 Greetings and welcome to this episode of Quality of Life. In this episode we're going to talk about skilled nursing centers and what services they can provide for somebody when they come to their lifetime, where they are looking for such services. Today joining us is Michael Frey, who is administrator for Meadowview Manor Skilled Nursing Center. Welcome, Michael. Thanks, Dave. Nice to be here. Thank you. Before we get started, could you give us a little bit of your background as far as how long have you been involved with the nursing center? Sure. I've been with Meadowview Manor for just over a year, but I've been in long-term care with the same company Extended Care for just over eight years working on my ninth. My background is I got my license as a social worker, and that's what I started my career off as. About a year and a half ago I got my license as a nursing home administrator, and that's where I'm at today. What type of services does a skilled nursing center provide? Well, I think a lot more than what most people would think. We offer a wide range of services anywhere from a short-term skilled setting to more of a long-term setting where we're going to help all with activities of daily living, helping those who are battling chronic conditions. So we assist with addressing the grooming, the bathing, tasks that they might otherwise have difficulty with at home or even with the support of their family. In the short-term setting, what our goals are is to get people back home. So we have a number of services from occupational therapy to speech therapy and physical therapy, which probably most people are familiar with, and our goal there is to get a person back to their prior living ability so we can get them back home or back to an assisted living or wherever it is that they would like to live. Okay. What should I do about, you know, if I want to choose a nursing center? Good question. I think there's a lot of things that you have to take into consideration. One, what I would recommend doing is hopping on the internet and doing some research first. I would take a look at the CMS website, and it stands for the Centers for Medicaid and Medicare Services, and they do a real thorough evaluation of all the nursing homes in the United States. It's based on a five-star ranking system where they rate each nursing facility, our skilled nursing facility, up to five stars on their past survey history, their staffing ratios for RN coverage and LPN coverage through your direct hands-on care, as well as for their Q metrics, which is a number of different components, anywhere from pressure sores or incontinence or pain management, a number of things that we get measured on as a skilled nursing facility to manage and improve upon. So hop on that website, and you can find that website actually on it's www.medicare.gov, and take a look there. That's where I would start. Once you've narrowed it down to maybe three or four skilled nursing facilities, and I guess going back for a second, I would look at the facilities that are five stars, four stars, and maybe even the three-star facilities. Once you've narrowed them down, location obviously might be important, because you'll want to be able to visit your loved one and not have to drive miles to do that. So that might help narrow it down again to maybe two or three. Now I suggest stop in that nursing center, take a look at it, and maybe not even give them a call, but just drop in so they're not expecting it. Sometimes I wonder if skilled facilities, if they're expecting it, they're going to try to pretty it up a little bit for you. Just drop in, see what it's like when they're not expecting you. See what the meals are like, maybe have a meal there. I know most skilled facilities will invite you and they'll have a meal. That way you get a taste of what the food is like. See what the activities are like. Make sure that they have a calendar with a number of events going on throughout the day, even on the weekends, so that the residents of that facility have things to do. I think that's real important for their psychosocial well-being, and I think it's important for socialization. It's important for a number of reasons. So you want to make sure that the meals are there, that the activities are there, and then you want to see how the staff is interacting with the residents and with each other. Are they calling them dear or sweetie or honey? Do they really know their name? I think that's very important. And you've got to weigh your options. Sometimes people go in and they find these big beautiful centers, and there might be a lot of residents in those centers where they might feel a little overwhelmed. For some, they might really enjoy that. For others, they might be looking for a smaller setting, kind of that little mom-and-pop shop. So it's weighing some options, seeing what you feel comfortable in. Once you've done that, have a chance to sit down with the administrator, with the business office manager, and get some information about the place, a little background. I think that would probably be the most important places to start. Okay. Do they offer references as well? Say if I came to your facility and say, could you give me some references as well for people to check? Is that usually done? References? Let's say if I have one of my family members who wants to go to a nursing home, and I'm doing my research, and I say if I would approach Meadowview Manor, could I ask, is there any references like other people who have stayed there or whatever other families? Is that usually done or not? Yeah, what we try to do is get testimonials throughout a person's day, both long-term and short-term, so you get a good idea of what some of our long-term residents are going through, as well as our short-term residents, you know, the things they liked, I mean, if they had some frustrations. That way you get a whole picture of their stay at one of the particular facilities. So most places are going to have something similar to that. Okay. You had mentioned CMS in their website, you know, in healthcare, which is definitely what a skilled nursing center is part of. I used to work in a hospital. Okay. And we always had routine surveys like Joint Commission would come in, which they would do it for all the CMS in your benchmark measurements that you had to submit. Are those similar surveys that happen on a routine basis in the skilled nursing center, as well? Yeah, actually, every nine to 15 months after the facilities last survey, they go into what's called a window, where at any time during that window, they can expect another annual survey. And then a team from either the Madison Green