Providers
The Bed Offer Is Not the Decision: Compare the Facility Paper Before You Say Yes
When the hospital hands you a skilled nursing bed, the choice rests on the facility's certification, its inspection record, and its admission terms, so read those before you answer.
A hospital discharge planner may hand you a list of facilities with open beds, and the family may feel pressure to answer the same afternoon. You can ask for more time, and you can compare the facilities on the same questions. The decision rests on paper you can check yourself.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Start with your right to choose
Federal discharge planning rules in 42 CFR 482.43 require the hospital to give a patient a list of available post-acute providers and to respect the patient's choice among them, subject to the facility's ability to accept. Ask the case manager to write down every facility on the list, along with the bed status each one reported. Keep the list with the discharge folder so you can see what was offered and when.
Check that the facility is certified and inspected
Look each facility up on Medicare.gov's Care Compare tool to confirm it is Medicare-certified and to read its recent inspection reports. Missouri licenses skilled nursing and residential care facilities under RSMo Chapter 198, and the Missouri Department of Health and Senior Services keeps the licensing and inspection records. Read the findings themselves, including how the facility responded to them, instead of skimming a summary.
Your goal is not to pick a winner from a number. It is to see whether each facility's inspection history matches the level of care your parent will need, and whether the problems cited have been corrected.
Read the admission agreement before you sign
Federal nursing home rules in 42 CFR Part 483 prevent a facility from requiring a third-party guarantee of payment as a condition of admission. Read the rest of the agreement with a pen in hand and check these points:
What the daily rate includes, and what is billed separately. What happens to the bed if your parent is sent back to the hospital and returns. What notice you get, and what happens to your parent's place if Medicare coverage ends and a different payment source is needed. How the facility handles a change in your parent's condition or a request to move rooms.
Ask the same questions of every facility
Write the same five or six questions on one sheet and take it to each facility you are comparing. Ask who sets the therapy schedule and how many minutes are planned each day. Ask how many nursing staff are on each shift on the unit your parent would be on, and ask for the number, not a general promise. Ask who gives medicines during the stay and what list the facility will send home with your parent. Ask who is your contact person and how you will be told about changes.
Put the answers in the same order on the sheet. Any answer that comes back as we will check is an open item, so note it and ask for a date when you will hear back.
If you cannot decide yet
Ask whether the bed can be held while you finish the comparison, and get the answer in writing. If you need help looking at options outside the hospital list, the Local Help After a Discharge page lists where to start in the St. Louis area.
This is a checklist for comparing paperwork. Questions about your parent's care needs belong with the hospital team and your parent's own doctor.