By Amanda Nafzger, RN
Director of Nursing
Arlington Court Skilled Nursing & Rehab

The idea of a skilled nursing facility has evolved dramatically in the last decade. No longer are nursing homes thought of as they were in the 70s and to be a forever home for an elderly patient. They are now the place that a patient would go to to receive therapy services, medical oversight, respite stays, hospice/palliative services, and a lot of other services.

Typically a patient goes into the hospital for an acute or chronic condition that has caused a disruption in their everyday life that may require them to receive therapy or medical oversight before discharging back home. The hospital will make a recommendation to the patient/patient’s family on what the next step should be. If the next step is for them to be discharged to a SNF then they will be provided a list of SNFs for them to pick from. The best advice is to call these SNFs to see what kind of patient’s they are able to take care of adequately as this varies from facility to facility and then make sure you tour the facility to ensure that the environment is where you would want to be or have your loved one placed.

The push from the insurance companies is to get the patient in and out of the hospital as quickly as possible which puts the patient at a greater risk for return to hospital so you want to make sure the facility can truly handle the patient safely. At Arlington Court we get a number of patients with several different medical issues such as mental health exacerbations, increased weakness, recent CVA, dementia/Alzheimer’s disease (for our secure unit), UTIs, blood clots, anemia, dehydration, recent surgeries (knee replacements, hip fractures, ortho infections, external fixators, amputations, CABG, etc.), patients requiring IV ATB for an extended amount of time, new ostomies, new gastric tubes, new suprapubic catheters, recent or old TBI, Parkinson’s patients that require maintenance therapy, CHF, recurring falls, Diabetes management, and several others.

We start the plan of care as soon as we get the referral from the hospital and send a clinical liaison who is a nurse to meet the patient at the hospital to ensure we can adequately meet the patient’s needs. When the patient is admitted to the facility we obtain baseline labs to ensure that the patient does not have an active infection, dehydrated, not anemic, or need anything preventative immediately. Myself and the therapy manager meet with the patient daily so that we can notice any acute changes day to day. On the weekends a clinical manager is there who meets with the residents daily looking for those same changes. If there is a concern, we are able to get labs, x-rays, initiate IVs, obtain ultrasounds, give new medications all in house as soon as the physician orders it. This is all to keep the patient in house so they can continue the plan of care because every return back to the hospital delays the goal to getting back home.

As an example, if you or your loved one has CHF, we would have them receive therapy daily, they would get weighed every morning at the same time and utilizing the same scale. We would follow the low salt diet prescribed by the hospital and have our dietitian educate all parties on recommended foods. We would monitor for swelling of extremities and face. If we noticed a change we would notify the physician after the nurse performed a head to toe assessment and recommend stat labs such as a BNP (this shows is they are in active CHF), get a chest x-ray, possible IV push Lasix to get the fluid off, get a weight immediately, we would also notify their cardiologist to get an appointment scheduled, and notify the family of our concerns/the plan of care.

There are several things that can be done in a skilled nursing facility that do not require a patient to go back to the hospital and promote a safe discharge back home after the patient’s SNF stay. Facilities have gotten to the point that they have several capabilities to care for you or your loved one adequately and keep them in a healing environment that does not disrupt their progress they had made thus far. At Arlington Court we are also able to directly admit back to facility rather than you going to the hospital if you are unsuccessful at home and require more therapy within 30 days of discharge depending on your insurance so you can come back to an environment that knows you personally and you are accustomed to. With the advances in healthcare, here at Arlington Court, we have adapted to institute a home like environment that focuses on treating patients in house to create the best possible outcomes in a situation that no  one would like to be in.