Bay or Milwaukee area will come in, excuse me, for a few days, three, four days, and they will do a complete audit of your facility. They'll look at the cleanliness. They'll look at some of those key metrics I was talking about. They'll look for infection control policies, procedures, how they're ruled out and deployed throughout the facility, and the competency of the staff. So they do that roughly every 12 months. Absolutely. Okay, thank you. Okay, so I've chosen a nursing center, picked one I want to move in. What's the average length of stay for somebody who's going to be there? That too is a good question. I would say that's a real hard question to answer. And it depends on what you're coming in for. We do see a lot of people coming in after a hip or a knee surgery, so like post-orthal. And it's going to depend on your physical ability, you know, how active you were prior, maybe some of your current ailments, and how you respond to the therapy. I would say for a patient that's coming in with a hip or a knee, it could be anywhere from a few days to a few weeks. I think it's a pretty common length of stay. Some other patients are coming in, say with a CBA or a stroke. They might want to utilize a little bit more of their benefit, their Medicare benefit, their manicure benefit, and stay a little longer. One interesting statistic that I could give you with stroke is that 90% of your rehab comes within the first 90 days. And the remaining 10% of what you're going to get back after a stroke comes within the next two years. So if Medicare is offering up to 100 days of skilled service, I think it's really important for those folks to try to capture as much rehab as they can before they no longer meet the criteria for skilled care under the Medicare guidelines, which there's a nice complimentary of staff there that help determine what your benefits are and keep you aware of that as you continue on with your therapy process. And that's a good point you bring up on what your range of benefits are, because when my wife had her stroke, it was the insurance only paid for X amount of days in rehab and then that was it. So like you had said, take advantage of what you can. And then hopefully with the work that was done in the rehab, it'll bring the rest. And like you said, that can last up to two years with the exercises they give. Along with that, is the skilled nursing senator used for, let's say, an end of life sequence? Say if you have a terminal disease and is that something that the skilled nursing center would also facilitate or is that more of a hospice type function? Well, actually our skilled nursing facilities today, more so than ever, I think, are working with the hospice agencies trying to partner up because these skilled nursing facilities can supply that 24-7 care. In hospice, what they're doing is they're coming in and adding to an already great service by bringing in a team of nurses and social workers and chaplains. So it makes that experience for the family, for that patient as easy as that process possibly can be for that person. It is a very difficult time but having that partnership with hospice certainly makes that process much more easy. Okay, so I know I realize I have to, I want to look for a skilled nursing center. We already talked about some of the things I should do in choosing one. Is there any other type of research that I could do or anything else I should look at before really approaching the facility or requesting a tour? Yeah, I would say. I forgot to touch on this earlier but there are awards that skilled nursing facilities can achieve. One of them is the A-H-C-A-N-C-A-L Award. It's a real prestigious award. It's based on the Baldridge Performance Excellence Program which holds a very high standard of quality care that a facility needs to meet to achieve this award. Currently, Metal Humane Red just received the Silver Award This award goes in three steps. You first apply for the bronze and then the silver and then eventually the gold. In applying for these, you have to write a paper explaining your quality assurance programs, what you do when you see an area of deficiency and how you correct that and then how you deploy that throughout your staff which is I think so incredibly important because it's one thing for your senior leaders to really understand how to facilitate or take care of an organization and its residents but if your front-line staff who I think are probably your most important employees the ones taking care of mom and dad if they don't know how to do it it does know good. So understanding how you deploy those practices down to the line staff, the front staff is what these awards are all about and like I said for 2014 Metal View Manor was able to capture that silver award through our deployment processes. So excellent question. Yeah and with any organization really you build quality into your processes and it just doesn't start at the top with somebody with an idea it's got to be top to bottom side to side you know in and out everywhere and that's what makes a true high performance quality organization and that's in any industry really. Exactly. So excellent. No I mean it's one thing for your staff and dietary to understand residents' preferences if they like the grilled cheese or the hot dog but it's equally as important for them to know you know what foods are important for skin integrity weight management a whole number of different things you talked a little bit about hospice earlier and the different types of foods that we're going to serve to somebody on hospice opposed to someone who is looking at maybe trying to lose weight or has different goals in mind. So having everybody in the facility from housekeeping to dietary to nursing and maintenance all be on that same page always looking for improving quality absolutely important. I know in the joint commission training that I went through one of the things is first impressions is always the key to everything and then the training we took and you know that's why going on a tour you know doing research first then going on the tour you know that's what they says you know it's quality got to be all the time it's not just here there it's got to be 24 by 7 top to bottom everywhere because you know it could be a squeaky wheelchair or you know some little tile out of place in the ceiling and that leaves the you know lasting first impression which can be a you know effect whether they decide to come to a facility or not. Yeah. So if I choose and I get accepted and I'm on my way what are the methods that I can use to you know pay for the service? Well there's a wide range of benefits that are available to