What to Expect When Your Loved One is Admitted to a Nursing Home

By: Danielle Jones, LSW

There are two main types of stays at a nursing home. Short term acute care also called skilled care and long-term care placement also referred to as intermediate level of care.

Short term rehab entails skilled services such as physical, occupational, speech therapy, and/or complex nursing. Short term rehab is typically covered by insurance if all the insurance criteria is met. It is
important to understand skilled nursing home stays are based on a few factors. First, your loved one’s progress in their skilled services is a key factor. They must be showing improvement justifying the need for skilled services to continue. This includes making gains in therapy, improvement in activities of daily living (ADLs: dressing, bathing, grooming, toileting, bed mobility, feeding, transfers, and ambulation), and complex wound care. Another factor is the insurance. Medicare and managed care insurance have specific guidelines which must be met to continue skilled care. Individuals with managed care insurance require the facility to provide updates to them. The insurance company makes the determination if they will authorize more time for skilled services.  Individuals requiring short term rehab typically have a stay of 30 days or less and the plan is for them to return home. There is a team of staff members who will be providing care to your loved one in efforts to address all their care needs. This includes nurses, nursing assistants, physical therapists, occupational therapists, speech therapists, a social worker, dietician, activity director, and a physician. The nurses communicate very closely with the physician on any medical needs. Within the first seven to 10 days a care plan meeting should take place. This is a brief meeting with the interdisciplinary team to discuss your loved one’s short-term rehab stay. The resident and at least one key family member are invited to meet with the team. At this meeting the social worker will discuss the discharge plan, care options, medical equipment needs, home healthcare, and other pertinent resources. Nursing will review nursing care needs including medications, weight concerns, wounds, and labs. Therapy will review your loved one’s progress in therapy and also any functional concerns. This is an opportunity for the resident or family to voice any questions or discuss concerns related to your loved one’s skilled stay. Communication between the interdisciplinary team, the resident, and the family will be ongoing until discharge.

Long term care is another level of care at a nursing home. This is often referred to as intermediate care. These individuals require ongoing assistance with their activities of daily living indefinitely. Long term
care residents no longer meet the skilled care requirements. Their conditions are chronic and focus on managing their health including medication management, assisting with bathing, dressing, grooming, toileting, and transfers, and coordinating their care to maintain their level of functioning and promote safety. Long term care is not covered by traditional insurance. However, a long term care policy could. Long term care can be paid for by private pay or through Medicaid if eligible. All long-term care residents have care plan meetings within the first seven to 14 days they are admitted and every three months thereafter. Any questions or concerns in between care plan meetings should be communicated to the charge nurse or a member of the care plan team. Many new long-term care residents go through an adjustment period. This is a huge adjustment for the new resident and you as the family member. During the adjustment period your loved one may have some changes in their mood or behavior. This may include depression, agitation, yelling, and wandering the building. They may also ask to go home often. These are all normal responses. Remember, their whole life has changed. Your loved one may now have to rely on others they do not know to provide personal care. Also, the loss of autonomy and independence is a very difficult aspect to long term placement. The adjustment period can last weeks to months. Most individuals adjust within the first three months of placement. Bringing in personal belongings and decorating their room may help. Encouraging facility activities, and visiting often giving love and support will all help with acclimating them to long term care placement. The staff can assist your loved one and you with the adjustment period.

Whether your loved one is admitting to a facility for short term rehab or long term care placement a good facility will assist and support you and your loved one by communicating well, providing education to help make informed decisions and addressing your questions and concerns.