For those who qualify for a short-term rehabilitation stay in a Skilled Nursing Facility, it is standard for the various department heads at the facility to conduct weekly meetings to discuss the progress and expectations of each patient. As a family member or loved one, you may be asked to attend a Care Conference Meeting – especially as the discharge date gets closer. Since many of our clients are unsure of what will happen at these meetings, here is an overview of what to expect:
Who attends?
A Social Worker or individual from Social Services, the Director of Nursing, all supportive therapies involved (Physical Therapy, Speech Therapy, Occupational Therapy) and supportive departments, such as Dietary and Activities, may attend. If appropriate and he or she is able, the patient will also attend. The Care Conference Meeting may last 20 to 30 minutes and give all parties an opportunity to provide a progress report.
What to expect:
A Care Conference is designed to discuss all aspects of the patient’s progress and the current prognosis, and for the team to recommend the discharge date and help identify the appropriate level of care required. You will have the opportunity to ask pertinent questions, express your concerns, and understand important aspects of your loved one’s short-term rehabilitation stay.
Questions to ask:
- What medications are being taken and/or have been changed?
- Has there been a urinary tract infection (UTI)during the rehab stay?
- Are there any skin issues or wounds being treated?
- Is the person medically stable?
- What are realistic goals for the future to help determine the appropriate type of care needed?
- When is the approximate discharge date?
- What it the specific plan for care to follow?
- Will therapy and nursing services follow when discharged? How will this be coordinated?
- Is there any specific durable medical equipment (DME) I need to learn how to use?
What are my rights?
The Skilled Nursing Facility is required to provide a 48-hour notice prior to discharging the patient. This timing is determined when the Medicare guidelines have been met or the patient has plateaued in his or her rehabilitative recovery. If you disagree about the timing of discharge, talk with the Discharge Planner about your concerns and how to move forward with the process. For more information about a Medicare Appeal, visit https://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html.
We can help!
When our clients ask us about what to expect, we emphasize that it is important to start thinking about a discharge plan upon admission into the Skilled Nursing Facility. If it is not a realistic option for the patient to return home, we will provide guidance and appropriate resources for a smooth transition.
If you have questions or concerns about your options, call our office – our Family Consultants are here to assess your situation and help you explore options and next steps that will best meet your needs. Call us today! (916) 965-5565
Written by Carol Kinsel, GCM