The Difference Between Skilled Nursing and Nursing Home Care Last Updated May 25, 2022 Show
According to the CDC, around 1.7 million people reside in one of the 15,000 nursing homes around the country in a given year. These long-term care facilities provide different services, however, based on the amount of time and care required for each of their residents. These services break down into two groups, Skilled Nursing and Nursing Home Care. A skilled nursing facility (SNFs)includes senior care, meal preparation, and non-medical assistance, but also have specialized staff such as speech-language pathologists, rehabilitation specialists, audiologists, among others. These medical professionals are not typically staffed in a nursing home. Skilled nursing care is typically provided for rehabilitation patients that do not require long-term care services. This type of care is also referred to as post-acute care, in that it typically is provided following an emergency hospital stay. Nursing home careis similar in that residents receive care with the presence of certified nurses, meal preparation, and non-medical assistant like bathing; however lack the on-site licensed medical practitioners of a skilled nursing facility. Nursing home care provides permanent custodial assistance, whereas a skilled nursing facility is more often temporary, to solve a specific medical need or to allow recovery outside a hospital. Differences In CoverageThere are important differences in medical coverage between these two care options that you must be aware of. Outside of private pay and insurance program there are two main sources of government funding from Medicaid and Medicare. The biggest difference is that skilled nursing care is covered by Medicare under most circumstances, whereas long-term care services in nursing homes are not. Medicare CoverageIf needed to meet your medical goal, there are a variety of services at a skilled nursing facility that are covered by Medicare. These include:
Up to 100 days in a skilled nursing facility is covered for the most part by Medicare. For 20 days or less, this is fully covered. Here’s a breakdown of exactly what Medicare covers for a skilled nursing facility:
For a long-term nursing home, care is typically defined as non-medical custodial, which is not covered by Medicare. Unless the nursing home is also a skilled nursing facility, which entitles you to benefits up to the 100 days, most people pay for nursing care out of their own private insurance, or pockets, until they potentially become eligible for Medicaid. Medicaid CoverageWhile Medicare covers many skilled nursing facility stays, it will only do so for a limited time. If someone doesn’t meet Medicare’s requirements for the skilled nursing facility, or have reached the limit, Medicaid may pay for skilled nursing facility care. According to Medicaid, there are a number of nursing homes that are also Medicare-certified skilled nursing facilities. So, if someone is discharged from the hospital to a skilled nursing facility that is also a nursing home, the individual may not need to change facilities once their skilled nursing requirements are complete. If that patient is eligible for Medicaid, and the nursing home is also a Medicaid-certified, they may continue to reside in the home under the Medicaid benefit. If however the nursing home is notMedicaid certified, the person would need to transfer to a nursing home that is in order to exercise their Medicaid benefit. For a nursing home, you must first determine if the nursing home accepts Medicaid payments, as not all do. Secondly, before Medicaid will pay for a nursing home, it must be proven that this long-term care is "medically necessary" for the patient. Finally, in order to be eligible for the Medicaid support for nursing home, the patient must provethat they have income and assets below certain guidelines. Because requirements and rules vary by State, it’s important that people contact their local Medicaid office to discuss their specific situation. How Skilled Nursing Facilities WorkSkilled nursing facilities are a source of transitional care between a hospital, and a personal residence. More often than not, a stay in a skilled nursing facility is defined and short-term in nature. The care at a skilled nursing facility is distinct from that of a nursing home. Specialized services such as pathologists, hearing specialists, rehabilitationists, dietary aides, occupational therapists, and others, can all be offered at a skilled nursing facility. One of the biggest differentiating factors between a nursing home and skilled nursing facility is who provides the care. In a nursing home, it’s typically a non-medical worker providing custodial care, whereas in a skilled nursing facility, any of the following can provide care:
Consider an elderly man who fell, causing broken bones, and ending up in the hospital. Once the immediate medical intervention is complete after a few days, that person no longer needs to be in the hospital, however still requires specialized rehabilitation and wound care services that they cannot receive at home. This patient can then be transitioned to a skilled nursing facility, receiving fully paid Medicaid benefits up to 20 days, and partially paid benefits up to 100 days. Overview Of Nursing Home CareThe most common definition of a nursing home is that it is indefinite custodial care. This means that someone requires dailycustodial non-medical assistance, like bathing, grooming, medication monitoring, mobility, and more. Consider the above example of the senior who fell in the shower. Following a 3-day stay at the hospital, they were moved to a skilled nursing facility to receive professional rehabilitation and wound care. After medical rehabilitation,they would be able to return to the community, either to their home or an assisted living facility. But for a patient who has Alzheimer's disease that is not able to take care of themselves, ongoing custodial care and assistance with activities of daily living would be required. As discussed above, for the vast majority of circumstances, Medicare does notcover nursing home care. While in nursing home care however, Medicare will cover standard hospital services, medical supplies and health care expenses. How To Know When You Need Skilled Nursing Or A Nursing HomeThe key difference between a skilled nursing facility and a nursing home is the required medicalattention and the length of stay. A skilled nursing facility is typically used following a short hospital stay, where specific professional medical services are needed to help the patient with a complete recovery. Following a short skilled nursing rehabilitation stay, a patient assessment will be completed to decide if the patient is able to return to the community. RegulationBecause these are two distinct categories of care, there are differences in how skilled nursing facilities and nursing homes are governed and regulated. Nursing homes must follow state “surveys” which evaluate violations or immediate threats to patient safety and satisfaction. It is then up to the administration of the nursing home to rectify these violations. The CMS provides quality measures for both short and long-term stays in long-term care facilities to keep them accountable. Skilled nursing facilities are also governed by their state, the U.S. Department of Health, and CMS. Your Checklist For Visiting A Potential Skilled Nursing FacilityThe ultimate goal after any medical incident or intervention is to return home safely and to normal life. Although the hospital may be ready to discharge you, you may require some more time from a professional and licensed medical practitioner to be able to achieve that ultimate aim. There are a number of things you should consider when choosing a skilled nursing facility. Is the facility close to other support you have in your life such as family and friends? What are the meals like? What types of medical specialists are present at the facility, and does that fit your specific needs? Because there are so many considerations, FamilyAssets has put together a comprehensive checklist for you to use when visiting a potential skilled nursing facility. Coverage And Availability
The Skilled Nursing Facility
Staff
Activities
Medical staff
Rooms
Accessibility
Food
Other Questions
Your Checklist For Visiting A Potential Nursing HomeSimilar to a skilled nursing facility, there are a number of critical considerations when choosing a nursing home for you or your loved ones. This is even more important with a nursing home, given the fact that a skilled nursing facility is temporary, and a nursing home is longer-term. Here are the key questions you should be asking when visiting potential nursing homes: Coverage And Availability
The Nursing Home
Staff
Activities
Medical Services And Staff
Rooms
Accessibility
Food
Other Questions
Final ThoughtsThere are clear differences between a skilled nursing facility and nursing home care. A skilled nursing facility is typically following a hospital stay, and serves a specific medical rehabilitative purpose. Generally speaking, the end state for a skilled nursing facility, is for the patient to return home. A nursing home on the other hand, is classified as custodial care, and involves many non-medical support activities like bathing, grooming, medication monitoring, social and recreation activities, amongst others. |