The Difference Between Skilled Nursing and Nursing Home Care Last Updated March 08, 2018

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 care is 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 Coverage

There 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 Coverage

If needed to meet your medical goal, there are a variety of services at a skilled nursing facility that are covered by Medicare. These include:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation to the nearest supplier of needed services
  • Dietary counseling

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:

  • Days 1–20: $0 per day.
  • Days 21–100: $167.50 per day to be covered by patient or insurance. .
  • Days 101 and beyond: all costs covered by patient or insurance.

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 Coverage

While 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 not Medicaid 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 prove that 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 Work

Skilled 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:

  • Registered nurses (RNs)
  • Speech pathologists
  • Vocational nurses
  • Audiologists
  • Medical doctors
  • Rehabilitation specialists

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 Care

The most common definition of a nursing home is that it is indefinite custodial care. This means that someone requires daily custodial 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 not cover 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 Home

The key difference between a skilled nursing facility and a nursing home is the required medical attention 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.

Regulation

Because 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 Facility

The 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

  • Is the facility Medicare-certified?
  • If applicable to your situation, is the facility Medicaid-certified?
  • Are there available beds?
  • What special medical services do you need, and does the facility provide them?

The Skilled Nursing Facility

  • How loud are the common areas?
  • Is the skilled nursing facility close to friends and family?
  • How does the facility look? Is it clean and an appealing place to live for a period of time?
  • How does the facility smell? Any unpleasant odors?
  • Is the temperature of the facility comfortable?
  • Are the exterior grounds pleasant, and have social and walking areas?

Staff

  • Are the staff available, friendly, and interactive with the residents?
  • Is a staff member available to give you a guided tour? Are they knowledgeable?
  • Do you see staff knocking on doors before entering?

Activities

  • What recreational and social activities are available to residents of the facility?
  • Are there indoor and outdoor activities?
  • Is there a pool?
  • Is there transportation options for other local activities?

Medical staff

  • What is the ratio of nurses on site per resident?
  • Is a licensed doctor available, and how often are they on-site?
  • What is the history of the facility, and who are the management team?

Rooms

  • Are the rooms of sufficient size?
  • Are the rooms clean?
  • What types of furnishings come with the rooms?
  • Do residents have privacy in rooms?
  • Do residents have the ability to secure personal items?
  • Are there enough windows for natural sunlight?
  • Do residents of the skilled nursing facility have access to phone, internet, and TV?
  • Are the bathrooms shared?
  • Are there quiet rooms available for reading or private visits from friends and family?

Accessibility

  • If applicable, is the entire facility wheelchair accessible?
  • Are there handrails across the facility to help with those who have mobility issues?

Food

  • Speak with current residents to find out what the food is like.
  • If you get hungry outside of meal hours, what are the options?
  • Is outside food allowed?

Other Questions

  • Where’s the nearest hospital in case of emergency?
  • Does the facility have data on past patients’ progress?
  • How well did patients with your similar needs do?
  • What is the typical stay length for someone with your needs?
  • What is the typical therapy plan for your situation?

Your Checklist For Visiting A Potential Nursing Home

Similar 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

  • Is the nursing home Medicare certified?
  • If applicable, is the nursing home Medicaid certified?
  • What level of care do I need, and does the nursing home provide that?
  • Does the nursing home have beds available?

The Nursing Home

  • Does the nursing home offer specialized services, like ventilator care, or a dementia unit?
  • Is the nursing home close to family and friends?
  • How loud are the common areas?
  • How does the nursing home appear? Is it clean?
  • How does it smell? Any unpleasant odors?
  • Is the temperature of the facility comfortable?
  • Are the exterior grounds pleasant, and have social/walking areas?

Staff

  • Are the staff available, friendly, and interactive with the residents?
  • Is a staff member available to give you a guided tour? Are they knowledgeable?
  • Do you see staff knocking on doors before entering?
  • Does the nursing home run background and criminal checks on its staff?
  • Is there high staff turnover? If so, why?

Activities

  • What recreational and social activities are available to residents of the nursing home?
  • Are there indoor and outdoor activities?
  • Is there transportation options for other local activities?
  • Can residents get help choosing the right activities for them?
  • Do residents get reminders of their activities?

Medical Services And Staff

  • What medical staff are available on-site, and what others are on call?
  • How often is a nurse available, or is one always on site?
  • Do residents get preventive care, like a yearly flu shot?
  • Do residents of the nursing home have access to their personal doctors?
  • Will the facility help arrange transportation for these and other medical appointments?

Rooms

  • Are the rooms of sufficient size?
  • Are the rooms clean?
  • What types of furnishings come with the rooms?
  • Do residents have privacy in rooms?
  • Do residents have the ability to secure personal items?
  • Are there enough windows for natural sunlight?
  • Do residents of the nursing home have access to phone, internet, and TV?
  • Are the bathrooms shared?
  • Are there quiet rooms available for reading or private visits from friends and family?

Accessibility

  • If applicable, is the entire facility wheelchair accessible?
  • Are there handrails across the nursing home to help with those who have mobility issues?

Food

  • Speak with current residents to find out what the food is like.
  • Do you get choices for food?
  • When are meal times?
  • Can you bring food back to your room?
  • If you get hungry outside of meal hours, what are the options?
  • Is outside food allowed?
  • If applicable, can the nursing home accommodate specific dietary needs and allergies?
  • Is there a private dining area for residents who have family and friends visit?

Other Questions

  • Where’s the nearest hospital in case of emergency?
  • Does the nursing home fit your budget?

Final Thoughts

There 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.


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