doctor explaining diagnosis to his female patient

Understanding Skilled Nursing Care and How to Cover the Cost

When an elderly loved one requires specific medical care or can no longer be safe in a home setting, the option of a care facility is often discussed. This conversation can be emotional and confusing for all involved. The terminology around care facilities is generally vague and requirements vary across states. Funding options are different between facilities types and the list of questions about regulations can be endless.

The right information and dependable resources can help the conversation about care facilities become more clear and less frightening.

What is a Skilled Nursing Facility?

To many people, a skilled nursing facility (SNF) looks much like a nursing home or a rehabilitation facility. Some organizations offer all these types of care, which is why it is important to understand the difference. At the basic level, the difference comes down to the level of care – skilled nursing care is provided by trained, registered nurses in a medical setting under a doctor’s supervision. Skilled nursing facilities are short-term, acute care facilities that provide transitional care, after surgery or a prolonged hospital stay, with the goal of the patient returning home. Applications of skilled nursing care include:

  • Post-surgical or wound care
  • Monitoring of blood pressure, heart rate or blood sugar
  • IV therapy
  • Injected medications
  • Therapies, including physical, speech and occupational

Does Medicare Cover Skilled Nursing?

Following a qualifying hospital stay, Medicare Part A does cover up to 100 days in a skilled nursing facility. A SNF will provide care that includes tube feedings if needed, would care and the administration of medication. Medicare Part A may cover skilled nursing care if you meet these qualifications:

  • You were an admitted inpatient at a hospital for at least three days in a row
  • You enter a Medicare-certified SNF within 30 days upon leaving the hospital and you receive care for the same condition you were treated for during your hospital stay
  • Your condition requires skilled nursing care seven days per week or skilled therapy services at least five days per week

Eligibility for coverage is determined by the Centers for Medicare and Medicaid Services. If you are deemed eligible for Medicare Part A, the deductible covers the first 20 days per benefit pay period. Once that is met, you pay a share of the cost for each additional day you remain at the SNF. The patient would bear full financial responsibility after 100 days of skilled nursing care.

While Medicare does cover care in a skilled nursing facility, Medicare does not cover long-term custodial care in a nursing home. While Medicaid or private long-term health insurance may provide coverage in this situation, Medicare provides no coverage for medical care for nursing home residents.

What Type of Facility is Right for You?

If you need a skilled nursing facility, there are many options. The hospital staff can help you during, or even prior to, your stay at the hospital. However, if you are interested in exploring options on your own or with your family, here are a few criteria to consider:

Understand what you want and need. Some types of facilities provide certain levels of care. Ensure you are looking into skilled nursing facilities that provide the level of care you require. If you prefer a facility with strong recognition in nursing care, religious connections or excellence in physical therapy, those are all things to identify and put on your list to investigate.

Make calls and visits. Call the skilled nursing facilities that interest you and schedule visits. Ask questions during your visit to ensure they offer the level of care you need, as well as the care environment you want. Sometimes, it is helpful to make a second visit to the facilities you like the best. Ask about staff longevity, online reviews and food procedures. All of these can be signs of quality facilities.

Read the contract. Once you receive the contract for the skilled nursing facility, ask questions about anything you do not understand. It is often valuable to have a trusted friend or family member review the contract, as well.

Looking Ahead

Lakeland Rehabilitation & Health Care Center is experienced in creating custom care plans to address the needs of your loved ones who require skilled nursing or memory care services. We create a culture of caring and respect, treating your loved one with dignity at every turn.

When you are ready to explore an extra level of compassionate support to help your elderly loved one, call Lakeland at 217-342-2171.