A Day in the Life: Skilled Nursing Facility

I often see patients come and go, since skilled nursing facilities typically offer transitional care. Most of our patients are with us for three or four weeks, on average, though some are here for long-term care for chronic health conditions.

Janet has been here for a week, but she still has a long road to recovery ahead of her. She came into our care after a serious fall left her with a broken hip and a broken arm. She also seems to be showing some signs of confusion and forgetfulness since her fall, so she’s being observed for further cognitive issues while in our care. After surgery and a short hospital stay, she was transferred here to continue her healing.

“Good morning, Janet,” I said as I entered the room. I opened the curtains before helping her get ready for the day. “How are you?”

“Alive and kicking,” she responded with a small grin, “at least with my left leg. My right side is useless.”

I laughed, because she has answered me the same way every morning.

“Let’s go ahead and get you ready,” I responded, as we began her daily routine of bathing and dressing. We chatted happily about Janet’s daughter and her two great-grandsons coming for lunch today while I brushed her short hair.

Learn more about Skilled Nursing Care, from Seniors Guide

I gave Janet take her morning medications. She told me, as she always does, how grateful she is for her pain medication, especially since she will head to the facility gym for physical therapy after breakfast, which can be both physically and mentally challenging. “It’s the most I’ve exercised in decades,” she said. “I’m proud of that ‘0.0’ sticker on my car bumper!” Then she added sheepishly, “But I’ll admit, I’m beginning to feel good after those workout sessions. Jane Fonda, look out, here I come!”

As I stepped out of her room, Janet began eating her breakfast, which had been delivered to her room on a tray. The facility’s dietician has her on a restricted diet, since bloodwork done in the hospital showed that she is pre-diabetic.

After breakfast, an orderly came to wheel her to her therapy appointment, and I helped transfer her to her wheelchair. Despite the wide hallways with handrails and handicap-accessible non-skid surfaces, Janet is not yet able to use her walker for any significant distance.

I’m excited to hear about her lunch appointment with family, and I know she’ll fill me in about how excited she was to introduce her daughter and young great-grandsons to everyone in the cafeteria, and how happy those boys will be to order their favorite meal – grilled cheese and mandarin orange slices – in the restaurant-style dining room. The highlight of their visit, she says, is getting ice cream from the soft-serve machine that runs daily. It’s the same thing every visit. I’m just happy that she has that consistency to look forward to, since not every patient here has family visits.

I met and got to know Janet’s daughter, Carol, from the beginning. Carol had truly done her research when looking for a skilled nursing facility, and it showed – she asked questions about licensure and inspections, deficiency scores, and staff-to-patient ratios. She seemed to be at peace with her decision to bring her mom here after touring the facility and seeing the clean, hospitable environment and the other residents, who looked happy and well-cared for. She also loved that despite the well-organized routine (which her mother thrives on), residents are also free to make some of her own decisions, which supports Janet’s need for some small semblance of independence.

After lunch, I passed the game room and noticed that Janet’s family had joined her around a small table to help her work on a puzzle. She sure does love her puzzles. She also loves arts and crafts, so she is in for a treat – the activities coordinator has arranged for a new class Janet will love: a local scrapbooking supply store owner is coming to teach residents how to make their own greeting cards.

Later, I took Janet her afternoon medications and reminded her of her occupational therapy appointment. In these sessions, therapists help her perform the daily tasks that became challenging after her fall. She will regain some independence as well as self-confidence. She tells me every morning how happy she will be when she can do more on her own, even just brushing her own hair.

My shift is almost over, so I check in with the incoming nurse to give her the day’s updates. I let her know that Janet plans to eat dinner in her room this evening, as the full day has worn her out. She also wants to eat while watching “Wheel of Fortune” in her room rather than going to the dining room. “That Pat Sajak is still so adorable,” she said. “I’ll miss him when he retires, but I won’t mind watching Ryan Seacrest instead. Just don’t tell Pat that.” Yes, Janet is always good for a smile.