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Aging Happens: Ins and outs of SNFs

A skilled nursing facility (given the acronym SNF, as in “sniff”) is often the next step in recovery after a hospitalization. They are part of the whole system of health care delivery services that we have come to accept as normal and necessary. No doubt, they have a vital function to perform for their patients and residents. But what most people do not know is that they are rated by Medicare and that you can compare the local SNFs in many categories. This link, 1.usa.gov/1OYf4HH, will actually allow you to see how the five local SNFs rate in areas such as health inspections, overall ratings, and many details that might surprise you. On a 1-5 star rating, here’s the current overall rating for the local SNFs:

• Hearthstone Nursing and Rehabilitation Center, 2901 E. Barnett Rd., Medford, OR 97504, 541-779-4221, one star;

• Avamere at Three Fountains, 835 Crater Lake Ave., Medford, OR 97504, 541-773-7717, two stars;

• Avamere Health Services of Rogue Valley, 625 Stevens St., Medford, OR 97504, 541-779-3551, three stars;

• Linda Vista Nursing and Rehab Center, 135 Maple St., Ashland, OR 97520, 541-482-2341, three stars; and

• Rogue Valley Manor, 1200 Mira Mar Ave., Medford, OR 97504, 541-857-7777, five stars. This is listed as one of the local resources, but it is really designed for their residents. In some rare instances, they might have a bed available for a community patient.

Here’s what happened at one of these SNFs recently. Doris was receiving rehabilitation following a fall. She needed physical therapy in order to strengthen and become more stable again. The plan was that after a short stay, she would return to her own beautiful home, where she would be assisted for a few hours a day by caregivers. This was not the outcome.

Instead, she somehow got a serious infection in the SNF requiring strong antibiotics. This led to more medical issues and she was feeling even sicker now. She lost her appetite and did not have enough strength to get out of bed any longer. She really disliked being there (this is an understatement) and wanted to be somewhere else. None of her conditions were considered either life-threatening or required actual medical interventions, beyond oral medications. For the most part, medications can be given in many other settings. Plans were made by her professional/family team to transfer her to a licensed adult foster care home, where with only five residents in total, she would receive more personalized care. Unfortunately, the SNF saw things differently and it looked like they were going to resist her discharge from their facility.

The SNF will tell you that their decision to not discharge was based on her medical conditions. Other points of view saw this differently. The nurse who provides services to the foster care home was certain that none of these ailments needed a skilled medical facility, and that Doris’s needs would be appropriately managed at the foster care home. However, despite this information and Doris’s wishes, the SNF had just requested and received 10 more days of payment for services from Medicare.

I heard about similar situations from a nurse who used to be an administrator at another SNF some years back. She told me that in fact, as a for-profit business (which these SNFs are, except for Rogue Valley Manor), they actively encourage legitimate ways to retain patients in order to secure additional Medicare payments for services. I’m sure they also care for the medical needs of their patients. However, these are businesses after all, and healthy economics is how they stay operational.

Now I can’t tell you that the SNF did not have Doris’s best interests at heart, medically and otherwise. I do know that it took no less than nine people (professionals and family members) to have the SNF finally agree to discharge Doris to the foster care home. Once she was graciously settled into her new surroundings, she began to feel a lot more at ease. She immediately started to show signs of improvement and was much happier. Hopefully, she’ll recover enough strength to return to her own home at some point.

Skilled nursing is necessary and much needed in many circumstances. The people themselves who work there perform many of the most difficult tasks we do for one another, without a high level of financial compensation. Their work needs to be respected, honored and appreciated. If you find yourself in this situation, be aware of what the facility has to offer, make wise decisions and be alert to how things operate, including discharge. Having a strong advocate at these times is always a benefit.

Ellen Waldman is a certified Aging Life Care Professional. Submit questions about aging and Ashland-area aging resources and column suggestions to her through her website, www.SeniorOptionsAshland.com.