What Kind of Medical Care Will the Nursing Home Provide?

The generic term "nursing home" is applied to what are actually two different kinds of facilities. An intermediate care facility is staffed and resourced to provide only assistance with the activities of daily living-bathing and hygiene, toileting, dressing, etc.-that the patient can no longer handle independently. A skilled nursing facility, however, provides for these basic needs while also administering medical care. Unlike an intermediate care facility, it has registered nurses (RNs) and licensed practical or vocational nurses (LPNs or LVNs) on staff 24 hours a day.

Skilled nursing facilities are often used to provide step-down care, which transitions the patient from acute care in a hospital to a higher level of care during the recovery process and then to a reduced level of care over the long term (such as in an intermediate care facility or via home health care) or even a return to normal life at home. Particularly in such cases, rehabilitative care such as physical or speech therapy (as necessary based on the patient's condition) becomes very important, and a skilled nursing facility will offer therapy services.

The facility will also provide what might be called "adjunct" medical services, such as a special diet, mental health care, or dental care. While not necessarily directly related to the patient's primary medical condition (except in the case of prescribed diets), this additional care contributes to the patient's overall health and well-being.

The most important medical services offered in a skilled nursing facility are focused on the specific condition that brought the patient there. Because of the wide range of conditions that may be treated in a skilled nursing facility, a certain degree of specialization is inevitable. Consequently, not every facility that you consider may have the staff or equipment necessary to best address a particular medical condition, and this will be one of the most important considerations as you evaluate candidate facilities.

Some of the most frequently seen specialized care requirements include:

• Intravenous (IV) drug therapy
• Respiratory therapy
• Physical, speech, or occupational therapy
• Pain management
• Dialysis
• Alzheimer's and dementia management

A facility that specializes in a particular medical condition is a huge plus. In part this is because of the resources it will have available-if, for example, your loved one requires dialysis, it's much less disruptive for the patient if the facility has dialysis equipment on-site, rather than having to transport him or her to a dialysis clinic every few days. Even more importantly, though, the staff will have extensive experience in that specific type of care. Just as I'm sure you'd rather have your heart surgery performed by a cardiologist rather than a urologist, placing your loved one in the care of nurses who are well-accustomed to handling dementia or managing pain is going to produce a better outcome.

All nursing homes are required by federal law to evaluate each patient within two weeks of admission. Based on that evaluation and input from the patient's physician (diagnosis, records of prior care, and prognosis), the facility will develop a care plan. This plan should be shared with both you and the patient in a care plan conference, and you are certainly entitled (and advised) to ask should you not be invited to one. The law also mandates follow-up assessments designed to measure the effectiveness of the care plan; these must take place at least every three months.

As for physician care, the facility will have a doctor on call. He or she will make rounds periodically, and while the frequency may vary from facility to facility, the legal minimum is once per month during the patient's first three months and once every two months thereafter. Of course, your loved one's existing primary care physician is still an option, though not all doctors make patient visits in nursing homes. If not, and if you or another friend or family member lives nearby, your loved one can continue to make office visits with their existing doctor instead.