The middle man.
One of our patients decided he wanted to wear a sombrero all day for no particular reason, which was a decision I supported very strongly.
After two months of working in a skilled nursing facility (SNF), which is otherwise known as a post-acute rehab (PAR), I’ve realized what we are – we are the middle man. We are the temporary home for most folks, and we do what we can with the time we have. We are somehow responsible for putting together the pieces from before and making them work better after. No wonder I’ve been so busy!
My title is Social Services Director, which is a catch-all for most non-medical pieces in the facility’s day-to-day operations. A resident needs their teeth cleaned? I’ll schedule a dentist to come out and see them. Lost your favorite capris? I’ll follow up with housekeeping. Have a complaint about a staff member? Come see me; I’m the grievance officer. Want to move rooms? I’ll arrange it and haul your stuff. Meeting with your nurse to discuss your care? I’ll take notes and try and translate the medical speak for you. Broke your arm? I’ll…well, I’ll call 9-1-1 for that one.
Most patients that are with us are short-term stays. After they have an acute event (break an arm, get pneumonia, fall, etc) and go to the hospital for a few days, they come to us for longer recovery. At our SNF, they receive 24-hour nursing care and work with physical, occupational, and speech therapists to recover and get their strength back. Our average length of stay is about 30 days. Afterwards, folks discharge from us back home, or maybe to a different facility, like an Assisted Living Facility (ALF) or other community where they can receive ongoing assistance. Basically, we take the pieces the hospital throws at us, and try and turn them into a long-term solution for our patients. We help plan the next steps, and work to ensure that there isn’t another trip to the hospital in the near future. Then, we send them on their way, as the middle man will do.
SNFs are also the middle man between patients and their health care insurance company. A lot of what we can/can’t do is dictated by someone’s insurance. And guess what – not all insurance companies are equal. Tim and Tom could both come to us with broken arms, but Tim’s insurance might pay for him to spend six weeks in our facility, while Tom’s cuts him off after four and a half weeks. My officemate gets the fun job of being the one to deliver the news to a patient that, surprise, their insurance just denied their claim moving forward and they better get their discharge plan in motion, because they’ll have to start paying out-of-pocket three days from now. By the way, paying privately for SNF care is about as expensive as it gets. Tom will have to pay up front for a month of care if he stays on paying privately, which runs to the tune of $441/day, or about $13,000/month. That’s a big change from his insurance covering all costs, including transportation to and from any related medical appointments outside of the building and all in-house therapy costs.
We go to bat for our patients on a daily basis, my officemate especially. He calls insurance companies and provides documentation that yes, they are still benefiting from treatment here, and no, we don’t think it’s safe for them to return home yet. Whether or not the insurance company agrees after that to continue to pay for someone’s stay is up to them, but it’s up to us to deliver that news to the family and help them plan their next steps. He also calls the hospital and asks what they were thinking to put someone on a certain medication, and to thank them for letting us deal with the side effects that come from it. Lucky us, right? I think the main thing I’d like families to know is that we are doing everything we can to help make their loved ones’ recovery experience safe and effective, but it’s not always up to us. Unfortunately, everyone loves to blame the middle man.
