Choosing a Rehab Facility for a Loved One

It’s 10:30 on a Monday morning, and your cell phone rings. It’s your mother’s next-door neighbor, calling to tell you that your mother slipped and fell on the ice while getting her newspaper, and she thinks her ankle might be broken.

So you rush around, trying to get things in order, so you can meet your mom at the hospital. You need to get someone to teach your class, manage your desk, cover your shift. This really couldn’t have happened at a worse time.

Then you get to the hospital, where a doctor tells you that your mom’s ankle is, indeed, broken. She’ll need surgery to reset it, and she’ll be in the hospital for a couple days. Even worse, she won’t be able to go home right afterwards—she’ll need to stay at a rehab facility for a couple weeks. Huh? A rehab facility? What’s that? How’s it different from a nursing home? Or assisted living? You ask the doctor these questions, but she says to talk to the social worker, then walks away.

Suddenly you realize that you’re in way over your head. You have a lot of things to figure out, and you don’t know where to find the answers.

This is a very common scenario, and, statistically speaking, it will happen to you someday—if it hasn’t already. It can be frightening, and no matter how many family members you have for support, it can also be lonely. But it doesn’t have to be. There are many resources available to you when you’re thrust into this decision-making process—resources that can help you choose the best facility given your mom’s needs and wishes. Keeping a cool head, putting your loved one first, and drawing assistance from the following team members and tips will get you through the process with as little stress as possible.

Team Member #1: The Hospital Social Worker/Discharge Planner
This person works with you regarding the discharge plan for your loved one. She will confer regularly with the physicians, nurses, and therapists regarding your mom’s progress and expected discharge date.

Since the surgeon has recommended a stay at a rehab facility, the hospital social worker will present you with a list of skilled nursing and rehabilitation centers within your area.

She will also probably give you a pretty tight timeline—sometimes only a day or two!—to pick one. Here are some things to keep in mind:

• The hospital social worker cannot, under hospital policy, recommend which facility to choose. She can, however, answer questions such as, “Which one would you send your mother to?” and “Which of these facilities has the lowest return-to-hospital statistics?” These are good questions, and definitely worth asking. Also worth asking: “Does this hospital specifically partner with any of these facilities?”
• The hospital social worker is an advocate for your mom, but she’s employed by the hospital. This means that she has a lot of hospital protocol to follow, and it means that she’ll want frequent contact with you. This is good—she wants to make sure that you act on your mother’s behalf. She’ll likely call you every two hours at this point, asking if you’ve made a decision yet!

Team Member #2: Your Mother’s Primary Care Physician (PCP)
Unless your mom’s PCP is specifically treating her at the hospital, don’t assume that he knows what has happened to her. In a perfect world, the PCP would be contacted as soon as your mom was admitted, but that’s not always the case. Make sure to either contact him or have the hospital contact him as soon as possible.

Ask your mom’s surgeon or family physician where they recommend she stay for rehab. In fact, if your mom’s PCP is an attending physician at one of the places on the list the social worker gave you, the PCP can remain your mom’s physician within the facility. If your mom’s PCP does not have attending privileges at the facility you choose, your mom will be temporarily reassigned to one of the available physicians—most likely the medical director—at the rehab facility. Keep in mind that being able to see her regular doctor might bring your mom peace of mind, and bring continuity to a situation that’s otherwise full of changes.

Team Member #3: Your Local Ombudsman
Ombudsmen are underutilized but valuable resources. Search the web for your local office. Your ombudsman can serve as a great third-party to your team, working in the best interests of your loved one. This person can also act as a good sounding board, and even give you survey results of different facilities. You can also ask for recommendations and get information about specific training requirements for long-term care staff.

Team Member #4: The Admissions Coordinator

This person facilitates admissions for the skilled nursing and rehab center, so keep in mind that she works for the organization, not for you. However, she can be a great resource to your team—if you ask the right questions. She can help you field concerns about cost, what happens if your loved one doesn’t heal as expected, what happens if your loved one needs to go into assisted living, who pays for your loved one’s care, how much insurance covers, etc.