people. I think the big one that most people are probably going to be familiar with is their Medicare benefit Medicare Part A and B and D. D is your drug plan B is where your therapies are going to be paid from and then Medicare Part A is what your room and board and your medications are going to be paid from excuse me the medications through D but your room and board there's also going to be managed care programs now those are those are the Medicare replacement policies I think which are becoming more and more popular I wouldn't want to give any kind of recommendations on what is better or sure or what's going to suit that person but certainly you know going down to the ADRC and speaking with somebody there they can help they can help guide you there which I think is real important because those policies are so confusing but we also have a very young population coming into us too needing a hip or a knee surgery and they're bringing their commercial insurance is in with them from where they work which we will run those benefits just like we would with the managed care or the Medicare private pay is also an option most people are hoping that they have some other form of insurance but private pay is certainly an option and for the bulk of our patients that are by us or any skilled nursing facility for that matter I think Medicaid is probably going to be the most relevant and Medicaid is a program that is set up through the state of Wisconsin to help those seniors be able to afford health care and for that again going down to the ADRC and getting in touch with someone to apply for medical assistance would be important there and that's where you we're having a business office manager at a skilled nursing facility is so important because she will help or he will help you through that process there's so much paperwork and it becomes very confusing as to all the information you need and to have that person that does that day in and day out help guide you and lead you through that and it makes that process very easy and seamless and not that you miss anything along the way that's interesting paperwork it seems like everywhere you go there's paperwork you know in a society that's supposedly electronic with smart devices you know it seems like we have just as much paper as before it's unbelievable yeah we fill the stuff out so that's just a side note to me that's my IT hat on so to speak yeah as far as that goes no I know a lot of facilities are like you said they're going paperless with the EMR processes trying to get everything on record but yeah it definitely doesn't eliminate all the paperwork okay are there any certain dietary restrictions or that you you address through your care or your plans or let's say allergies or certain you know other types of circumstances that you know a patient may be coming into you to see what do you do for that or how do you handle that well that too it's it's a process that's completed by our interdisciplinary team which involves our nursing staff or dietitian who plays a very integral role in that part that that person's primary physician and the team is a whole so what we want to do is we want to A. look at what their goals are and then B. provide them with what is the safest most appealing diet to them so we do offer the different types of consistencies if that is needed whether that's mechanical or puree diets grinding the meats the foods up a little bit finer easier to swallow we also offer the different consistencies of liquid so we can do just the the thin liquids or the the honey or the nectar the liquids that help prevent any type of aspiration if there are swallowing issues which we also have a speech therapist there that works hand in hand with that to help a person try to get to the the most whole solid foods again and thin liquids that you know most people are going to want to prefer but we do all offer the the no added salts the controlled carb diets a wide variety of different diets but again it's it's driven by the patient and the dietician at the facility and their doctor so we have care planning meetings upon admission and then at least every 90 days after or more if they ask or we feel it would be necessary to sit down and talk about those things talk about you know what are your goals have they changed you know are you happy with your diet upon admission we also take down people's food preferences so we can kind of customize a meal to them so so we're so we're serving things that people want so if I want steak and lobster I can get that absolutely nice we would work with you I got me hungry you'll have to go out later there you go but we do do that we come up with you know your preferences and now we also have an alternative menu so once you get to lunch if you see on the first option and the second option that it's just not it's not what you want that day we have this alternative menu and I think a number of facilities may have this and it's something worth looking at when you go in for your tours but an alternative menu so can you get at any time of the day could you get you know different soups or sandwiches or salads or eggs or fruit vegetables different things that you know if you're not interested like me who's a very picky eater might not be interested in what's being served that day so I can still call Domino's or Chinese absolutely and we do have that and you should I think when people come to a skill nursing facility they come in there to live and I think that that sometimes there's a misconception that that's not why you're coming there right you're coming there to live and you should treat that as your house you should you should want to do the things that that you've always done so yeah if ordering that Domino's Pizza is going to make you happy on Friday night pop in a movie and eat Domino's absolutely you know let your nurse and I'll let your doctor know this is what what my preferences are this is what my goals in life are this is how I want to care plan the rest of my life and and live it live your life to the fullest and they'll let you know what the consequences of that are they'll educate you on that and you can wear those options but I I think there there has to be a balance of health and quality which I think is so incredibly important and then then definitely tied to the associated care plan that's been developed as well absolutely as far as that goes absolutely with that you know the the continuation of care so if I transfer let's say from the hospital to a skilled nursing center for the reasons and then do I still get to see my own physician or is there a new set of staff and physicians or how often can I still see my physician