Navigating the Skilled Nursing Facility Journey: A Case Manager's Perspective

Sunday, November 16, 2025

In this episode of Navigating Eldercare, host Laura Daniels welcomes Naeemah Marquez, a Licensed Master Social Worker and the Vice President of Care Transitions for Ignite Medical Resorts. Naeemah shares her expertise on the intricate world of skilled nursing facilities (SNFs) and post-acute care. They discuss the definition of a SNF, the critical role of a case manager as a "broker of resources" and discharge planner, and what families can expect during the admission, stay, and discharge process. Naeemah offers invaluable advice on setting realistic expectations for recovery, coordinating successful transitions, and the importance of family involvement to prevent readmission. She closes with a powerful story illustrating the profound impact of guidance and advocacy in a family's eldercare journey.

• 00:02 Welcome and Introduction to Navigating Eldercare

• 00:20 Host Laura Daniels (Care Advocates Founder) Introduction

• 00:45 The Mission of Care Advocates

• 01:42 Introducing Guest Naeemah Marquez and Her Background in Social Work

• 02:38 Naeemah's Inspiration and Drive in Care Transitions

• 03:07 Defining a Skilled Nursing Facility (SNF)

• 03:34 SNFs as a Bridge to Recovery

• 04:00 The Role of a Case Manager/Discharge Planner in SNF

• 04:39 A Typical Day for a Case Manager

• 05:22 Supporting Patients and Families During the Stay

• 05:54 The Admission Process from the Hospital to Ignite

• 06:41 Average Rehabilitation Stay Length and Determining Factors

• 07:10 Most Common Types of Therapy (PT/OT)

• 07:39 Setting Realistic Goals: The Care Conference Meeting

• 08:08 Advice for Families to Ensure Successful Recovery Post-Discharge

• 09:34 Common Challenges: Patient Acceptance of In-Home Caregivers

• 10:54 Coordinating the Next Steps: Transitioning Home or to Assisted Living

• 11:51 The Interdisciplinary Team (IDT) Process

• 12:21 Key Resources and Referrals Post-Discharge (Skilled Home Health, Hospice, Visiting Physicians)

• 13:49 What Naeemah Wishes Families Understood About Skilled Nursing

• 14:17 Setting Realistic Expectations: Not a 100% Return to Baseline

• 15:14 The Patient Journey from Admission to Discharge

• 16:39 How Ignite Medical Resort is Different (Luxury Rehab and Hospitality)

• 17:39 A Story That Defines Naeemah's "Why" (Sister of a Patient)

• 20:50 Laura's Appreciation for Naeemah's Advocacy

• 21:27 Naeemah's New Role as VP of Care Transitions

• 21:54 Naeemah's Goal for Her Team: Realizing Their Role as Advocates and Change Makers

• 22:50 How to Contact Ignite Medical Resorts

• 23:39 Closing Remarks and Free Consultation Offer from Care Advocates

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