What is Skilled Nursing?
A Skilled Nursing Facility is a health-care institution that has available nursing care 24 hours a day, the supervision of the care of patients by a physician, the capability to store and dispense drugs, and which meets federal criteria for Medicare and Medicaid reimbursement. The CDC reported in 2016 that there were 15,600 nursing homes with 1.3 million residents in the United States.
Skilled Nursing Facilities provide two distinct categories of service which are Short-Term Rehabilitation and Long-Term Care. Facilities providing short term Skilled Nursing are known as Skilled Nursing or “SNF” while those facilities providing long term care are commonly referred to as “Nursing Homes”. SNFs and Nursing Homes may be on the same campus, but patients or residents are typically housed in separate wings. SNFs may also be located in continuing care retirement communities, assisted living facilities and even in some hospitals.
Both facility types provide meal preparation and assistance with activities of daily living. A SNF will have professional medical staff who are trained to help speed the rehabilitative process including doctors, registered nurses, audiologists, vocational nurses, and rehabilitation specialists. A Nursing Home is set up for indefinite custodial care such as helping residents with eating, bathing, dressing, and grooming. Custodial caregivers are not required to have formal medical training although trained medical professionals may be on the staff of a Nursing Home.
When is Skilled Nursing or a Nursing Home needed?
A SNF may be needed for someone who is ready for discharge from the hospital but not able to return home. The SNF will provide a high level of medical attention with the goal of the patient completing their rehabilitation and returning to their prior living environment.
A Nursing Home may be needed for someone who no longer can live at home safely and requires 24-hour care that may not be medical in nature. Help can be provided including assistance with bathing, dressing, eating, medications, and other activities of daily living (ADLs).
Services Which are Provided at a SNF
SNF Services which are covered by Medicare include:
- Semi-private room (you may pay an upcharge for a private room if available)
- Skilled nursing care
- Needed medical supplies and equipment
- Medical social services
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Dietary Counseling
- Ambulance transportation if needed
Additional services may be provided but not covered by Medicare.
Prior to hospital discharge, hospital case managers usually work closely with a patient, their family members, and the SNF that the patient selects.
Services which are Provided at a Nursing Home
Basic Nursing Home services include:
- Semi-private or private room
- Housekeeping and linens
- Meals which match dietary requirements
- Medication monitoring and administration
- Personal care (including dressing, bathing, and toilet assistance)
- 24-hour emergency care
- Social and recreational activities
At the next tier of care, additional services more typically found in a SNF may also be found at some Nursing Homes.
Cost of Care in a Skilled Nursing Facility
For the first 20 days for a covered event Medicare will pay 100 percent of the cost. For the next 80 days Medicare pays 80 percent of the cost. After 100 days Medicare makes no payments.
Conditions which have to be met for Medicare to pay include:
- A qualifying hospital stay
- Doctor’s recommendation that daily skilled care is needed
- Part A coverage with days remaining
- Services are provided by a Medicare certified SNF
- Skilled Services are needed for either a hospital-related medical condition that began while the patient was getting care in the SNF for a hospital-related medical condition
So, what you pay is:
- Days 1–20: $0 for each Benefit Period
- Days 21–100: $170.50 Coinsurance per day of each benefit period (typical amount, check with your SNF for an exact number)
- Days 101 and beyond: all costs
Cost of Care in a Nursing Home
Nursing Home costs vary greatly in different regions of the United States with the Southeast and Midwest the least expensive while the East and West coasts are more expensive. In 2018 a semi-private room in a Nursing Home was $245/day or $7,441 per month. A private room cost was $275/day or $8,365 per month. Calculate the cost of Care in your Area.
The non-medical custodial care provided by a Nursing Home is not covered by Medicare. Most people pay for Nursing Home care from either long-term care insurance or other assets they may have. Once income and assets are below certain guidelines a Senior may be eligible for Medicaid. A Regional Medicaid office can provide guidance in this area. Some Nursing Homes do not accept Medicaid so make sure you find that out if you may be relying on Medicaid.
Search for a SNF or Nursing Home
The Senioridy interactive search tool can be used to help you find a SNF or Nursing Home. Enter your location or move the map to your location and you’ll see a list of potential Facilities. You can filter results by various options. Use it today to assist you in your search for a Skilled Nursing Facility or Nursing Home.