Mom broke her hip. How do we find a good SNF for her recovery?

Texas, one needs to go visit the places to get an actual feel. I never trust reviews as a reviewer can be in a snit over something that they [the reviewer] themselves cause and want to tarnish the continuing care facility.

Don't judge the place by how it looks outside. My Dad was in a rehab/nursing home that was building back in the 1950's, not a very cheery looking place.... but Dad had excellent care, the rehab was great, and food was very good. Dad didn't mind being there.

On the other side of the coin, my Mom went into long-term-care. The place was less than a year old, looked very nice inside. Even thought Mom had good care, it was nothing like the old Rehab my Dad was in.

Hopefully a caregiver from the Dallas/Fort Worth area will see your post and give you a recommendation.

As for your Mom's recovery. For every hour she was under with anesthesia, it will take one month to recover.... so if surgery was 2 hours long, then 2 months to recover from the anesthesia fog. The older a person is, the longer it takes to heal. So give Mom plenty of time. Broken bones are very painful so the pain meds will also make her zoned out.

Is she going for rehab, with the intention of getting her strength back, or will this be a permanent move for her? I think the criteria is a little different for each.

A few thoughts (I have a checklist but it's on an older computer and I can't immediate access it):

Visit during mealtime; do residents eat together in a central room or alone in their own room? Look for menus; see what's available and try to get a look at some of the meals. The best I've seen had a chef from a former high profile restaurant. The food was literally to die for. At a another facility, the brownie was stale and the fish looked like drywall. Blah.

Does the facility extend comfort to visitors and family with hot coffee and water? Does it offer a free meal for the family? (this was a surprise, but a pleasant one)

Wander by the physical therapy room and see what's available. For someone recovering from leg fractures, a parallel bar setup is helpful. Are there "beds" that can be lowered and raised? These provide a wider range of PT that can be done. Or does the PT room just have a few exercise bikes and variations thereof? Steps with side rails are also a good form of leg therapy.

There should also be a variety of OT devices, beyond just putting round or square pieces in appropriate holes. Some have kitchens so people can practice preparing meals. Some have laundry facilities so the resident can learn how to use top or front feed machines.

Activities - how often, what are they? Are there pet visits and live music? Any pianos at which visitors can play?

Most importantly, what is the staff to patient ratio? The last one to which I took my father had 8 aides available during the day for about the same number of patients. One I didn't take him to had a 1:14 ratio (1 aide for 14 people on the wing - yikes!) The less aides, the longer it could take for patients to get help with ADLs.

Observe the faces of the residents/patients. This is an individual issue, but when I've seen too many people staring vacantly and left alone, I would be concerned. Some places have puzzles, tv rooms, movies, etc. Getting someone out of the room and interacting, or just being with others, can make a big difference than being alone in a room.

Good ones also have common areas; that best one was configured so that visitors could see out into the courtyard, or forest for that particular side of the building. Staff and visitors both told me that deer came up from the forest in the evening to feed along the perimeter of the small facility.

Are the rooms private? This seems to be the trend, at least in my area. Check for cleanliness, and especially a bathing area in the room. Older homes used to use communal bathing facilities, causing embarrassment and anxiety when my parent would have to be cleaned.

The ones I've used in the last several years had private bathing facilities, in the resident's private room. And they were immaculate.

Are there any unpleasant smells?

What is the resolution process? I.e., if issues arise, how are they addressed and resolved? Watch for mouths beginning to open to address the question (good sign) , or, alternately, blank faces (bad sign).

What security is there? Since there are people coming and going, this is always an issue of concern. The last facility had a private security force as well as a bank of cameras at the front doors, of which there were 2. The outer door could be opened by visitors, with the handicapped buttons to push. The second, inner door could only be opened from the lobby. It's the first time I've seen cameras monitoring the grounds and access available only when the receptionist or staff pushed the right access buttons.

