How To Pick a Skilled Nursing Facility in Los Angeles
Sarah OrdoverFeb 1st, 2023
Most of my clients have had to deal with skilled nursing (SNF) for their loved ones at some point. How do you choose where to go? I get calls asking for suggestions daily.
Your mom has been admitted to the hospital for more than a three-day stay for a fall, surgery, or some other medical condition, and then the hospital wants to discharge her to an SNF, commonly referred to as a rehab facility, nursing home, and sometimes a post-acute facility. All four terms skilled nursing, rehab facility, nursing home, or post-acute facility can refer to the same category of care facility. They provide 24-hour skilled nursing care, as well as related or rehabilitative services. A discharge to an SNF usually occurs when a patient needs further observation or if they need physical, occupational, or nursing therapy prior to going home or to an assisted living community.
BEST SNF RATING WEBSITE: CAL LONG-TERM CARE COMPARE
One of the tools that I use when I am helping someone pick a rehabilitation facility is Cal Long Term Care Compare, https://callongtermcarecompare.org
I find it the easiest to understand and most comprehensive of the online nursing home comparison databases. All the online services are working from the same Center for Medicare and Medicaid Services (CMS) data. To receive government-paid Medicare or Medicaid funds (Medi-Cal in California), a nursing facility must be certified and licensed. In California, the State agency must perform licensing surveys of nursing homes every 2 years to determine whether they meet the licensing requirements. A nursing home's Overall Quality rating is based on its ratings for Health Inspections, Quality Measures (QMs), and Staffing. Ratings for each domain and the overall rating range from 1 star to 5 stars, with more stars indicating higher quality.
Cal Long Term Care Compare, https://callongtermcarecompare.org presents in the easiest format CMS data on staffing, quality measures for short-stay patients, and health inspection reports. It compares a particular facility’s numbers against the state average.
Cal Long Term Care Compare also uses its own system to rate nursing homes using five performance levels represented by labels or “badges”. The highest-performing nursing homes are labeled “Superior” and the lowest-performing nursing homes are labeled “Poor”. The cut-offs for each level are:
· Superior: Facility scored in the top 10% of all California facilities
· Above Average: Facility scored in the 75 – 90% range (top quartile, but not top decile) of all California facilities
· Average: Facility scored in the 25.1 – 74.9% range of all California facilities
· Below Average: Facility scored in the 10.1 – 25% (bottom quartile, but not bottom decile) range of all California facilities
· Poor: Facility scored in the bottom 10% of all California facilities.
In all of Los Angeles, only 15 skilled nursing facilities receive Cal Compare’s Superior designation. These include some that are attached to assisted living communities that we work with such as Hollenbeck Palms in Downtown Los Angeles, Villa Gardens in Pasadena, and Windsor Manor in Glendale. Other superior SNFs include Guardian Rehabilitation in mid-city, Mid-Wilshire Health Care Center downtown, and Marycrest Manor in Culver City.
THE 100 DAY STAY SNF MYTH
Medicare Part A Skilled Nursing Facility coverage is generally available to qualified individuals 65 years of age or older who meet the following 5 requirements: 1) the resident requires daily skilled nursing or rehabilitation services that can be provided only in a skilled nursing facility; 2) the resident was hospitalized for at least 3 consecutive days, not counting the day of discharge, before entering the skilled nursing facility; 3) the resident was admitted to the facility within 30 days after leaving the hospital; 4) the resident is admitted to the facility to receive treatment for the same condition(s) for which he or she was treated in the hospital; and 5) a medical professional certifies that the resident requires skilled nursing care on a daily basis.
Where these five criteria are met, Medicare will provide coverage of up to 100 days of care in a skilled nursing facility as follows: the first 20 days are fully paid for, and the next 80 days (days 21 through 100) are paid for by Medicare subject to a daily coinsurance amount for which the resident is responsible.
But beware, the 100-day Medicare coverage in a skilled nursing facility is largely a myth. The average length of stay at an SNF in California is 20 days. Coverage ends if the resident stops making progress in their rehabilitation (i.e. they “plateau”) and/or if rehabilitation will not help the resident maintain their skill level. Coverage will also be terminated if the resident refuses to participate in rehabilitation.
When Medicare coverage is ending because it is no longer medically necessary or the care is considered custodial care, the facility must provide written notice at least two days before on a form called “Notice of Medicare Non-Coverage” to the resident and their designated representative. This notice explains:
- The date your covered services will end
- That you may have to pay for services you get after the coverage end date given on your notice
- Information on your right to get a detailed notice about why your covered services are ending
- Your right to a fast appeal and information on how to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to request a fast appeal
APPEALING YOUR SNF DISCHARGE
You have the right to appeal a discharge, which should be done one day prior to the termination date and after you receive your termination letter. Your social worker should be able to walk you through the process or go to https://livantaqio.com/en/beneficiary/discharge_appeal for information on how to appeal.
ABOUT SARAH ORDOVER, OWNER, ASSISTED LIVING LOCATORS LOS ANGELES
Assisted Living Locators Los Angeles owner Sarah Ordover is one of LA’s top senior living advisors. Certified in dementia care, Sarah is a trained aging specialist who holds an RCFE assisted living administrators license. Sarah thoughtfully guides families through the senior living decision-making process, helping them find the best solution for their loved ones. Call Sarah at 310-853-8282 for a consultation. Assisted Living Locators is free to clients.