Family Living Focus: When a Loved One Needs a Skilled Nursing Facility

Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor
Emeritus, University of Minnesota

Following are tips for a successful stay for the patient, visitor, and
caregiver:

It is important to figure out how your care recipient can be a good patient,
how you can be a good visitor and how the Skilled Nursing Facility (SNF) can
be a good caregiver.  One SNF Administrator said, “Good outcomes only occur
when there is communication and partnership to the care.”

Being the Good Patient:

Realistically help manage your pain
If you felt well, you would not be in a SNF.  People go to SNFs to recover
from knee or hip replacement surgery, to receive IV 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. Do not 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 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 did not come with your meal and you have politely
requested it, but it has not 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, do not 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 demanding work and it
does not hurt to thank someone for being kind or to know them by name.
Bringing the occasional baked goods or bouquet of flowers as a way of thanks
does not 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
Knowing the shift change time will 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.
Encourage them to participate in the activities at the SNF but also bring
them things to do when you are not 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 are visiting, do not 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 is always heartwarming for the caregiver to see most of the people where
your care recipient is staying know them by name and acknowledged them when
they see them outside of their room.

Leave your personal problems at home.
There are some jobs where it does not matter if you are cranky because you
got into a fight with your boyfriend or your car would not 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.

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 SNF 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.