Skilled Nursing Care vs Nursing Homes: What’s Different?

Nurses holding hands.

A large chunk of our population, about 1.7 million people, live in nursing facilities throughout the country. There are about 15,000 nursing facilities, and they do not all provide the same type of care. The type of care provided varies depending on the estimated length of stay and the care needs of the patient. There are two levels of care in nursing facilities: Skilled nursing and nursing home care. You may be searching for the right type of care for yourself or a loved one. We would like to go over in detail these two kinds of care options and highlight the differences so you can choose the right one for you.

What is Skilled Nursing Care?

Skilled nursing care is a type of care that can only be performed by licensed nurses or therapists. It is often necessary after a hospitalization or surgery. The patient requires more rehabilitation and medical care before they can return to normal life. An example of a patient who needs skilled care would include someone who suffered a fall and in need of short-term physical therapy and wound care. Confusion often comes with the term “skilled nursing,” as it is often used synonymously with the word “nursing home.” However, skilled nursing is a type of service or care, rather than a facility. Short-term skilled nursing services through home health care can even be provided in a senior’s private home if prescribed by a doctor. The “where” has nothing to do with it. Are you looking for a skilled nurse to help you recover at home from an injury? Post a job with us!

What is a Skilled Nursing Facility?

A skilled nursing facility, or SNF, is a transitional facility often considered a short-term stop between the hospital and home. SNFs specialize in post-acute care. This means care provided after an emergency hospital stay. SNFs provide in-patient rehabilitation and medical treatment. Due to the high level of care needed for these patients, a highly trained staff is needed. Skilled nursing staff includes: 

  • Registered Nurses (RNs)
  • Licensed Practical Nurses (LPNs) 
  • Licensed Vocational Nurses (LVNs)
  • Speech therapists
  • Occupational therapists
  • Physical therapists
  • Audiologists
  • Medical directors 

Many of these skilled nursing staff positions are not available at nursing homes. Round-the-clock medical assistance is available at SNFs. Senior care, ADLs (personal care activities of daily living: eating, bathing, getting dressed, toileting, transferring, and continence), meal preparation, and non-medical assistance are all included, just like in a nursing home. However, unlike nursing homes, SNF care is temporary and focused on a specific goal of the patient’s recovery. 

Facilities that provide skilled nursing care are inspected often and must follow a strict set of guidelines outlined by Centers for Medicare & Medicaid Services, or CMS. These facilities are also regulated by their states and the U.S. Department of Health. Here is a list of facilities where you can find skilled nursing care: 

  • Hospitals
  • Assisted living, or senior living communities
  • Life Plan communities
  • Nursing homes
  • Other certified locations

During the Covid-19 pandemic, some may be able to renew their SNF coverage without having to first start a new benefit period. If you are not able to be in your home or are affected during the time of coronavirus, you can get SNF care without a qualifying hospital stay.

A nursing home is also a skilled nursing facility.

What is a Nursing Home?

A nursing home is the physical building used to house residents who receive assisted living or skilled nursing care. These long-term care facilities provide eldercare and are an alternative to live-in care. Patients in a nursing home need indefinite custodial care 24/7. A nursing home would most likely be an ideal place for an Alzheimer’s patient or similar irreversible medical condition.  

A stay in a nursing home is considered more long-term or permanent and is often not covered by Medicare. In a long-term nursing home, the care received is known as non-medical custodial. This means a non-medical worker is providing custodial care. However, if the nursing home is also a skilled nursing facility and the patient qualifies, Medicare will contribute to the patient’s care for up to 100 days. This is uncommon. Most people pay for nursing homes out of pocket, or with insurance until they hopefully become eligible for Medicaid. Medicare will not cover the majority of nursing home expenses. But in some cases, it will cover health care expenses, medical supplies, and some standard hospital services. 

Nursing homes are subject to state surveys to ensure they are complying with rules and regulations, as well as ensuring there are no threats to resident’s safety. If there are any violations, the nursing homes’ administration must fix the violations. The CMS also holds eligible nursing homes accountable to their guidelines. 

Medicare Coverage

Medicare covers many skilled nursing facilities stays, but only for a limited time. When first entering a Medicare-certified skilled nursing facility, the patient’s overall health is determined. The patient will undergo examinations for physical and mental health. They will be assessed of their medications, their ability to perform ADLs, and their ability to speak and make decisions. If the patient needing post-hospital care is enrolled in Medicare and meets their requirements, they will be allowed to stay at the facility for up to 100 days. Here is the breakdown of how much Medicare will pay:

  • Day 1-20: $0/day
  • Day 21-100: $167.50/day to be covered by patient or their insurance
  • Day 101-indefinite future: all costs to be covered by patient or their insurance

