Top 5 Questions You Need To Ask When Touring A Rehab Facility
When you or someone you love needs short-term rehabilitation, it can get really overwhelming really fast. There’s so much information it can seem impossible to know where to start looking!
The good news is that by reading this, you’re already taking the right steps. You have to start somewhere! At this point in your journey, you may be either planning for a surgery or already in the hospital. The hospital staff or surgeon working with you should provide you a list of nearby facilities who can serve your needs, and that will be your starting point. It’s always recommend that families tour the rehabilitation facilities they’re considering. For family members who are helping from far away, we recommend you call each facility and check out the facility’s website. Some facilities have virtual tours that can give you a better feel for their space.
Once you get to tour, there are a few questions you want to be sure to ask. Below are our top 5 recommendations of questions you need to ask when on tour.
Question 1: How much nursing attention will my loved one receive?
Now this gets a little confusing because what most people want to ask is, “What is the nurse to patient ratio?” which makes sense. That’s the measurement we use for a lot situations (ex. teacher to student) and it’s a measurement we’re familiar with. However, the Centers for Medicare and Medicaid Services (CMS), who regulate everything, don’t use this measurement because that would be too easy! What CMS measures, is individual hours of care by licensed staff per patient per day. It sounds confusing but hang in there, we'll explain.
Currently, CMS requires that patients receive 3.2 hours of individual care per day, and as of July 2018, that will bump up to 3.5 hours per day. Now, 3.2 may not sound like a lot, but keep in mind everything that is going on in a day. Most people in recovery require a lot of rest, and are sleeping quite a bit of the day. Your loved one will also be receiving personal therapy from a rehab therapist, daily activities from someone in the Activities Department, and frequently chatting with Social Services to name a few. Additionally, if your loved one requires assistance eating, they will receive additional individualized care during that time. All of that individual care time is not included in the required 3.2 hours. Those required 3.2 hours are spread out throughout the day, so what that means is there should always licensed staff present.
Now, although CMS only requires these 3.2 hours, many rehabilitation facilities staff higher to make sure they can appropriately take care of every patient’s needs. During your tour, ask how much licensed care your loved one will be receiving with this standard in mind. The higher the number, the more that facility is working to make sure your loved one’s needs are met.
Question 2: Do you accept my insurance? What is my copay?
This seems like an obvious question but with all the different insurance plans out there it’s still important to ask! Nearly every nursing and rehabilitation center take Medicare and Medical. Medicare and Medical are generally pretty straight forward, and to learn more about what Medicare covers in a nursing home environment, you can check out our Medicare 101 post. It’s all of the other insurances where things start to get tricky.
If you have a secondary insurance (an insurance in addition to Medicare), first ask the rehabilitation center if they have a contract with that company. The next part of your homework is to call your insurance agency. Because every plan is a little different, the facility won’t know if you have an additional copay until things go to billing, and, if the insurance company won’t cover your care, by that point the bill may have potentially already started to add up. So first call your insurance and give them a heads up about the facility you are planning to stay with. Second, ask them if they have a "skilled nursing facility benefit." At this point, they should be able to tell you how much they will cover, and they may be able to get the ball rolling on your coverage, that way you have one less cost to worry about.
Question 3: How much therapy will my loved one receive?
One of the most popular questions, and a great question to ask. The answer to this question will vary, so it's good to get a heads up about how therapy operates. What you want to know is how many days of the week they offer rehabilitation services, and will your loved one receive therapy every day rehab is open. Once you find out how often they will be seen, you can ask roughly how long each appointment will last and what happens if your loved one isn’t feeling good on a particular day. Does rehab get skipped altogether, or do they modify the workout for that day?
You should also ask what therapies they offer if a person is in too much pain to exercise some days. If you've just had a major surgery it's not unheard of to be in a lot of pain and facilities should have at least a couple of intervention tools besides medicine (ex. heat therapy, ultrasound therapy, etc.) for pain management.
Now as much as you may want to know, it’s impossible for a facility to tell you exactly how long your loved one will take to graduate from therapy. If you want your loved one to receive personalized care, their care plan will need to be uniquely tailored to their needs and abilities. It’s not a one size fits all, and really, you don’t want it to be. It can be a bummer not to have an answer to this question, but at the end of the day, your family will receive better care when it is tailored to their exact needs.
Question 4: What if my loved one refuses to cooperate?
This happens. People get tired and frustrated. This can be a draining experience! But we also don’t want our loved one self-isolating, refusing to take part in therapy, and not cooperating with the nurses’ and doctor’s orders, because then how will they ever get better? First, it’s important that you know about a patient’s rights. Every patient has rights and legally, a rehab facility is required to respect those rights. So if you have someone who doesn’t want to participate, legally they have the right to refuse and we have to respect that. But that doesn’t mean a good facility won’t try every trick in the book to look out for a patient’s best interest and convince them to continue fighting for their health. Ask your tour guide about what interventions the facility takes to make sure someone is staying social and working towards their goals.
Another way to answer this question is by looking around you. What do you see? You want to look for people up and about and in the halls or gathering areas. If people are in their rooms, are they dressed? Are they engaged in some sort of activity? No matter what facility you visit some people will be sleeping, but you want to make sure you also see a lot of active people. This silently demonstrates that the staff encouraged their patients to get up and out of bed, and get engaged in activities that keep them healthy.
Question 5: How does discharge work?
If you’re coming into a rehabilitation center, often the goal is to go back home or to some other more independent level of living. And when you do return home, you probably understand there’s going to be a lot of changes. As if all of the work coordinating a rehabilitation center wasn’t confusing enough, now you have to start thinking about home health, continued therapy, home safety improvements, etc. The good news is, now you’re not alone. As a good rehabilitation center, there should be dedicated staff to make sure your transition home is safe, and that your loved one doesn’t end up back in urgent care. Ask your tour guide when the discharge plans begin. They should begin on the first day of admission. From the moment your loved one enters a facility, staff should be assessing them to find out their goals, and setting up their individual road to recovery. Generally the Social Services department will help you in finding and getting set up with the right home health agencies for your next steps in the road to recovery, along with any special equipment (like a new walker), and answering your other questions and concerns.
And that wraps up our “Top 5 Questions You Need To Ask When Touring A Rehab Facility.” To recap, you want to ask:
1. How much nursing attention will my loved one receive?
2. Do you accept my insurance?
3. How much therapy will my loved one receive?
4. What if my loved one refuses to cooperate?
5. How does discharge work?
Remember, things seem overwhelming now, but you can figure it out and you’re taking the right steps by doing your research. Also remember to ask your own personal questions! It helps us take better care of your loved one when you are involved. Good luck and as always, share this if you find this helpful and call if you have any questions.