What is Skilled Nursing?

A nursing home/rehab facility, also known as a skilled nursing facility is a place that provides 24-hour care. These facilities provide skilled nursing care, personal care, custodial care and rehabilitative care to persons who are ill, recuperating after surgery or physically weak. Some may also offer respite care to give relief to a family caregiver.

A nursing home can be freestanding or it can be part of a continuing care retirement community (CCRC). A CCRC allows residents to move from one level of care to another, as needed, and can include independent living, assisted living, and/or a nursing home. A hospital can also have a skilled nursing unit within the hospital that serves patients who need short-term care and rehabilitation services.

Who Needs a Nursing Home?

There are generally two kinds of people that need a nursing home

  1. People who are recuperating after a hospital stay from an illness or injury. Often times a person has limited time to find a nursing home before being discharged from the hospital. Family and friends usually help in the nursing home search and evaluation process by visiting the nursing homes while the patient is still in the hospital.
  2. People who need 24 hour intermediate or custodial care, more care than an assisted living facility or home care agency can provide. The person needing this kind of care may not have an immediate time constraint placed on them to find a nursing home. When this situation occurs, proper time can be taken to thoroughly evaluate which home is right for their care needs.

Important Considerations

Three things you should understand before residing in a nursing home.

Use the extensive “Questions to Ask” Comparison Worksheet that allows you to evaluate three facilities you are considering. If your time frame for finding and choosing a nursing home is limited, use our Nursing Home Quick Tip List of five key considerations for a prospective facility (a little later in this article).

  • What services and products are covered by your insurance(s)?
  • How long are you covered for?
  • What charges are you responsible for paying?
  • What does your long-term outlook, look like? (In terms of care needed and financial future.)

Visit Florida’s Long-Term Care Ombudsman Program here for more information.

Finding a Nursing Home…the Process

Education is the key to making sure you choose the nursing home that is best for you or your loved one. Start the process early by educating yourself as soon as it is determined that a nursing facility is needed and by relying on key advisors that you trust. There is a lot to learn, from understanding the care services that nursing homes provide, to learning how to pay for care. Studies show that those who do their due diligence will have an overall better nursing home experience than those who do not. There is a difference in the quality of care and the services provided among nursing facilities. Some are better than others.

The medical needs of nursing home residents vary greatly between individuals. Likewise, the nursing care services available vary greatly between facilities. Although every nursing home provides basic health care services, some facilities serve special needs like wound care, Alzheimer’s or the care of tracheotomies. Some even have specialized medical equipment to take care of patients on dialysis or ventilators. If you are being discharged from a hospital, your physician or discharge planner can provide you with a list of nursing homes that can cover your specific health care needs.

Start by calling the facilities on your initial list. Ask to set up a time that you can come by for a visit and tour the facility. It is a good idea to find homes close to the patients loved ones so they are able to visit more frequently. Ask family and friends for recommendations and whether they have had any personal experience with any of the homes on your list. From your initial list, you will be able to narrow the field of choices down to two or three that you would like to visit. Touring the nursing home is perhaps the most important determining factor when evaluating a facility. Make sure you take along our Nursing Home “Questions to Ask” Comparison Worksheet or use our Nursing Home Quick Tips List if time is short when touring the home you are considering. Do more than just talk to the administrator and the admissions director. Talk to the care staff if possible while touring. Keep your eyes open to both what you see and what you don’t see happening during the tour. Even though time is sometimes critically short for selecting a nursing home, be selective.

Nursing Home Quick Tip List

The Quick Tip List was developed to give an overall indication of what to look for when touring the nursing home by looking at just 5 categories of questions. The questions are easy to understand, common sense things to look for when touring a facility. Just use your senses (Look, Listen, Smell and Taste) for each category of questions and you will be able to determine whether a facility has high standards. Higher standards are the key to better the care. Don’t accept explanations or excuses from the nursing home you are considering. If you find a nursing home with low standards, move on to the next nursing facility.

Look for Cleanliness and be aware of any strong odors. 

  • Look at the floors – Are they shiny if tiled, and are they free from stains, if carpeted?
  • Look at the furniture – Is it dirty and worn?
  • Look at the structure – Are the walls, doors and fixtures in good repair?
  • Is the home well lit? Are there any strong foul odors?
  • Are there overpowering “good smelling” fragrances that could be masking or covering up foul odors.

Look & listen to observe the following:

  • Is the staff well-groomed and dressed professionally and appropriately?
  • How does the staff interact with patients and visitors?
  • Does staff seem friendly, caring, patient, polite and helpful?
  • Do they seem happy?
  • Does the care staff seem to work well with each other?
  • Is staff polite and courteous or are they complaining to each other?
  • Is the interaction between management and the care staff positive?
  • When you ask questions, does management seem forthcoming or are they hesitant to answer? Do they seem agitated or aggravated?

Look, listen, & smell to observe the following:

Note: Do not go into any patient’s room without the expressed permission of the patient and the staff. Please respect the privacy of the patients.Are the patients that you see groomed and clean? (shaven, nails trimmed and dressed appropriately)

  • Do you smell any strong odors coming from the patients?
  • Do patients seem to be receiving attention by staff if needed?
  • Are the patients that are more active and social involved in any activities?
  • Do they seem to be enjoying their interaction with staff?

Look, listen, smell and taste to observe what is going on in the dining room and kitchen. Tour the nursing home during meal time and ask if you may dine. Look for food choices.

  • Is the food attractively served?
  • Is the food served at an appropriate temperature?
  • Is the food tasty?
  • Do residents seem to like the food being served?
  • Is there enough staff to assist patients who need help eating?

Look at and listen to how the staff interacts with the patients during meal time. Ask if you can see the kitchen and talk to the dietitian. Food is one of the most important aspects of patient satisfaction. Look for a nursing home that treats this standard very seriously.

  • Do they seem to be enjoying their interaction with staff?

Care standards should be evaluated as it relates to both skilled care services and custodial care services.

Skilled Care Services

Medicare has come up with a tool to help people to determine whether a nursing home is providing quality care to patients. The Medicare Nursing Home Compare website found here has a Five Star Rating System on nursing home care that contains quality of resident care and staffing information for more than 15,000 nursing homes around the country.

Here are a few ways you can evaluate the facility’s standards for skilled care while you are on your tour.

  • Does the nursing home have a current license?
  • Does the administrator have a current license?
  • Is the nursing home Medicare-Medicaid certified?
  • What is the RN/LPN to patient ratio for day, evening and night?
  • What is the nurse aide to patient ratio for day, evening and night?
  • Are there onsite therapy programs where patients are receiving therapy?
  • Does the nursing home have special programs where staff have been specifically trained to take care of such care issues as Alzheimer’s or wound care?
  • Do you see any evidence of such programs and care taking place?
skilled nursing / rehab

Custodial Care Services

Custodial care can be determined by evaluating the Activities of Daily Living (ADLs) of those who need care. It is easier to evaluate whether the care is being administered and administered properly because we, as lay people, can see, hear and smell the results or the lack of results of the caregiver’s actions in personal care services.