You've just come across the third and final part of my little essay on Skilled Nursing Facilities, which we are abbreviating as S.N.F.s. Do not proceed unless you have read Part 1 and Part 2, preferably in that order. Also, I want to remind you that many of these nursing facilities are quite good at what they do and that they all should not be characterized by the real bad ones, of which there are too many.
My mother spent one hellish night in a bad one and I thereafter spent a lot of time trying to make sure she never spent another minute, let alone another night in a bad one. To do this, I had to understand the system whereby the hospital she was in would discharge her to an S.N.F., and I had to use that understanding to find the best possible S.N.F. and to make sure she went there instead of to a bad one.
Somewhere during that process — I can't tell you exactly when — I asked myself a question that would resound in my noggin for the rest of that challenge and throughout the follow-up which I'm now about to describe. The question was: "What would Bilko do?"
I hope you know who Bilko was. In case you don't: He was a fictional character in one of the best situation comedies ever produced. The show ran from 1955 to 1959 and was originally titled You'll Never Get Rich and later, The Phil Silvers Show. Most folks today recall its name as Sgt. Bilko, which is the name it had in some reruns.
Phil Silvers played Master Sergeant Ernie Bilko, a fast-talking, money-hungry con artist with a myriad of "get wealthy" schemes that never quite resulted in an enhancement of his income. He was a master of bullshit, lying to people and conning them and tricking them into doing things that would advance his schemes…
…and yet you loved the guy because, first of all, a lot of the bullshitting he did was for a good cause, like tricking swindlers into giving back the money they'd swindled from some innocent victim. Or beating some ridiculous system that the Army had in place. And sometimes when one of his really dishonest plans did seem to be succeeding, he'd feel guilty and do the right thing and call it off. Also, he was very funny.
In my life, I have won and lost battles. The "wins" have rarely if ever been because I was stronger or faster or louder or more of a bully than the opposition. They have sometimes been because I was more persistent…or sometimes when I simply had "right" on my side. When "right" hasn't worked — and sadly, it often does not — I have sometimes succeeded by taking a lesson from good ol' Sarge Bilko and out-thunk the system. That doesn't always work either but when my lovely friend Carolyn had to be moved from a hospital to an S.N.F., I think it did.
Carolyn had cancer. She spent a month in a hospital where it became obvious that she was past the stage where beating the disease was possible. The doctors were quite good but it was all they could do to try and slow its spread and minimize the pain. Four weeks after she'd been admitted, they decided it was time to move her to a Skilled Nursing Facility.
This meant that they would send a form to every nearby private S.N.F. that was covered by her insurance. It would state what she needed in the way of care, how long she might be there, etc. The S.N.F.s would respond and say whether or not they could or would accept her. Once one of them did, she could no longer remain in the hospital. She had to either move to a private residence or to that S.N.F. and we had decided that the private residence option would not do.
Suddenly, time was crucial. If a rathole S.N.F. called and said, "Yes, we can take her right away," she'd wind up in that rathole S.N.F. right away. I immediately went to a person at the hospital in charge of such arrangements and made friends with them. If I had come in, angry and demanding and threatening to get that person fired or to sue the hospital, I am sure that would not have worked. I'm not saying it wouldn't have worked in some situations but, first of all, I'm not really good at that approach and, secondly, the minute I met that particular hospital employee, I knew it would not work with her.
The lady there liked me and understood that I didn't want to make trouble for her. I just wanted what was best for a loved one. She gave me a list of the S.N.F.s that would be receiving the form about Carolyn. I think there were six places on it.
I then went, in some cases with my friend John accompanying me, to each of those six facilities and requested tours. I looked for cleanliness and tried to assess the attitude of the employees. Whenever possible, I chatted with some of the employees away from whoever was giving the tour. I even struck up conversations with a few patients. I'd learned a lot about what to look for after my experiences with the S.N.F.s my mother was in.
It was pretty easy to scratch five of the six places from my list. When I decided an S.N.F. wouldn't do, I'd have some version of the following conversation with the person in charge…
ME: Well, this looks like a nice enough establishment and thank you for the tour. I just had to make sure. When my mother was moved to a Skilled Nursing Facility a few years ago, it was such a horrible place that I complained to her insurance company and they severed ties with the place.
THAT PERSON: Really?
ME: Yes. It saved me the trouble of suing them. I had to do that once when a caregiver agency sent not one but two caregivers, one after the other, who robbed my mother. Imagine someone stealing from a 90-year-old blind woman.
THAT PERSON: That's horrible. Now, you say the name of your patient is Carolyn Kelly?
Three of the managers asked the name of the S.N.F. that had lost its insurance affiliation and one asked for the name of the caregiver agency. I don't know if any of them checked to see if I was telling the truth…but I do know that none of those unacceptable S.N.F.s agreed to accept Carolyn Kelly as a patient.
(And please note: I didn't go The Full Bilko. I didn't lie. As explained in Parts 1 and 2, I did cause one S.N.F. to lose its deal with my mother's insurance company and I did sue — and settle out-of-court — with that caregiver agency.)
The fifth S.N.F. seemed quite acceptable to me. It was not wonderful but it seemed to be clean, the nurses seemed sharp and caring, and the gent who managed the facility seemed like someone who was ready/willing/able to solve any problems that cropped up.
It was also well-located for John and me to get to and not that far from the hospital to which Carolyn would have to be transported for some of her treatment. And it was located on a hillside and most of the rooms had a spectacular window view which I knew Carolyn would love.
It would do, I decided so I didn't tell its manager about the S.N.F. that lost its Kaiser connection or the caregiver agency that I sued. The only problem was that they didn't have a bed available for Carolyn and it might be several days before they did. As we left, John asked me, "What are you going to do about that?"
I said, "Unless a better S.N.F. turns up, I'm going to be scaring all the worse ones away from accepting her until a bed opens up here." Which is what I did. Carolyn had to remain in the hospital because no S.N.F. would accept her. I visited two others that became possible, decided they were worse than the one on the hillside, and had the above quoted conversation with their managers.
None of those places would take her so in the hospital Carolyn stayed…for about an extra eight days, which is when the S.N.F. on the hillside finally had a bed available. The nice lady at the hospital who'd given me the list had by now figured out what I was doing and she called and said, "Congratulations. You're getting her into the Skilled Nursing Facility you wanted to get her into."
Carolyn was treated very well there for the rest of her life. If I sound way too pleased with myself for arranging that, I am. There was no way to stop the cancer but she didn't spend her final months in an unsanitary building where people screamed all night. No one should.
I offer my experiences here in case they'll help someone help someone. Reading back, I may have not sufficiently detailed the horribleness of that first S.N.F. where my mother was moved. It became apparent to me that such nightmarish facilities exist because when a patient is to be moved to one, it's rare that someone representing the patient goes and checks the places out first. And the bad S.N.F.s are not that worried about a friend or family member taking legal action against them or reporting them to the hospitals or other authorities.
I was twice in a Skilled Nursing Facility — the same one both times — when I had my knee replaced. No one checked them out for me but unlike my mother and Carolyn, I was alert and able to ask questions and effectively complain when necessary. I also had insurance that covered better places than were available to my mother or Carolyn. So I got to be in one that was pretty good and I was not helpless while I was there.
The thing about Bilko was that he was assertive and unwilling to be smothered by a system. He spoke up. He understood the rules of any situation and he figured out a workaround, usually by appealing to the vanity or fears of those who stood in his way. I hope you never have to deal with the possibility that someone you care about will wind up in a dreadful nursing facility…
…but if you do, give this three-part article another read. Or better still, watch some reruns of Sgt. Bilko. Either might help.