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
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
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.
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