Thanks for the ideas. My brother and I visited some places yesterday (Sunday) and were able to tour them. What I learned is I should have been doing this starting years ago! What a daunting task. Mom will be going to a place for short-term rehab is my understanding with a goal of returning home after she can walk again. They had to do a partial hip replacement so no bending or twisting allowed until healed. She will have to learn to dress, bathe, etc. Right now she is so weak she can barely make it to the door of the hospital room with the walker and physical therapist. Ortho doc told her if she didn’t work at rehab she would never walk again.

Her BP is tanking and her hemoglobin is 7.3 as of yesterday. Apparently, new guidelines are to not transfuse unless 7 or below. She pulled out her IV and incision drainage tube during her delirium and they never put them back. I think she is dehydrated and anemic. And with a broken left leg and operated-on right hip, you can imagine how much fun getting to the commode chair is! It is so painful for her that she decided not to pee or poop anymore. This is a disaster! And don’t get me started on the quality of care in this hospital (because there is none). @GardenArtist, thanks for the list. Your wisdom and experience are always appreciated.

This may or may not be obvious to some folks. Over the past several years, my mother (age 90) has been in and out of skilled nursing facilities because of surgeries, falls, etc. The hospital will give a list of up to 10 (sometimes it's 10, sometimes it has been 2). Not having any idea where to send her, we found out that my Mother's preacher knows all of the locations because he visits all of them regularly visiting people over a course of years. He literally told us which ones to stay away from for various reasons and which ones were the cleanest, friendliest staff, etc. If she doesn't have a clergy, perhaps a friend does.

Gardenartist, what a great list! I wish I had one like it when looking for Moms NH. The pickings are very small in central NY however so it might not have made much difference. If I had looked for one with a 1:1 staff to resident ratio, I would still be looking however. Moms has 38 residents per floor, on good days they have 5 CNAs, on OK days they have 4, on chaos days there’s only 3. There is no minimum in NYS. Sometimes the helpful LPNs jump in to help, some are “above” the grunt work and won’t help.
So I’d love to know where better ratios can be found, so I can plan ahead for myself!

Rocket, thanks for the compliment. I learned to make lists after going through some rough experiences and learning that the social workers/discharge planners at hospitals provide lists based on criteria that aren't always in a patient's best interest.

I thought there was a state minimum standard for ratios of patients to staff. There is in Michigan.

I also found that the best care was initially at a well run chain, but that deteriorated to the point that it didn't even meet basic standards. However, I found that a SNF founded by the Dominican Sisters of Peace was the best so far (other than one in Ann Arbor, but AA is a teaching hospital area and standards are higher all around.)

Sorry to learn you've had some bad experiences as well. I asked one SNF I interviewed 3 times before someone finally told me what the ratio was. When two people said that they "meet the minimum state requirements", red flags went up. And I was right - that was the place with the 1:14 ratio.


Rusbar, good idea to get information from someone who visits a lot of different SNFs and knows the good from the bad!


Texas, one thing concerns me, right now. That's that the IV was pulled out and apparently not put back in again. If she's dehydrated, she's not even going to feel up to thinking about recovering.

I would address, first the nurse, then the charge nurse, then the administrator, if that IV isn't put back in ASAP.

Even if she's taking fluids by mouth, she may have been getting antibiotics through the IV line.

My understanding is that if a floor nurse can't restart the IV, someone from Anesthesiology should be called to get one restarted. Make sure the staff knows you're on top of this; they really "dropped the ball" when my father was in last time.


As I think about all the issues with SNFs, I'm beginning to think a continuing ed course on selecting SNFs might be a good idea.

Just for information in case anyone’s interested, here’s a list of the minimum staffing requirements by state. There are quite a few, surprisingly including NY which regulates every breath we take, that have “no minimum requirement” for CNAs. Michigan is 1:8 which is pretty good. Maybe we should move back.

http://theconsumervoice.org/uploads/files/issues/Harrington-state-staffing-table-2010.pdf

Why isn't the Social Worker helping to locate a rehab/nursing facility? Be aware, a broken hip is serious in the elderly. Mom may not be able to come home if she doesn't rehab well. Also be aware that Medicare only pays 100% the first 20 days, 21 to 100 only 50%. After 100days it's private pay or Medicaid if she has no money.

texasrdr22, see my post on your question: "Rehab After Broken Hip" Asked by texasrdr22 about 2 hours ago 05/3/2018

Mom has now been in the hospital 9 days. After one unit of blood, her hemoglobin level is only 8 with no plans to give more. Concern about fluid overload is the reason the PA gives. Mom is not getting IV fluids and hardly drinks anything. I don’t doubt but what she is severely dehydrated.

