My brother recently needed to stay in a skilled nursing facility (SNF) for two months. My brother. Not my mother.  Not my father. Not my Great Aunt Josie (not that I actually have a Great Aunt Josie). My 43-year-old-brother.

Robert is disabled due to uncontrolled epilepsy. That’s not exactly why he needed to stay in a skilled nursing facility, however. The short version is Robert kept getting serious staph infections after an epilepsy-related surgery and was going to require a six week course of intravenous antibiotics. This is where the skilled nursing facility came in.

This experience was, for me, a crash course in the language of skilled nursing, residential care and all the medical jargon you can imagine.

Of course, Robert’s not the first person to enter a SNF nor will he be the last. Robert may be unusual as far as the age range of the population at SNFs, but the population in general keeps getting older and many of us or our loved ones will require skilled nursing care at some point in our lives.

My crash course involved figuring out how Robert can be a good patient, how I can be a good visitor and how the SNF can be a good caregiver. The good people at the skilled nursing facility with which I am familiar helped me create this list, but it certainly could apply at all SNFs. As one administrator said, “Good outcomes only occur when there is communication and partnership to the care.”

Realistically help manage your pain
If you felt well, you wouldn’t be in a SNF. People go to SNFs to recover from knee or hip replacement surgery, to receive i/v antibiotics, to transition from intense hospital care to a slightly lower level of nursing care and, hopefully, eventually back to home or to a residential care facility. Many times, patients are in pain and require pain medication. One guideline for patients is to help the doctors and nurses manage the pain effectively. Don’t cry wolf by asking every ten minutes for more pain pills. Work with the doctor to be sure the dose is adequate for the pain and there is a plan for breakthrough pain.

Have patience with the staff
Realize the staff has many, many patients and are on a schedule to give high quality care to all of those patients. No day is like any other because there are always unpredictable emergencies, but there are meals to give out every day at particular times; medicine to be carefully sorted and charted and given to patients several times a day; showers and restroom assistance to be given as well as physical therapy and doctors’ visits to be scheduled. Have patience if butter didn’t come with your meal and you’ve politely requested it, but it hasn’t come when you would have liked. Have patience with the nurses as they count and recount the dosage of the medication to be sure each patient receives the correct medication. Have patience.

Be involved in your recovery
The administrator reiterates, “The partnership involves the resident as they need to be receptive to care as well as staff from the facility.” If you need physical therapy to improve, don’t resist your physical therapist.  Be involved and be honest with your therapist. If the pain is too much, maybe the time of your session can be adjusted to better suit you. Communicate with your therapist so they can give you the best care for you and your situation.

Being the Good Visitor

Get to know the caregivers
It is crucial to establish a rapport with the caregivers. Know who is taking care of your loved one. Working in a SNF takes a certain caring type of person and it is not always pleasant work. There are cranky patients, diapers and beds to be changed and sometimes, oozing wounds or sores that need to be carefully handled and managed. This is difficult work and it does not hurt to thank someone for being kind or to know them by name. Bringing the occasional baked goods as a way of thanks doesn’t hurt either.

When necessary, talk to the caregivers about a problem. Some are easily resolved, some may need to wait a short time for the maintenance person to fix. The administrator stresses “families need to advocate for their loved one.” The care facilities expect families to communicate with them about any perceived problems or issues. To help ensure success in resolving issues, start with the assumption the caregivers care about your loved one (they do).

Know the shift change time
I am guilty of not following this simple rule! It was actually unintentional, but I picked up my brother for discharge during a shift change. The caregivers were still very accommodating, but it created extra work during an already chaotic time. Knowing the shift change will also allow you to talk to nurses during less busy times. If there is one particular person who is relaying information to you, know his or her shift so there is not frustration when this person does not return the call for hours.

Have patience with the patient.
Your loved one is in pain or, if they are getting better, probably bored out of their mind. Encourage them to participate in the activities at the SNF, but also bring them things to do when you aren’t able to visit (crossword puzzles, books, magazines, a deck of cards). When you are visiting, take them outside to get fresh air if possible. Push them around in a wheelchair or walk with them for a change of scenery if allowed. Play cards with them. Talk with them about your day and people they know and miss. Bring pictures for their room. Visit as often as possible. Patients who have visitors are known to heal more quickly than those who do not. While you’re visiting, don’t be afraid to say hi to some of the other patients. A smile and a hello to someone stuck in wheelchair (possibly not even aware of where they are or why) never fails to get a return smile or a twinkle in their eye.

Being the Good Caregiver

Know your patients
It was always heartwarming for me to see most of the people where Robert was staying knew him by name and acknowledged him when they saw him outside of his room. They knew he had seizures and took great care to ensure his safety. They were diligent about calling me when seizures did occur. They were caring and compassionate; not only with my brother, but with the other patients as well.

Leave your personal problems at home.
There are some jobs where it doesn’t matter if you’re cranky because you got into a fight with your boyfriend or your car wouldn’t start that morning. These jobs do not involve serving sick people. When your job is to give the best possible care to someone, there is no room for snippy comments or cranky behavior. Yes, it is not enjoyable to change an adult diaper, but do not make the patient feel bad for being in that position. No one purposely decided to have their body turn on them and lose control. I’ve seen aides change a patient’s diaper with love and care and without leaving the patient feeling embarrassed or ashamed. That is a skill you cannot teach, but it is one to aspire to.

Communicate with the patient and their family Communication is essential to giving good, quality care. The family needs to be kept informed about treatment, physical therapy, medication changes and discharge plans. The administrator adds, “We need families to help with the transition to our facility and the transition back home.” There cannot be too much communication. If the SNF doctor is too busy to talk to the family directly, someone should be appointed to be the person relaying information. Calls need to be returned in a timely manner. Ongoing communication during the patient’s stay will improve the care of the patient, speed up recovery time and make for a smooth transition out of the facility.

All aspects of the patient’s care are integrated and, if handled effectively, will speed recovery. The skilled nursing facility administrator says, “I always emphasize the partnership aspect for the care of the resident. It only works when we have a supportive family, a family that will be by the resident’s side during therapy, meals and care meetings.” These tips are just a few of the ways to help that process along.

Trish Hughes Kreis is a freelance writer, full-time legal administrator, mom to three wonderful children and wife to one understanding husband. Trish coordinates the care of her youngest brother, Robert, and has managed to persistently slog through the maze of social services and government programs available to help her brother.

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