One of the most common and familiar senior care options is a nursing home. While the term skilled nursing is often used interchangeably, they are actually quite different. One is a type of care (skilled nursing) and the other is a senior living option (nursing home). Let’s define both more clearly, so you can make an informed decision for your loved one.
What is skilled nursing?
Skilled nursing is a high level of medical care provided by trained individuals, such as registered nurses (RNs) and physical, speech, and occupational therapists. Examples include wound care, intravenous (IV) therapy, injections, physical therapy, and monitoring of vital signs and medical equipment.
Where is skilled nursing provided?
Skilled nursing can be provided in several settings – in a hospital, its own stand-alone facility, as a unit within a nursing home, in an assisted living apartment, or in the home. In this blog, we’ll be discussing skilled nursing as its own facility or as a unit within a nursing home. This combined facility has become more common as continuing care communities seek to provide all the services a senior might need as they age. This is also where much of the confusion lies between the terms skilled nursing and nursing home.
What is the purpose of a skilled nursing facility or a skilled nursing unit?
A skilled nursing facility (or unit within a nursing home) is for seniors who need to recover from an injury, illness, or surgery. Seniors are often transferred to a skilled nursing facility or unit following a hospital stay. It’s commonly referred to as post-acute care. In most cases, they are well enough to be released from the hospital, but still need significant medical care to recovery. A skilled nursing facility is not a permanent living situation, but rather a temporary arrangement while the senior regains health, strength, and mobility.
What services do skilled nursing facilities provide?
In addition to the medical and rehabilitative services noted above, the staff at skilled nursing facilities also provide help with the tasks of daily living, such as meals, housekeeping, and personal care. While skilled nursing and post-acute care centers do offer in-depth medical care, they are very different from hospitals. Dining rooms, activities, outings and companionship offer residents and patients mental, physical and social stimulation to help in the recovery process.
How do I choose a skilled nursing facility?
If your loved one is about to be discharged, but still needs medical care, the hospital is responsible for identifying skilled nursing facilities within the geographic region that can meet their needs. Once a placement is found, if they no longer need a hospital level of care, they’ll become financially responsible for the continuing hospital stay. Unfortunately, patients, families, and friends may not be happy with the hospital’s proposed skilled nursing facility choices. In that case, you’ll need to quickly identify an alternative facility. The best places to begin are:
- Elder Care Locator – After typing in your zip code, the Elder Care Locator provides contact information for local area agencies on aging, state agencies on aging, health insurance counseling programs, legal services, and the Long-Term Care Ombudsman. These agencies can help you identify and evaluate nursing facilities.
- Nursing Home Compare – Developed by the Centers for Medicare & Medicaid Services (CMS), this site uses a five-star rating system to classify the quality of care in each Medicare-participating skilled nursing facility. Although potentially helpful, ratings through Nursing Home Compare should not be the only factor in choosing a facility, as some of the quality ratings criteria are self-reported. By using this website, you’ll be certain to select a facility that’s Medicare-approved, so it will be eligible to receive payment from Medicare.
Where does the senior go after being released from a skilled nursing facility or unit?
The facility must develop a post-discharge plan of care, developed with the senior and caregiver participation, which will help with the adjustment to a new living environment.
Depending on the senior’s capabilities and/or preferences, they can:
- Return home, with or without the support of home care
- Return (or apply to) an independent living community, with or without the support of home care
- Return (or apply to) an assisted living community or residential care home
- Return (or apply to) a nursing home
You can learn more about rights related to discharge planning at The Center for Medicare Advocacy.
Who provides the services at skilled nursing facilities?
Much like a hospital, staff members include the following types of professionals:
- Registered nurses
- Licensed practical nurses
- Speech/Language pathologists
- Licensed vocational nurses
- Medical directors
Each facility is different, but most also have a dietician and activities director. Even though most seniors remain in a skilled nursing facility for a short time, the staff try to make the experience more pleasant than a hospital stay.
How can I pay for care at a skilled nursing facility?
Depending upon the state in which you reside, in 2017, the overall average cost was $235 per day for a semi-private room and $267 for a private room.
Fortunately, Medicare covers all or part of the stay in a skilled nursing facility up to 100 days. You must have a qualifying hospital stay of at least three full days and meet all the following conditions:
- You have days left in your benefit period (typically up to 100 days).
- Your doctor believes it’s medically necessary that you get skilled nursing to treat your condition.
- You had the condition when you were in the hospital during a qualifying stay, or the condition developed while you were in the hospital.
- The nursing home you choose is certified by Medicare.
Here’s how it works:
- Days 1–20: Fully covered by Medicare
- Days 21–100: $167.50 per day to be covered by patient or insurance
- Days 101+: All costs covered by patient or insurance
If you need to stay longer and Medicare has run out, other options include long-term care insurance, private funding, or liquidating a life insurance policy. It’s always best to consult with a financial planner or elder specialist.
How are skilled nursing facilities regulated?
Both nursing homes and skilled nursing facilities are state regulated by the Department of Health in conjunction with the U.S. Centers for Medicare and Medicaid Services (CMS). Subject to unscheduled inspections called "surveys," they are evaluated for any violations or immediate threats to patient safety and satisfaction. In addition, residents of a skilled nursing facility have certain rights and protections under federal and state law. These laws help ensure your loved one gets the care and services needed.
What is the purpose of a nursing home?
A nursing home is a permanent residence for a person who needs help with activities of daily living but does not require specialized medical care. Seniors may be transferred to a nursing home directly from their home or from an assisted living community as their needs become more intensive. If a senior has been recently hospitalized, his/her caregivers and the staff will need to decide if they need a temporary stay at a skilled nursing facility, or if the nursing home can manage their recovery and ongoing medical needs. What services do nursing homes provide?
Although the services of nursing homes vary, most commonly they include:
- Room and board
- Monitoring of medication
- Personal care (including dressing, bathing, and toilet assistance)
- General care (using oxygen, catheter care, eye drops, vitamins, stretching, etc.)
- 24-hour emergency care
- Social and recreational activities
- Transportation services
- Housekeeping services
Who provides the services at nursing homes?
Certified Nursing Assistants provide much of the daily care with oversight. However, federal law requires that a registered nurse be present in Medicare and Medicaid-certified nursing homes at least eight hours straight a day, seven days a week, and that there be a licensed nurse, who can be an RN or LPN, present 24 hours a day. In addition, nursing homes typically have a dietician and activities director on staff.
How can I pay for care at a nursing home?
According to Northwestern Mutual, the national average for a semi-private room runs $245 a day, while a private room averages $281 a day - or about $89,000 to almost $103,000 a year.
Medicare does not cover nursing homes, only the first 100 days of skilled nursing, as described above.
Medicaid is an option in certain circumstances. In order to be eligible for Medicaid support, you must prove your income and assets fall below certain guidelines. Because each state has different requirements, be sure to contact your local Medicaid office for more information. In most cases, if your income is above the requirements, you’ll need to pay for nursing home costs out of pocket. Once your money falls below the criteria, Medicaid will begin paying.
Other options include long-term care insurance, Aid & Attendance Benefit for Veterans, and private funding. Seniors may also want to consider how to utilize their life insurance policy or use a reverse mortgage.--
As you can see, the fact that skilled nursing can be provided separately in its own facility or as a unit within a nursing home has certainly confused the general public. Hopefully this blog has cleared it up and given you the information needed to make smart decisions for your senior loved one.