After 3 different nurses stuck her far too many times, I insisted they get a PICC Nurse to put in the IV using sonogram guidance. It took an additional 15 hours for the PICC nurse to show up because someone did the order wrong. On top of that, the order for blood was cancelled because some staff member wrote in the notes that “the family does not want a transfusion”!!! What??? So screwed up.

We will hear the decision of the insurance company today regarding my appeal of the denial of acute rehab. Mom is running a fever today and that, coupled with the low hemoglobin is causing her to be even more lethargic. We may be here a while longer. Rehab will have to wait.

PS: Not sure why they give Mom a menu to order her meals. It is day 9 and on only one occasion has she received anything remotely close to what she ordered! And we are in a big city major hospital.

Take a breath. I have yet to read a GOOD online review for a SNF. As someone else said, most people who write a review are in a snit about something. The only way one can ensure good care and attention from a SNF is to be an INVOLVED family member who visits multiple times weekly (every day if possible and at different times so that the staff never knows when you are coming). Also, it may not be up to family to "choose" a SNF. When my relative who had dementia broke her knee, I visited some SNFs while she was in the hospital, but later discovered it was not my choice but was up to which facility would "take her" because of her limitations at being able to do the PT. So, she ended up at a facility that was 4 miles from my house. It was a bit shabby looking, but it worked out for the best as it was so close and I was able to visit daily.

Mom was finally released from the hospital and the denial for acute rehab care was overturned as a result of my formal appeal. She has now been in the rehab facility for 8 days and is amazing me every day with her progress! She is standing and walking with a walker, learning to use tools to dress herself as long as the "hip precautions" are in place (not bending, twisting, crossing legs, etc). She is scheduled for 3 hours of therapy a day with Group, Occupational and Physical therapies. She must do 15 hours per week. So far, so good! The other day she walked 167 feet at one time which exceeded the established goal for her set by the PT group.

I stay with Mom at night and once the Physical Therapist trained me to help Mom with transfer to the toilet, my life got easier since I did not have to wait for a tech to show up to take Mom. Most times it took so long that Mom could not wait. Mom does all the work with the transfer and I am there just in case something were to happen. So far so good! I am so glad I fought to get her into this facility and not a SNF. This facility is in the top 1% in the nation for their success rate in returning patients to the community. We want Mom to be able to bathe, dress and toilet herself again just like she was before the broken fibula and broken hip. She is getting there!

I am getting proper grab bars installed in preparation for her to come home. They have a tentative discharge date of 5/19 (coincidentally the exact number of days Medicare/insurance covers!)

Texas, I've never heard of "Group" therapy. I assume patients do specific exercises all together in a group, rather than individually? Could be very helpful as individuals know they're not alone.

All the rehab therapy I've seen has been one to one, therapist to patient.

Since your mother's not in a SNF, what kind of facility is she in? Is it solely dedicated to rehab, something like some of the Medilodge facilities?

I'm glad to read of the great report of your mother's progress though - that's wonderful!

GardenArtist, group therapy is indeed a group seated in chairs in a circle. Each could have a different reason for being in rehab. The “exercises” are simple arm movements sometimes holding weights. There is also a social aspect to it with the Occupational Therapist asking each group member a question while batting a balloon to them. The patient answers the question (ie What is your favorite holiday?) while batting the balloon back. OT does the first half hour then PT works legs for the rest of the hour.

Mom then has one hour of physical therapy one-on-one and an hour of occupational therapy also one-on-one. The sessions are spread out with a break for lunch between. No therapy on weekends unless you did not get 15 hours during the 5 previous days. She also has the same therapists every day which is great.

The facility is called a “Rehabilitation Hospital”. Nobody lives here. It is solely rehab.