What is Skilled Nursing Care and Rehabilitation?

Skilled Nursing Facilities, or SNFs, offer a high level of in-patient medical treatment and rehabilitation. SNFs provide 24/7 care to patients who no longer need hospitalization but still require complex nursing and therapy in order to recover from acute injury, illness or surgery. The staff providing the care have received advanced training and licensing, and include registered nurses (RNs), licensed practical nurses and physical, occupational and speech therapists, all working under doctor supervision. Skilled Nursing and Rehabilitation Facilities can operate as standalone businesses or they can be part of a nursing home or assisted living facility, in a separate unit, wing or floor.

The goal of SNFs is to help patients regain sufficient function and health to return home or transition to another housing option that requires a lower level of care, such as a nursing home or assisted living facility. Because patients enter a skilled nursing facility after a hospital stay, SNFs often describe the care provided as “post-acute care”. This post-acute care often requires some form of rehabilitation for sufficient recovery, so skilled nursing and rehabilitation go hand-in-hand. The types of care provided include:

• Cardiac care
• IV Therapy
• Wound care
• Pulmonary rehabilitation
• Post-stroke recovery
• Monitoring of vital signs
• Speech-language pathology
• Physical therapy
• Occupational therapy

What is the Difference between a Skilled Nursing Facility and a Nursing Home?

SNFs and nursing homes do share some overlap, which can make differentiating between the two somewhat difficult. And again, a nursing home may offer skilled nursing and rehab in a separate wing or area. But they both assist with activities of daily living (ADLs), such as bathing, dressing, walking, toileting and eating. They also manage minor medical tasks, like monitoring medication or oxygen, but beyond that, the types of medical care offered by SNFs and nursing homes differ tremendously.

As described above, SNFs offer “skilled care” – specialized medical care and therapy that can only be safely provided by professionally-trained staff for post-acute recovery and rehabilitation. Care frequently involves the use of hospital-quality medical equipment, which is not available in nursing homes. Nursing homes provide “custodial care”, or care that can be provided by non-licensed staff, often nurse aides. This includes assistance with ADLs, cooking, laundry, and administration of medication. Residents of nursing homes are usually medically stable but have chronic or ongoing conditions that require 24-hr supervision as opposed to 24-hr medical care, such as mobility or cognitive issues. Nursing homes don’t need to have registered nurses in-house, around-the clock and can have RNs or doctors on call.

The duration of care is another major difference between SNFs and nursing homes. According to the Centers for Medicare and Medicaid Services (CMS), the average length of stay in a SNF is 28 days. In contrast, a nursing home is a home, rather than a clinical setting, and is designed to be more permanent. A nursing home has residents instead of patients. Nursing homes focus on daily, non-medical care, with an emphasis on social engagement and building a sense of community. Meals are served in a communal setting, and planned activities and neighborhood excursions are a regular part of life.

The final major difference between Skilled Nursing Facilities and nursing homes is cost. Medicare does not cover the costs for custodial care, which is what nursing homes provide. SNF stays in a semi-private room may be partially covered by Medicare Part A if certain criteria are met, including but not limited to:

• The stay is ordered by a doctor
• A qualifying hospital stay of at least 3 days preceded the order
• Care is complex enough that it can only be performed by professional personnel, such as nurses or therapists
• The services are received in a Medicare-certified SNF

If these and other criteria are met, Medicare will cover stays of up to 100 days as follows:

• Days 1-20: 100%
• Days 21-100: copay
• Days 101+: 0%

What are the Benefits of Skilled Nursing and Rehabilitation?

• Skilled nursing is available 24/7, under the supervision of a doctor
• A specialized therapy and care plan involving a variety of treatment methods
• Lower chance of rehospitalization
• On-site tests and procedures
• Dietary assistance
• Medicare coverage for qualifying cases

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