A good admissions coordinator will even meet you and your mom at the hospital, so that you can all be part of the dialog together. She can check the benefits on your mom’s insurance and coordinate with your local Medicare office to make sure you understand any out-of-pocket costs associated with your mom’s stay.

Choosing a Facility
Once you’ve narrowed down your search to two or three facilities, schedule tours. Although nursing aides or activities assistants can show you around after 5 p.m. if your schedule requires that, they may not have all the answers you need.

So try to schedule your tours with admissions coordinators during business hours, and ask:

• What the facility’s staff-to-resident ratio is—especially at night and on weekends. Things always look hustle-bustle during the day, but what if your mom needs help at 3 a.m.? 
• To meet the people who will provide direct care for your mom—people like the rehab director, with whom you can talk about therapy plans, and the social worker, who will schedule regular family care plan meetings.  
• To see the room that your mom would have, and to meet her potential roommate. Or, if your mom prefers, ask about the criteria for a private room, and whether you can get her on a waiting list for one.
• How the facility is organized in terms of layout—whether people with specific diagnoses reside in specific wings or on specific floors, etc.

It’s also important to consider that many organizations claim to specialize in certain things—orthopedics or cardiac rehab or memory care, for instance. If the facilities you’re considering claim specializations, find out what the specializations entail. Do staff go through regular training in these areas? What are the continuing-education criteria?

One facility might call itself “Alzheimer’s-disease specialized,” for example, when the only dementia training the staff undergo is viewing a 90-minute DVD once a year. Another facility might claim the same specialization, but the admissions coordinator might show you training records of all 100 staff members attending a fully-accredited program such as CPI’s Dementia Capable Care—and she might introduce you to the on-site Certified Instructor. Which facility feels safer and better positioned to provide good care? 

There is no federal standardization process for long-term-care-industry “specialization.” There are some local guidelines, but they vary from state to state and field to field. Specialization is a vague word that doesn’t necessarily indicate specific training on the parts of staff—just a general patient type they admit. Or a specialization could indicate that some staff are specially trained, and others are not. But everyone who works in a facility is a potential care partner for your mom. You will want to know about interdisciplinary specialized trainings like CPI’s Nonviolent Crisis Intervention^® program and the Dementia Capable Care program. Integration of these methods indicates that everyone will work together for your mom. It also means that you yourself can partner with activities, nursing, and therapy personnel to be an integral part of your mom’s care plan, and reinforce her success.

Once You’ve Chosen the Place You All Feel Good About
Work with the social worker and your mom’s doctors on an appropriate discharge day and time. If possible, don’t allow your mom to be discharged from the hospital on a Friday. This may be difficult, but if your mom is discharged on a Friday, she may not see a therapist for an assessment until Monday morning—a delay that could affect her success in therapy and recovery. On top of that, if you need something addressed—room issues, meal schedules, etc.—it probably won’t get fixed over the weekend. You want your mom’s early impressions (as well as your own) to be as positive as possible, so communicating that to her physician is important.

After Admission
Get to know the organization that’s helping your mom. Introduce yourself to the staff, and learn their names. Volunteer if possible, even if for only an hour per week. The more you know the people who care for your mom, the more empowered and comfortable you will feel about her care. And the more they know about you and your mom, the more person-centered your mom’s care is likely to be. Staff will know you as a valued member of the team.

If you do face challenges with your choice of rehab facility, document everything. Write down the good, the bad, and the ugly. Communicate your concerns to everyone on the care team—the director of nursing, the assistant director of nursing, and the director of social services. Getting copies to multiple department heads ensures that your concerns will be addressed right away, as most facilities have a daily departmental meeting in which issues are discussed.

And take a breather! You have been going through a new, scary process. You probably missed some time at work, with family, with friends, with yourself! Now your loved one is receiving treatment at a facility that you chose with care. You didn’t just close your eyes and pick a building off a list—you considered the needs of your loved one, the training of the staff, and the quality of the care. Now take a step back, relax, and enjoy some time with your mom while she gets rested, strong, and healthy again. Well done!

—Virginia Pflanz, Sales Director, Dementia Care Specialists