Understanding Nursing Homes and Skilled Nursing Facilities
When a senior falls or has a different health crisis like a stroke or surgery they may require monitoring and care from a team of rehabilitation providers. Having a basic understanding of the difference between nursing homes and skilled nursing can help when you set off on this journey. Often during a hospital stay you will start to hear medical providers talking about discharging your senior into skilled nursing or a skilled nursing facility, called a SNF (pronounced sniff by healthcare providers). To complicate matters, skilled nursing care encompasses more than nursing care. Skilled nursing actually includes a variety of services like physical therapy (PT), occupational therapy (OT), speech/language pathologists (called speech for short), wound care, IV therapy, catheter care and more. There is a lot of healthcare offered with skilled nursing but you typically do not need it to occur in a hospital setting. Patients in need of skilled nursing are more medically stable and need more help with recovering. They don’t need to see physicians as often but they are not yet ready to go back to their baseline living situations. Skilled nursing facilities provide transitional care.
Skilled nursing care is offered in different settings and there are many factors that are considered when deciding where your senior will receive this care. This care can sometimes be offered at home but it is more commonly provided in a freestanding facility. Skilled nursing facilities are often housed within nursing homes and it can be difficult to make sense of it.
A nursing home is often used as an umbrella term for any senior care facility. I have mixed feelings about umbrella terms. On the one hand they are handy as they are generally understood terms. When you hear “nursing home” you know generally what someone is talking about. On the other hand they are terribly confusing when it is time to get in the weeds and parse out differences. As I was looking at what was available on the web when researching these facilities I was struck by the inconsistencies. Many websites use the terms interchangeably but make no mistake, insurance companies and facilities themselves will absolutely know the difference. So will you, if they get ready to discharge your senior from a SNF and you aren’t sure your senior is ready.
Hospitals provide the highest levels of medical care, the most monitoring by registered nurses and the most contact with specialists. Once a senior is medically stable they will be discharged or transferred to a skilled nursing facility. Sometimes skilled nursing is offered within a hospital facility but a different wing or department on the campus.
From a practical perspective it makes a lot of sense to house a skilled nursing facility within a nursing home. When a nursing home resident has a hospitalization and then needs transitional care before they can go back to their regular long term residence, it’s a lot easier and cheaper to transfer someone from one floor or wing to another rather than to another building via medical transport. This is where it can get confusing. When you go visit someone in a skilled nursing facility or a nursing home there seem to be two different types of clientele- you can often tell the difference when you find yourself in the wrong section. The skilled nursing side of things will have many rehab providers walking around- lots of assistive devices, more nurses milling about and patients will sometimes seem a bit younger. The nursing home section looks more residential, there is a little bit less activity and it’s a little quieter. Let’s dive into some of the other differences.
Staffing
Skilled nursing provides rehab and specialty care services- there is much more supervision and monitoring. Skilled nursing facilities are medical facilities that provide 24/7 nursing care under the supervision of doctors. Most patients need daily rehabilitative services like PT or OT.
Nursing home care is provided by licensed practical nurses and nurse’s aides under the supervision of registered nurses. Care is focused on activities of daily living (ADLs) like bathing, dressing and eating. Laws vary by state but doctors visit patients monthly for the first 90 days and then every 2 months thereafter unless there is a change in health.
Cost
Medicare Part A covers skilled nursing but it’s very technical and very confusing. Basic coverage is generally for a semiprivate room for 100 days providing you have had a recent 3 day hospital stay. Medicare covers all of day 1-20 and there will be a co-insurance for day 21-100, up to $200/day in 2023. Private rooms cost extra and Medicare doesn’t cover it.
When you are going through the process it’s sort of like dealing with the cable company- it feels like the goalposts are always moving and what someone said yesterday is different from what someone else is telling you today and both people will tell you what you have been told is incorrect. As soon as you are admitted to the skilled nursing facility discharge planning will commence. You will be notified of estimated then planned discharge dates and if you feel your senior is not ready for discharge you can appeal a discharge decision and the staff can help point you in the right direction.
Long term nursing home care is not covered by Medicare or private insurance companies. Medicaid and long term care insurance can help offset some costs but any way you slice it, it costs a fortune.
If you are caring for a medically fragile person who needs hospitalization at some point you will likely hear about skilled nursing and now you have a little better idea about what it’s all about. Bonus points if, when someone brings up skilled nursing, you say “oh you mean a sniff?”
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