After admission to the facility, patients will be required to undergo further exams throughout their stay. Unlike some assisted living facilities, SNFs cannot charge a buy-in fee. The SNF is required to draw up the fees in writing beforehand, and provide the figures to the patient or their caregiver. And they can be quite expensive, especially for long-term stays. Here is a list of skilled nursing care services that are covered by Medicare:

  • Semi-private room
  • Meals
  • Skilled nursing care
  • Medical social services
  • Physical and occupational therapy
  • Medications
  • Speech-language pathology services
  • Dietary counseling
  • Ambulance transportation
  • Medical supplies and equipment used

Medicaid

If a patient doesn’t meet the requirements for Medicare or have reached their limit, Medicaid sometimes steps in to pay. For example, if a patient ends up at a nursing home that is also a skilled nursing care facility and uses up their Medicare limit, they do not have to change to another care facility. Medicaid will step in as long as the facility is also Medicaid-certified and the patient is eligible. If the facility is not Medicaid-certified, the patient will have to switch to a facility that is. For Medicaid to pitch in, it must be verified that the long-term care of the patient is “medically necessary.” The patient must also prove that their assets and income fall below a certain level. 

So, we’ve given you a detailed overview of both skilled nursing care and nursing homes and their possible payment options. We hope that you have determined the appropriate care option for you. To aid in your quest for the right care facility, we have provided two separate lists of questions to ask when visiting either your potential SNF or potential nursing home:

Helpful Questions In the Quest for the Right Skilled Nursing Care Facility

SNF Basic Information 

  • Is the SNF Medicare-certified?
  • Is the SNF Medicaid-certified?
  • Does the SNF provide the care you need and have a bed available?
  • Does the SNF provide special services if needed in a separate unit (for dementia, ventilator, or rehab), and have a bed available?
  • Is the SNF close enough for friends and family to visit?

SNF Appearance of Residents

  • Are the current residents clean, groomed, and are dressed appropriately for the current season or time of day?

SNF Living Spaces

  • Is the SNF free of unpleasant odors?
  • Does the SNF appear clean and well-kept?
  • Is the temperature in the SNF comfortable for residents?
  • Does the SNF have good lighting?
  • Are noise levels in common areas comfortable?
  • Is smoking prohibited or restricted to certain areas?
  • Are furnishings sturdy, comfortable, and attractive?

SNF Staff

  • Does the relationship between staff and residents appear to be warm, polite, and respectful?
  • Do staff wear name tags?
  • Does the staff knock on the door before entering a resident’s room and refer to them by name?
  • Does the SNF offer training and continuing education for the staff?
  • Does the guide on your tour know the residents by name and is recognized by them?
  • Is there a full-time Registered Nurse (RN) on staff at all times, other than the Administrator of Director of Nursing?
  • Does the same team of nurses and Certified Nursing Assistants (CNAs) work with the same resident 4 to 5 times a week?
  • Do the CNAs work with a reasonable amount of residents?
  • Are CNAs involved in care planning meetings?
  • Is there a full-time social worker on staff?
  • Is there a licensed doctor on staff who is there daily? Can he or she be reached at all times?
  • Has the SNF management team worked together for at least a year?

SNF Residents’ Rooms

  • Do residents have personal belongings and furniture in their rooms?
  • Does each resident have personal storage space in their rooms?
  • Does each resident have a window in their room?
  • Do the residents have access to a personal phone and television?
  • Do residents have their own choice in roommates?
  • Can water pitchers be reached by residents?
  • Are their policies and procedures to protect residents’ possessions?

SNF Hallways, Stairs, Lounges, and Bathrooms

  • Are exits clearly marked?
  • Are there quiet areas where residents can visit with friends and family?
  • Does the SNF have smoke detectors and sprinklers?
  • Are all common areas, rooms, and doorways designed for wheelchair use?
  • Are there handrails in the hallways and grab bars in the bathroom?

SNF Menus and Food

  • Do residents have a choice of food items at each meal?
  • Are nutritious snacks available?
  • Are staff available to help residents eat and drink if needed?

SNF Activities

  • Are all residents able to take part in a variety of activities?
  • Does the SNF have an outdoor area and is staff available to help residents go outside?
  • Does the SNF have an active volunteer program?

SNF Safety and Care

  • Does the SNF have an emergency evacuation plan and hold regular fire drills?
  • Do residents get preventative care, like flu shots?
  • Can residents still see their regular doctors?
  • Does the SNF have an arrangement with a local hospital for emergencies?
  • Are care plan meetings held at convenient times with residents and family members?
  • Has the SNF corrected all the deficiencies in its last state inspection report? 
At the end of the day, a good nurse is always there to help you with your health needs.

Helpful Questions In the Quest for the Right Nursing Home

Nursing Home Basic Information:

  • Is the nursing home Medicare-certified?
  • Is the nursing home Medicaid-certified?
  • Are the nursing home and current administrator licensed in my state?
  • Does the nursing home have beds available?
  • Does the nursing home offer specialized services, like for dementia or ventilator care?
  • Is the nursing home close enough for family and friends to visit?
  • Are there resident policies that must be followed? What are they?
  • Are there extra charges for special services, like beauty shop services?
  • Will the nursing home provide a fee schedule clearing noting what services are part of the monthly fee, and what is extra?

Nursing Home Safety and Care

  • Have you checked the nursing home’s rating on Medicare.gov?
  • Does the nursing home take action to improve quality or staffing when needed?
  • Can residents still see their doctors? If so, will the nursing home help with arranging transportation for them to do so?
  • Does the nursing home have an arrangement with a nearby hospital?
  • Are care plan meetings held at convenient times for residents and family members?
  • Does the nursing home’s state or federal inspection report indicate any quality of care problems or citations?
  • Has the nursing home corrected all the citations from the last inspection report?

Preventing Abuse in Nursing Home 

  • Does the relationship between the staff and residents appear warm, friendly, and respectful?
  • Does the nursing home check potential staff in the state nurse aid registry to make sure they do not have a history of abuse, neglect, or mistreatment of residents? 
  • Does the nursing home have policies and procedures on prohibiting and reporting abuse and neglect?
  • Is the nursing home taking action to keep residents safe from abuse, neglect, mistreatment, or exploitation? 
  • Is there information about how to report concerns about the care and safety of residents? 
  • Is there information about how the facility responds to concerns that are reported? 
  • Has the nursing home been cited for issues related to abuse in the last year or two?

Nursing Home Appearance

  • Are residents clean, well-groomed, and appropriately dressed for the season or time of day? 
  • Is the nursing home free from overwhelming unpleasant odors? 
  • Does the nursing home appear clean and well kept? 
  • Is the temperature in the nursing home comfortable for residents? 
  • Does the nursing home have good lighting? 
  • Are the noise levels in the dining room and other common areas comfortable?

Nursing Home Living Spaces

  • Is the furniture sturdy, comfortable, and attractive?
  • Are exits clearly marked? 
  • Are there quiet areas where the residents can visit their friends and family?
  • Does the nursing home have smoke detectors and sprinklers? 
  • Are all common areas, resident rooms, and doorways designed for wheelchairs? 
  • Are handrails and grab bars appropriately placed in the hallways and bathrooms?

Nursing Home Menus and Food

  • Do the residents have different choices at their meals?
  • Can the nursing home accommodate special dietary needs?
  • Are nutritious snacks available?
  • Is staff available to help assist residents in eating and drinking during meals?

Nursing Home Staff

  • Does the staff member knock on a resident’s door before entering?
  • Do staff members refer to residents by name?
  • Does the nursing home offer their staff additional training and continuing education?
  • Is there a licensed nursing staff 24 hours a day, including a Registered Nurse (RN) present at least 8 hours per day, 7 days a week? 
  • Do Certified Nurse Aides (CNAs) help plan the care of residents?
  • How many nurses, including CNAs, will be available during the day, at night, and on weekends? 
  • Is there a staff member assigned to meet residents’ social service needs?
  • Will the staff call the resident’s doctor if there is a medical need?
  • Has there been a turnover in the past year of administrative staff?
  • Is the primary language of the resident spoken by the staff?

Nursing Home Residents’ Rooms

  • Can residents have personal belongings and furniture in their rooms?
  • Does each resident have personal storage space in their rooms?
  • Does each resident have a window in their room?
  • Do the residents have access to a personal phone, computer, and television?
  • Do residents have their own choice in roommates?
  • Are their policies and procedures to protect residents’ possessions?

Nursing Home Activities

  • Do residents have their choice in taking part in various activities, including residents confined to their room?
  • Do residents help plan and choose the activities available?
  • Does the nursing home have outdoor areas for resident use? 
  • Is staff available to help residents go outside? 
  • Does the nursing home have an active volunteer program? 
  • Do residents get to choose what time to get up, go to sleep, or bathe? 
  • Can residents have visitors at any time – even in early or late hours? 
  • Are residents able to leave the facility for a few hours or days? 
  • Are there procedures for leaving? 
  • Does the nursing home offer religious or cultural support? 
  • If not, what type of arrangements will they provide to meet those needs?

Caring for Residents with Dementia in Nursing Home 

  • Does the nursing home have specific policies and procedures related to the care of residents with dementia? 
  • If so, does the policy include the use of non-medication based approaches to care as a first attempt to respond to behavioral symptoms (which are often a means of communication) for residents living with dementia? 
  • What percentage of residents who have a diagnosis of dementia are currently being prescribed an antipsychotic medication? 
  • What’s the nursing home’s current rate of the antipsychotic medication use?
  • Does the nursing home participate in any efforts related to reducing antipsychotic medication use in nursing homes (like the National Partnership to Improve Dementia Care)?

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