For someone with a SCI, a Skilled Nursing Facility is often a place they go after leaving the initial acute care or an intensive inpatient rehabilitation facility (IRF), or for people who still need medical care that’s too much for them to get at home but don’t need acute hospital care. What you can expect at a SNF will be very different from IRF, which has intense, multidisciplinary therapy. 

• Less Intensive Therapy: Unlike an inpatient rehabilitation facility (IRF) where you might receive 3+ hours of therapy daily, an SNF typically offers 1-2 hours of therapy per day, five days a week. The focus will still be on physical, occupational, and potentially speech therapy, but at a less aggressive pace. The goal is often to maintain gains, continue gradual progress, or address specific functional challenges.

• Emphasis on Medical Management: SNFs are designed to manage medical complexities. For SCI patients, this means skilled nursing care for issues like:

  • Bowel and bladder management: Ongoing training and assistance with routines, catheter care, or suprapubic care.

  • Skin integrity and wound care: Prevention and treatment of pressure injuries (bedsores), which are a significant concern for individuals with SCI.

  • Spasticity management: Administering medications and implementing strategies to control muscle spasms.

  • Pain management: Addressing neuropathic and musculoskeletal pain.

  • Respiratory care: For those with higher-level injuries, this may include ventilator weaning, tracheostomy care, or respiratory therapy.

  • Medication management: Administration and monitoring of all necessary medications.

• Focus on Activities of Daily Living (ADLs): Nursing staff and therapists will assist with and train in ADLs such as bathing, dressing, grooming, eating, and transfers (moving in and out of a bed, wheelchair, etc.). The aim is to maximize independence within the SNF setting and prepare for discharge home.

• Team-Based Approach, but Less Integrated: While there will still be an interdisciplinary team (physician, nurses, therapists, social worker/case manager, dietitian), the coordination might feel less integrated or intensive than in an IRF. The physiatrist (rehabilitation physician) may visit less frequently, and the day-to-day care is heavily managed by nurses and nursing assistants.

• Varied Peer Group: You'll likely be among a more diverse patient population in a SNF, including older adults recovering from surgery, strokes, or other medical conditions. There may be fewer individuals with SCI specifically, which could impact peer support opportunities.

• Preparation for Discharge: A key function of the SNF stay is to ensure a safe transition home. This includes:

  • Equipment assessment and ordering: Working with case managers and therapists to ensure necessary durable medical equipment (DME) like wheelchairs, commodes, shower chairs, and adaptive devices are in place before discharge.

  • Caregiver training: Educating family members or caregivers on how to assist with personal care, transfers, medication administration, and recognizing potential complications.

  • Home assessment: In some cases, therapists or social workers may conduct a home assessment to identify accessibility needs.

  • Connecting with community resources: Providing information about local SCI support groups, home health agencies, and outpatient therapy options.

• Less Emphasis on Community Reintegration: While some SNFs may offer limited recreational therapy or outings, the primary focus is not typically on community reintegration or vocational training in the same way a specialized SCI rehabilitation center might.

It's important for individuals with SCI and their families to actively communicate their goals and needs with the SNF team to ensure they receive the most appropriate care and support for their unique situation.