Anyone have experience with after stroke care?

[ddi741]

Tomorrow we are going to be touring some rehab  / skilled nursing facilities.  My grandmother recently had a stroke and the hospital gave us a list of places to check out.

I'm not really sure what kind of questions to ask.
Are they gov't rated? state rated?

Some questions I thought of
How often she gets therapy
Other than physical therapy and occupational thereapy are there other programs, (maybe music therapy or something)
Visiting hours


I am going to try to google some ideas also but I figured I throw it out there incase anyone has had experience with this.

Thanks!

[Deleted]

Medicare offers this checklist: www.medicare.gov/nursing/checklist.asp

Did your grandmother's physician recommend a rehab facility or a skilled nursing facility (SNF)? Expectations for either are very different. I am currently completing a clinical practicum at an inpatient rehab facility (speech-language pathology student), and our patients receive 4-5 hours of therapy every day. it's really tiring for them but they're judged to be able to keep up with the rigorous demands of intensive rehab.

ETA: and of course good luck! 

[ddi741]

The doctor's gave us a list of centers. The heading says "Skilled Nursing Facilities" The preferece is to have her in the one that is attached to the hospital but just in case there aren't beds available we are going to look at a few others.

Thanks for that site!

[Deleted]

Got it! The demands on your grandmother won't be so high in a SNF.

I completed some observation hours at a few different SNFs in Indiana a few years ago - each one was very different. The longer you can "hang out" the better picture you will get. Certification and logistics will be important to ask about, but really see if you can observe patient/provider interactions. Some of the highest things on my list would be 1) are the patients well-groomed/cared for? 2) do they seem relatively happy/content? 3) do the nurses seem relatively happy?

[pugz]

I'm a hospital social worker and transitioning patients to rehab/SNFs is a big part of my job.

There are two different kinds of facilities: acute rehab and skilled nursing.

acute rehab:
-often housed in hospitals, although some are freestanding.
-strict medicare guidelines based on diagnosis to get in, strokes are an accepted diagnosis pretty much always.
-patient must be able to tolerate 3 hours of therapy a day (combo of physical, occupational, and speech)
-average stay is 7-14 days, medicare gives a number of days upfront based on diagnosis and covers only these days (typically at 100%)
-some patients are able to go straight home afterwards with home health, others go on to a SNF for additional therapy.

skilled nursing:
-rehab unit within a nursing home (most nursing homes have several wings, dementia/alzheimers wing, long term care (people that lived there long term), and skilled/rehab.
-medicare has looser guidelines for admission
-90 minutes of therapy a day, but if patient can't tolerate that much they start with less, medicare doesn't dictate #of minutes like they do at acute.
-medicare covers the first 20 days at 100%, next 80 days at 80%. No set days given up front, it's basically as long as the patient needs and is still showing improvement. Secondary insurance typically picks up the part medicare doesn't cover, depending on the plan.

medicare.gov has ratings for these facilities, but they are often skewed and I would not base a decision solely on the ratings. Touring the facility is the best way to decide. Ask to see the patient's rooms, find out if a private room is available (no extra charge under medicare for private room), ask to see where they do therapy as well.

I can't ever tell a patient where they should go, but I can give a list of facilities that families often choose in my area and that I often hear good things about. Even if I hear bad things about a certain facility I can't really share that, although sometimes I can say something vague like "i hear more bad than good".

[pugz]

oh and when you tour facilities, don't schedule ahead of time, you need to just show up and see what it's like when they aren't expecting you.

[Deleted]

The State Department of Health is the main governing body over nursing homes. Obviously they also have to follow federal laws and regulations, but the state is the biggest overseer of nursing homes. They generally are the ones who audit and rate them. Many states have the results of the audits on the Department of Health website.

How much therapy and things of that nature will be dependent on your grandmother. If she needs physical/occupational/speech therapy they will give her therapy, some patients require more than others. They should develop a plan of care for each patient, what kind of therapy they specifically do (re: music) would depend on whether or not they think that would benefit her.

The nursing home should have an activities department. They generally have a schedule of activities ranging from music, to crafts, to outings. It's not actually considered "therapy", just more along the lines of daily activities. You can request that they try to involve her in these activities as much as possible and even go in and do the activities with her.

In my experience most nursing homes these days do not have set visiting hours. I would still ask though.

[ddi741]

Thanks this is all very helpful.