well good question you got a you got a number of options there too every facility is going to have a medical director that oversees that entire facility if you come in if you're coming in from out of out of state or out of the area maybe families here and you live in Tennessee so you come in here to be close to family we have our medical director that will take on your care so maybe upon entering into a facility on a tour that's another good question to ask you know who is your medical director you know where where are some of your policies coming from because he helps play a role in that sure if you're coming in locally you're here in Sheboygan most doctors are going to round out all the facilities some maybe have a select few that they go to because it's it's very time consuming to see maybe every facility in town but but a large number of physicians are going to tour at each center so keeping your own physician is is there's a very very real chance that that could happen and then what happens is while you're at the hospital you're in pretty critical care and that doctor needs to be there and that's why you are in the hospital so that doctor can see you every day or multiple times a day see how things are going after a couple days or a few days or even a week if it was severe enough they're going to discharge you to a lesser skilled setting like a skilled nursing facility where where it's still very acute but not to the same degree as a hospital and that doctor then is saying at that point you are you are stable enough to be seen less often and through the the vision of the nurses maybe nurse practitioners that round at that center who are very trained very skilled individuals and that report back to that doctor during your stay at the skilled nursing facility that doctor will come see though at least once within the first 30 days and then the next two months after that by state law then after that it's every other month with a nurse practitioner subbing in and again it's a lot of communication from the patient to the nursing staff the CNAs to the nursing staff and updating the doctor and keeping him aware of what's going on with any positive changes or even the negative changes so the doctor can then decide to change the clinic here maybe come in for a visit or have that patient be seen at the hospital again like with anything else it comes on a communication you know the transfer of the patient or that handoff so to speak absolutely what we were trained on and there's a number of tools that I think a lot of facilities are going to have in place for that whether it's the S-bar communication tool the interact communication tool there's a number of tools that skill nursing facilities are using in adjunction with the hospitals to improve that communication you talked a little bit about the warm handoffs so there's some real positive changes things that are being implemented in today's healthcare that makes that transition that communication so much stronger and better even some of that electronic records that we have now what are some of the types of therapy services that a facility would provide most facilities you're going to see that they're going to have a physical therapy department occupational therapy and speech therapy those are your three common ones physical therapy I think most people are pretty familiar with it's a lot of strength endurance balance kind of the getting stronger therapy your OT is going to be more of your fine motor skills your activities of daily living so kind of getting ready to get back into the community get back into your house so you might do some cooking some cleaning some dressing bathing toileting things like that so you're taking all the strengths and abilities that you're getting from PT and now you're applying it speech therapy what speech therapy can do and most people think you know I can talk just fine I've been doing it for heximonal years I don't need speech but they also work on cognition and swallowing so it's big so they will work on speech if a person needs that so again going back to the stroke if you need help getting words out memory finding things like that which also ties so closely with cognition but they will help with with word finding problem solving again getting you back to your prior level of function so you can live the life that you were living before your ailment so they do offer the three one thing to look into though is how often are they offering the three are they offering in five days a week or seven days a week I think it's an important question you never want to sit coming on a Friday night and end up sitting Saturday Sunday feeling like you're wasting time so see if a facility can provide it seven days a week can I can I be seen on Saturday Sunday most physicians are going to order for five days a week or most insurance companies are going to cover for five days a week but if you can get started right away that's a good feeling even if then you take off a Wednesday and a Thursday later on that week sure what are some of the activities that are available for people I think you're going to see a lot of skill nursing facilities that they're going to really focus on trying to provide activities for for a wide variety of skill levels from the person who needs the wheelchair for mobility to the person who might be ambulating independently without a walker so you're going to want to come up with different tasks that maybe not everybody could do every task but that everybody could do something which is so important because the focus in the activities which in my center we call it our life enrichment program because what we're trying to do is enhance the quality of their life we're trying to look at their like I said before their psychosocial their social their spiritual needs through activities that are are going to be you know whether it's physical or emotional just a a wide variety of activities to keep that person as content and happy as possible we're about to wrap so do you have any other final thoughts Michael no if you if you ever have a question you know feel free to stop in for a tour myself or another person I'm sure I'd be happy as well as any other facility come in for a tour like I said before probably the most important thing when looking for a skill nursing facility okay well that concludes this episode of quality of life on skilled nursing centers on behalf of the show I'd like to thank Michael for joining us for meta view manor skilled nursing center if anybody has any questions or would like more information you can contact us on our website at www.wscsheboygan.com I'm your host Dave Augustine and thank you for watching