Respiratory Therapists on Choosing the Right SNF

Respiratory therapists who work in skilled nursing facilites know what to watch for -- and what to watch out for -- when searching for a suitable facility to care for patients who require respiratory care services. Following are several helpful hints collected by the AARC directly from respiratory therapists who work in skilled nursing facilities.

1. Does the facility staff care for respiratory patients on a regular basis or only occassionally? Remember that the first line of patient assessment comes from nurses -- if they do not regularly care for respiratory patients, their assessment skills will not be reliable.

• If regularly -- yes; consider this facility
• If occassionally -- no; do not consider this facility

2. Are the RT's who service the facility contracted or employed?

• If employed -- yes; consider this facility
• If contracted -- no; do not consider this facility

3. Do the RTs (and other medical staff) working there have competencies in geriatric care? Ask to see the documentation.

• If documented competency -- yes
• If no documented competency -- no; do not consider this facility

4. Is the facility free standing or attached to an acute care facility?

• If attached -- yes
• If free standing -- no; do not consider this facility

5. How does the facility provide oxygen to its respiratory patients? Rooms piped with oxygen? Concentrators? Tanks?

• If rooms piped with O2 -- yes (best option); consider this facility
• If concentrators -- yes (acceptable option); consider this facility
• If tanks -- no; do not consider this facility

Using tanks as backups to concentrators is fine; however, if tanks are the primary oxygen source, choose another facility. Tanks can run out even in the best of circumstances, so it's best not to take any chances. And keep in mind that most people who use O2 in nursing facilities probably need 5 liters or less per day. Concentrators can usually deliver up to 5 liters -- to be sure, you may want to inquire about the upper limit of their equipment.

Hallmarks of a facility that provides quality respiratory care service:

• There should be one designated area where durable medical equipment, like oxygen concentrators and suction machines, is stored. You shouldn't see unused equipment sitting in hallways or in storage areas designated for other uses.
• Stored medical equipment should be well maintained, clean, and covered neatly. You shouldn't see uncovered equipment with frayed electrical plugs or dusty filters.
• The facility should have a designated storage area for portable oxygen. The gas cylinders should be stored on carts in an upright position with "full" or "empty" status tags on each.
• There should be as many portable compressors to deliver nebulizer therapy as the number of beds in the facility that typically offer patients such therapy.
• Nebulizer compressors, suction machines, and oxygen concentrators should be cleaned thoroughly with disinfectant sprays and wiped down between each patient use.

A thorough patient assessment form will include the following:

• Selections that can be easily checked off or other means of providing explanation for medical histories significant to: eyes; ears; kidneys; respiratory system; heart; or diabetic or vascular conditions.
• Assessment of any previously required therapy for orthopedic disease; stroke; problems swallowing; or depressive states.
• Specific questions related to skin problems (especially if diabetes is checked off); mobility dependency (use of an "adaptive device" for daily fuctioning); past admissions to the emergency room or inpatient hospitalization (including place for diagnoses).
• Daily supplement or medication requirements pertaining to bowel habits; hydration needs; calcium for bone disease; oxygen prescriptions; dental care; allergies; or other chronic conditions.
• Specific questions inquiring about favorite social activities
• Questions about ambulance requirements for frequent trips to other medical facilities.

Statements on the AARC website should not be construed as specific medical advice for patients. The information should be used solely for its educational value.