Choosing a Short-Stay Nursing Home or Skilled Nursing Facility

Short-stay nursing homes and skilled nursing facilities (SNFs) are designed to function as bridges between the hospital and your home following an operation, procedure, or hospitalization. Their focus is on getting you or your loved one stronger and well enough to go home. When you go to the short-stay nursing home, you or your loved one will be evaluated, and goals will be set for your loved one’s recovery. These goals will be reassessed at regular intervals. If you or your loved one is not making the progress that was expected, the nursing home will need to adjust the plan. The same thing is true if you or your loved one makes better progress than expected.

At ProNobis Health, we understand the importance of choosing the right short-stay nursing home. We realize that the right chioce will be not only a high quality nursing home, but also one where you or your loved one feels welcome, safe, cared for, and respected. We can guide you to good information about nursing home quality. We want to help you think about what is important to you, the ART of choosing, and also consider how good the care is at the nursing home, the SCIENCE of choosing.

What You Value: The ART of Choosing

Because you or your loved one should only be in a short-stay nursing home for a limited time, the values to consider should focus on getting better as quickly as possible and being as happy and comfortable as possible during recovery. Here are some things to consider:

Location: For some people, being close to family and friends is one of the most important considerations in choosing a nursing home. Being close to family and friends makes it easier to visit frequently and more convenient when it comes to things like doctor’s appointments.

Services: An important part of your loved one’s recovery at a short-stay nursing home is having the services necessary to get well and come home. Ask about the basic services that most people in a short-stay nursing home will need, such as physical therapy (PT) or occupational therapy (OT). If there are other specific needs, such as wound care, ask if there is a trained wound care nurse available. If you anticipate your loved one will need help adjusting or coping, or if your loved one is showing signs of depression, inquire about mental health services. Some nursing homes have psychologists or social workers available for their residents. You may also ask about who takes calls for the nursing home if a resident has a medical issue. Sometimes a physician, physician’s assistant (PA) or nurse practitioner (NP) will be available for consultation with the staff.

Discharge Planning/Transitioning to a Long-Stay Nursing Home: The purpose of a short-stay nursing home is to return your loved one to as full function as possible and have them return home. Discharge planning should start early—anticipating any home needs and arranging things like home nursing care, home equipment such as assistive devices for the bathroom or bedroom, home PT or OT well in advance of discharge. The nursing home should make sure that the transition to home is smooth.

Despite the best possible care, there are some instances when it is clear that your loved one will not be able to return home. In those cases, the short-stay nursing home should be able to help you transition your loved one to a long-stay nursing home, either at the same facility or a different one. These needs should be anticipated well in advance of discharge and all the necessary arrangements made.

Culturally Appropriate Care: Although you anticipate that your loved one will only be in a short-stay nursing home for a few weeks or months, it is very important for everyone that the nursing home provide culturally appropriate care, including language interpreters available at any time, culturally appropriate meals, spiritual services, and in some places, other residents who share the same culture. Being isolated or made to feel different or being unable to communicate because of a language barrier will not help your loved one recover and may even lead to feelings of isolation and depression, which can make them get worse. Do not underestimate the importance of culturally appropriate care.

LGBTQ: Although the short-stay nursing home is likely to be temporary, your loved one should expect to be treated with respect and dignity regardless of sexual orientation or gender identity. This also applies to your loved one’s spouse, partner, and friends. Everyone should be made to feel welcome and respected. Ask specifically about the staff’s familiarity with LGBTQ issues. If your loved one feels isolated or even worse, is treated with hostility, his or her recovery will not be as smooth.

Information About Nursing Home Care: The SCIENCE of Choosing

It is also important to consider measures of how well the nursing home performs in areas like safety, staffing, and quality. The Centers for Medicare & Medicaid Services (CMS) has a website called Nursing Home Compare, which has good information about the quality of care at different nursing homes.

CMS pays short-stay nursing homes to help people get better, and CMS wants to make sure nursing homes are doing a good job. Nursing Home Compare gives nursing homes an overall score (5 stars is the best) that is based on three things: health inspection, staffing, and quality measures. Each of these categories also has a score; again 5 stars is the best.

Health Inspection: Inspectors go to nursing homes to check things like smoke alarms, disaster preparations, how the residents and staff interact, and how food and medication are stored. These things ensure a safe environment for the residents. If the nursing home has a deficiency, they may get a penalty and have to pay a fine, or CMS may refuse to pay a nursing home until they correct the problem. We will discuss this more below under penalties.

Staffing: This measure lets you know if the nursing home has adequate staffing based on the ratio of nursing staff hours worked to the number of residents at the nursing home. It looks at two factors: first, registered nurse (RN) hours per resident per day; and second, total staffing hours, which include RN as well as licensed practical nurses (LPNs), licensed vocational nurses (LVNs), nurse aides, and physical therapists (PTs). More stars means more staffing. Some nursing homes don’t have an RN on site every day, so they would get fewer stars based on this.

Quality Measures: CMS uses specific outcomes to gauge how well a short-stay nursing home is doing at helping residents recover and return home. The emphasis is on two things: (1) making sure that the goals set for recovery are met, and (2) making sure that residents don’t get worse while in the nursing home.

Here are a few examples of the important quality measures:

  1. Percentage of residents readmitted to the hospital within 30 days of discharge from a nursing home
  2. Percentage of residents sent to the emergency department from the nursing home
  3. Percentage of residents who received an antipsychotic medication for the first time while in the nursing home
  4. Percentage of residents with new or worsening pressure ulcers while at the nursing home
  5. Percentage of residents who improved their ability to move around on their own
  6. Percentage of residents who fell and had a major injury while at the nursing home
  7. Percentage of residents whose functional ability was assessed and whose functional goals were set and included in the treatment plan
  8. Rate of successful return to home and the community from a short-stay nursing home
  9. Amount of money Medicare spent on a resident in a specific nursing home compared to national averages

Penalties: If nursing homes have deficiencies, CMS may fine them until they correct the problem. Also, CMS may withhold payment to the nursing home until the deficiency is corrected. Although CMS does not list the penalties directly on their website, you can ask nursing homes if they have been fined in the past.

Abuse: Nursing Home AbuseThis symbol beside the name of a nursing home on the CMS Nursing Home Compare site means that the nursing home has been cited for resident harm, abuse, or neglect. This is important information to know.