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Interning at a Skilled Nursing Facility in the United States of America

Contributor: Rosalyn Neranartkomol M.Sc. in Gerontology

6th Year Medical Student at Medical University of Silesia in Katowice

United States of America

Senior housing in the United States of America has always been fascinating to me since I grew up in Thailand where such facilities do not exist in the same scale and splendor as the ones in the United States (yet). As part of the skilled nursing facility (SNF) administer license requirement, I was an intern at an SNF for a set amount of time; therefore, I was able to experience first-hand the workings of an SNF in California.

The SNF that I was an intern at was part of a complex that housed an independent living section, and assisted living section, and an SNF. The idea behind this type of senior housing is that one can move in from the beginning and move through each senior housing offering depending upon the person’s activities of daily living (ADL) needs. I cannot comment upon the facility’s assisted living and independent living’s sections, since I did not spend my time in those units, but I can see the benefits of having an integrated senior housing facility. My only thought about an integrated community such as this one is that it was lacking a memory unit. I believe that with what we know today, it would have been more conducive for residents to be separated into a memory unit, as needed as well.

SNF’s payment model varies depending upon individual circumstances, however, it tends to be costly, and Americans are encouraged to purchase long term care insurance to help offset the cost. SNF’s are mostly staffed by nurse assistants and due to the nature of the job there is a high turnover rate. Unfortunately, the administrator of each SNF’s oversees making certain that the SNF’s complies to each state’s regulation and having a certain number of nursing staff vs. resident ratio is one of the more challenging aspect of running an SNF’s. Oftentimes, SNF’s are for-profit and payment models can be tricky; therefore, there tends to be a staff whose main role is documenting care to ensure appropriate reimbursements from insurance companies.

Senior housing facilities are intriguing, and it is something that I believe may evolve in the future, but they will be here to stay. Working with older adults require us to look holistically and consider living arrangements of our patients, so having the experience of witnessing first-hand how an SNF operates would help inform any geriatrician when considering treatments and the outcomes of each patient. I would strongly encourage anyone considering a career working with seniors to try to visit these different living modalities to have a deeper understanding and connection with their patients.

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