How Does A Skilled Nursing Facility Differ From A Nursing Home?

As a caregiver, you want to make sure your loved one is receiving the best care possible. When deciding on a skilled nursing facility for your loved one, there is some important information to keep in mind to make an educated decision.

In this article, we’ll explore what a skilled nursing facility does. We’ll share some key questions you can ask to make sure your loved one gets the proper care. You will also find some helpful steps you can take to get treatment covered by programs such as Medicare, if possible. 

What is a Skilled Nursing Facility?

A skilled nursing facility is a place where your loved one can get 24/7 access to trained medical workers. This might include registered nurses, licensed practical nurses, and even therapists trained to help people with speech problems, post-surgery rehab, etc.

In general, a skilled nursing facility isn’t designed to become a permanent home for people who stay there. Instead, it is a place loved ones go to get temporary support. They might need extra help after surgery or for the treatment of a wound. 

During your loved one’s stay, they will get regular medical checkups, dedicated therapy as needed, as well as meals and general care. Some services are covered under programs like Medicare, while other special features can cost extra and won’t be covered. You can ask your loved one’s skilled nursing facility provider for an itemized bill explaining what Medicare covers and any out-of-pocket expenses. Then, you can approve those extra fees or agree to skip those services instead.

Know that your loved one will need a signed doctor’s note stating they need the help of a skilled facility to get coverage through Medicare.

How Are Skilled Nursing Facilities and Nursing Homes Different? 

Several key differences exist between a skilled nursing facility and a nursing home. For example:

• Duration of stay: Most people in a skilled nursing facility won’t stay permanently. Programs like Medicare often won’t pay for a stay at a skilled nursing facility beyond 100 days. Meanwhile, a nursing home often hosts people who plan to stay for extended periods or even permanently. 

• Medicare coverage of expenses: Although Medicare will cover many expenses in a skilled nursing facility, it generally does not cover nursing homes. In some cases, Medicaid will cover certain nursing home expenses if your loved one qualifies. Do some research and ask people you trust for clarity on costs and program coverage so you and your loved one enter any facility with an understanding of what will be covered and what you’ll need to pay.

• Private insurance: If your loved one has long-term care insurance, it’s possible they could get specific services covered at a skilled nursing facility or a nursing home. The types of services included will likely vary. Ask your loved one’s insurer to provide information on the services they cover at a skilled nursing facility.

• Variety of services: Although some basic amenities are available at a skilled nursing facility, they are designed to help your loved one heal and return to their home. On the other hand, a nursing home might have a bigger list of services, regular events for residents, and more rooms or amenities for various social functions such as meals and exercise. Both skilled nursing facilities and nursing homes typically offer information online or via a printed brochure that can give you a sense of what it’s like to stay there.

What Questions Should I Ask to Make Sure My Loved One is Well-Cared For?

Several questions can help you ensure your loved one gets the right care. They can also help you determine which type of support they need. For example, you can ask:

• Does my loved one need short-term or long-term medical support? If the answer is short-term, such as while recovering from surgery, a skilled nursing facility or even an in-home care provider might be the best solution. If you’re leaning toward hiring a home health aide, our guide on choosing a home health aide is a great place to start. 

On the other hand, if their medical needs will need more than three months of care, a nursing home makes more sense. This will ensure they can get the care they need throughout the months and years ahead.

• How can my loved one get cost-effective treatment? Every family’s answer to this question will be different. If your loved one is enrolled in Medicare and their doctor anticipates a recovery window of three months or less, a skilled nursing facility could help. Medicare pays for many of the expenses at a skilled nursing facility. Your loved one’s private insurance or personal savings can be used to cover anything that Medicare doesn’t pay for. 

If your loved one qualifies for Medicaid based on their financial situation, they could get treatment at a skilled nursing facility. Medicaid would kick in if they have no other funding means available. There are also services Medicaid will cover at a nursing home if they need more long-term support. 

• Will my loved one have access to high-quality caregivers? