Defining Skilled Nursing Facilities

Skilled nursing is a Medicare covered service and is health care that is provided when skilled nursing or rehabilitative services are needed to manage, observe and evaluate the care an individual receives. Medicare skilled services are provided for a short period of time (e.g. 100 days or less).

Skilled nursing facilities are licensed by each State’s Department of Health and Human Services and are certified by CMS for the provision of Medicare services. The skilled nursing setting provides intensely skilled nursing care aimed at helping an individual regain or maintain their independence and level of functioning, to the extent possible, or to provide comfort and support for the end of life. Skilled nursing is not custodial care.

Whereas, a nursing home, an Intermediate Care Facility or ICF, provides a room, meals, and help individuals with activities of daily living needs. Residents living in a nursing home usually have physical or memory problems that keep them from living on their own.

In terms of rehabilitation in skilled nursing facilities, hospitals make the arrangements for follow-up patient care after an acute hospital stay, like after a surgery. When released from the hospital, a patient transfers to the skilled nursing home to receive hands-on care from nurses. If a patient needs rehabilitation like physical of speech therapy, a patient receives the services until they're able to go home.

🔹 Nursing in the skilled setting tends to serve older/elderly individuals who
🔹 Have experienced a decline in condition
🔹 Need assistance with activities of daily living
🔹 Are sick with multiple co-morbidities
🔹 May or may not have a disability
🔹 May be recovering from surgery and are in need of rehabilitative services in a skilled nursing facility/unit
🔹 May or may not have support systems to assist them with their recovery care needs

The focus of care in the skilled nursing setting is to provide skilled nursing services (e.g. wound care, tube feedings, IV therapy, respiratory care, dialysis, anticoagulant therapy, insulin administration) and rehabilitative services.

Admission to a skilled nursing setting requires medical necessity and often follows hospitalization or is related to a decline in functioning.  The individual may be:

🔹 Recovering from surgery (e.g. hip replacement, fracture, amputation, tracheostomy placement, colostomy placement)
🔹 Experiencing an exacerbation of an illness/chronic condition (e.g. COPD, CHF, kidney failure, pneumonia, thrombosis, CVA, UTI), a progressive disease (e.g. Parkinson’s, Alzheimer’s, Huntington’s), a terminal illness (e.g. cancer)
🔹 Unable to care for him/herself.

Admission to a skilled nursing setting may be for a short stay admission (e.g. less than 100 days) for skilled services or for a long-term care admission for custodial care.  The provision of skilled nursing services is for a short period of time and usually, follows a qualifying hospital stay.

Most people pay for skilled nursing care with Medicare or Medicaid benefits, health insurance plans.

Many patients who live in nursing homes permanently exhaust their personal finances at some point. When this happens, Medicaid pays for the nursing home care. Know: Medicaid does not pay all costs.

Medicare pays for skilled nursing care when:

🔹 The patient has a qualifying hospital stay
🔹 The doctor decides you need daily skilled care.
🔹 The nursing home's certified by Medicare.