What Aging Parents Need to Know About Rehab/Skilled-Nursing Facilities

…And What Children Can Do to Help Their Aging Parents From Day 1

Senior Advisor, R, has been out of the rehab facility for a little over a month, but returns twice a week for out-patient physical therapy. I took the opportunity to interview M, Director of Nursing, at this state and government “A”rated facility, wanting to pose questions that I thought would help others.

Admission advice?

1.  Have at-the-ready: ID, Medicare card, Insurance card. If a Power Of Attorney is involved, the facility needs it asap (within a few days).
2.  If parents come in an ambulance from another facility, all possessions that were in their previous room are transported to the facility.
3.  Because they are going to be up and dressed every day, they will need appropriate clothing (shoes, sweater etc.), personal care items, and all meds from home (including vitamins).  As M says: “Every pill.”

Then what?

1. A doctor, following Medicare guidelines, will do an evaluation within 72 hours.  It should be sooner than that unless the parents come in on a weekend–then it’s a wait until Monday.
2.  Emotions can run high at this point. People need to understand that the skilled nursing staffing ratio is not the same as in a hospital (where it’s probably 1-5).  More likely it will be around 1-16. So expectations can be unrealistically high at the beginning.
3.  The doctor (who is there each week, but not each day) may only see the patient, after he/she is stable, once a month.  However, the skilled nursing staff is the “eyes and ears” and regularly conveys patient information though telephone conversations to the doctor.
4.  That said, according to M, “patients have more contact with the staff than in a hospital.” I’m thinking probably because their needs are different.

What additional information helps aging parents if shared?

1. Knowing about parents’ individual needs and routines –do they use a night light, have sleep apnea, unusual sleeping patterns (a farmer accustomed to getting up at 4am, for example will want an earlier breakfast if possible), are they incontinent etc, etc?
2.  In answer to my questioning as to whether certain personality types fared better, M gave me surprising information.  “If they’ve had anesthesia, they may be like a different person.  Anesthesia is probably the most crippling for this population.  It has to wear off and usually hasn’t when they come to us.”

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My experience: while Senior Advisor R was in the rehab facility, we realized communicating with the staff, when appropriate, got things done in a timely fashion, whether we or R initiated the discussion.

R’s take: upon admission to a rehab facility one must make a complete adjustment. One must accept the way things are. “It’s not like a hospital–not like having someone at your beck and call when you ring the call-button, says R,” adding “It’s not real nursing (except for those who must have it).  Asking the hardworking staff for more than one’s entitled to only incurs frustration for both patients and attendants. Realizing this early, helps. Indeed some people make themselves miserable wanting more than the staff can provide.”

As we try to help parents age well, if a rehab facility should enter the picture, draw upon R’s wisdom. There’s a saying she learned in rehab: “We’re not here to help you, we’re here to help you go home.”  “That’s the important thing to focus on,” she says. And R, at age 97, has done it perfectly.  Now at home she’s without caregivers, has an “alert” pendant and uses a cane (didn’t before).  Her walker remains unused.

Changing often: “Of Current Interest” (right sidebar). Links to timely information and research from top universities, plus some fun stuff–to help parents age well.

3/26/14 Help! Aging Parents was just nominated again for the Seniorhomes.com Best Senior Living Awards 2014, “Best Blogs by Individuals” category. It was a finalist in 2013. I appreciated your votes last year and would very much appreciate them again this year by clicking http://www.seniorhomes.com/d/help-aging-parents/2014-best-senior-living-awards/ if you’re on Facebook. Deadline 4/28/14 Thanks so much!

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