Today, I went out to evaluate some rehab centers. Mom's knee replacement surgery will be Oct. 21 and I needed to decide where she will go after the surgery for therapy.
There are seven rehab centers in out area. Mom went to one of them briefly last year and it was a disaster so we counted that one out quickly. I asked my physical therapist for suggestions and she picked three. One of them is closest to us but is mostly for long term care and reminded me too much of the poor quality facility my father was in when he passed away. I knew mom would hate it, even if it was very convenient.
The other two were nice, but different enough to give me a hard choice. Each had good points and bad ones.
I used a list of questions I worked up from various sources and our own situation to make my decision. These aren't in any particular order except number 1.
1) First, call the facilities you want to visit. Ask the receptionist about coming in for a tour and check the hours. Be sure to get the name of the person you will be asking for.
2) If your elder is going to need therapy of any kind, physical, occupational or speech, start with the therapy area. Look over the equipment available. Ask questions of the therapist on duty to see what they would do for your patient. In our case, one therapist described what the initial assessment would be like, what the different goals would be for my mother, like moving the knee to a certain angle, then getting up, using the walker, etc.
3) General cleanliness, atmosphere. Some facilities have beautifully decorated reception areas and dingy rooms and dining areas. Check all the common areas. Are patients stuck in wheelchairs and left sitting in the hallway, calling for attention, or are there activities and content residents? Is short term, rehab care on a separate wing from long term care? What is the nursing ratio to patients?
4) Is the dining area clean and inviting? Is it crowded? What is the ratio of aides to residents at meals (if your elder needs help, is it available)? Is there more than one offering at a meal? How are likes, dislikes, and food allergies handled?
5) Patient rooms. Check to insure there is a call button at the bed and in the bathroom. Is there a walk/roll in shower? Is there leg room under the sink for wheelchair access? Are the bathroom doors wide enough for walkers and wheelchairs?
(This is not a foolish concern. My mother's rehab a year ago had just been reopened after reconstruction. It had been damaged in the 2004 hurricanes in Florida and had been gutted and rebuilt, but no one had been smart enough to remember patients in rehabs and nursing homes use wheelchairs. That was one of many problems and I signed her out after 3 days.)
6) What kind of security does the facility have? (I found one with an open front door and an open side door at night. Neither one had a full time attendant. You have to wonder who could just walk in off the street and if patients could wander off without being noticed.)
7) What provisions do they have for patients with vision, hearing or language concerns? My mother is legally blind and has diminished hearing. She also needs to have nursing and therapy care from someone who speaks English very clearly because with her poor hearing, she can't understand anyone with a thick accent, which is common in our area.
8) What can or should your elder bring with them to rehab? I needed to know what to pack for her transfer from the hospital to rehab. For therapy, will she need exercise clothing? Will she be able to wear her own gown and robe? Should she bring her own wheelchair and walker or will they be provided by the facility? If she brings her own equipment and clothing, how should it be marked? (My father was in a nursing home for nearly two years before his death. Even though his clothing and belongings were clearly marked, any of them disappeared. I found his quilt on the lap of another wheelchair patient and when I questioned the floor nurse, she became belligerent and defensive, asking how I could be sure. Since I created the design and quilted it myself, and wrote a message on the back with his name and mine, she had to admit that it was his.)
9) Does the facility have insurance for theft or damage? After my father's Alzheimer's had made him unaware of his surroundings, his expensive hearing aide was dropped an stepped on my one of the staff. We found it in a paper cup in his nightstand in pieces. No one would admit to the accident and without him being able to respond to a hearing specialist to create a new one, he became even more isolated by his deafness.
10) Insurance coverage. Be sure you know what your patient's insurance will cover and for how many days, so you won't have any unpleasant surprises. Medicare requires an in-patient rehab to have daily access to a physician and 3 hours of physical therapy per day. If you have supplemental insurance, they may have restrictions of their own.
