You may be surprised at where you are actually going.
You are in the hospital and told that you are being transferred to an inpatient rehabilitation facility for further therapy and care before going home. You may envision a specialized, well-staffed facility? The truth, however, may surprise you. Your destination could well be a nursing home.
In a perfect world, that might not be an issue. After all, nursing homes already provide round-the-clock care for their residents, including medical and physical therapy-related services. But it is not a perfect world, and the challenges with receiving quality rehabilitative care in a nursing home setting are significant:
Staffing is a chronic issue. Nursing homes are notorious for their failure to attract and retain staff, and no wonder. With low pay, challenging work, and long hours, 94% of nursing homes reported staff shortages in a 2021 survey. Another contributing factor is the largely survey-based certification and compliance process that lacks objective criteria.
Standards are largely subjective. While being able to look up a Medicare-awarded rating for a facility might give you a sense of reassurance, a recent NY Times investigation concluded that Medicare’s own rating system is “broken.” Part of the problem is the lack of objective criteria and the reliance on the nursing homes’ self-reported information, which was often inaccurate and skewed in favor of the nursing home.
Nursing homes are often profit-focused and privately owned while being publicly funded. The combination of an owner focused on revenue, the massive reimbursements spent by the government to pay for services (over 1.5 trillion in 2020), and gaps in requirements and oversight create a situation which emphasizes profit over the patient. This often translates to substandard care.
Nursing homes are not primarily staffed for rehabilitative services. Although there are movements finally being made in that direction, there are no defined government staffing requirements for nursing homes beyond basic guidelines rooted in a decades-old study and recommendations from the 1987 Nursing Home Reform Act. Consequently, nursing homes may be providing specialized rehabilitative services with insufficient and poorly-trained staff.
So, before accepting a transfer to a rehabilitative facility, do your research and focus on safety and staffing. Often, hospitals will give you a list of options. Researching those facilities and asking smart questions about their operation, staffing, and what to expect can help you make an informed decision. Consider prioritizing rehabilitative-centered facilities over a nursing home. Have someone visit your top choices if possible. Much can be learned by seeing the facility and staff and observing patient interactions.
If you have suffered because of substandard rehabilitative care, talk to us. We may be able to help.