager is on call 24/7."
With careful attention to detail ahead of time, and availability of management around the clock, a very large percentage of potential problems can be avoided.