11) Ask about special medications and supplies. If your elder has a specific medication need, like mom's Forteo, an osteoporosis medication in an injectable pen, you need to find out if the facility can order it. Mom's medication is expensive and not normally available through pharmacies. It has to be a special order. Will you need to bring the medication from home? Supplies may also need to be checked. Mom has regular deliveries of her ostomy supplies and has tried many types and brands over the years. She has only found one that works for her, so I had to ask if they could order those supplies from our regular medical supply provider. (Hospitals, rehabs, nursing care facilities, and even home health care agencies are responsible for providing these supplies under Medicare.)
12) Get a card from the facility representative. You will need to know what to tell the case worker in the hospital so they can contact the facility when your elder is ready to be transferred. (Note:Medicare does not cover transfers. If you cannot transport your patient in your care, you may need to contact your nearest council on aging for the names of volunteers, non-emergency ambulances, etc. Your hospital case worker or the facility administration may also have services you can call.)
13) Ask if the case worker or therapist will be doing an in-home evaluation before discharge. This is done in advance to ensure that if the patient needs equipment at home, such as a wheelchair or commode chair, it can be ordered and be in place when the patient arrives home. The case worker will also help you set up home health care if it is needed.
14) Final word. Once you have narrowed down your choices, be sure to contact your state medical board and your local Better Business Bureau to ensure that the facility hasn't had any complaints. If you have any fears of abuse, neglect, or even billing disputes, you should cross that facility off your list. (I would write a letter to the facility naming the problems you found, including any complaints you learned of. Be polite and tactful. But the administration can't, or maybe won't, make any changes if they don't understand why you didn't chose them. They need to know what they did wrong or there is no chance that it will be corrected.)
I hope these suggestions are helpful in selecting a rehab center for your elder. If you have any other suggestions to add, please comment to this post. I would love to hear from you.
Take care of yourself and those you care for.
Kathy F
Other suggestions re. finding rehab center:
>> Definitely, drop in to visit at odd hours (without calling ahead), especially at night. There often is a big difference between staffing at night ... and during the day. See what it is like between the evening meal and bed time, when the staff is being pulled in all directions. That is often the time of most frustration. Do people have things to do, or are they bored waiting for hours to get assistance to go to bed? Also, if you plan to often visit at night, be sure you, personally, feel safe in parking area after dark.
>> Ask local clergy (they often visit their own people at rehab centers) if they have any insights or comments about what they've seen. They may also know people who have been there recently, to get their feedback. Check if the church (or a local women's club or other association) has an email contact list, which they could use to blast a message out asking for suggestions on which rehab center to go to. Often, the best insights are from former (and current) patients or caregivers who have been there daily. Don't hesitate to stop and ask current patients and visiting caregivers for their input, when you drop in for a visit. I've held many such conversations in the parking lots, too. Ask doctors (family and surgeon) if they have seen a difference in the recovery rate (especially for that particular surgery) from one rehab center over another.
>> I asked the caseworker at the hospital what rehab facilities had the best reputation. They aren't supposed to officially sway anyone, but often will provide insight, on the side. I asked her, if I was in a rush (as I was), what order should I approach the list she gave me. I learned that the best rehab facility in the city would not accept my elder Mom ... but that the lead rehab MD there also was the lead rehab MD at another facility, which we chose. Glad we did.
>> Do they have a wall display of recent successful rehab stories?
>> Key: Do you see people there being kind to other people?
>> What are the rules for quiet at night time? Daytime? Can the person across the hall have a TV blaring (because he is hard of hearing)? Is there a noise cut off time? Are patients required to wear a headset, or keep the TV low after 10 p.m.?
>> I stayed overnight by Mom during her first few days and nights at the rehab center, after her strokes. Very glad I did: I believe my being there flagged to the staff that I was always going to be watching and aware. Meanwhile, I made a point of being kind and thoughtful to all staff and patients. (At that time, I was amazed how outrageously noisy it could be at night time, if I didn't ask the staff to hush the TV across the hall at bedtime. Mom had perfect hearing.)
Posted by: Intrigued | October 09, 2008 at 11:09 AM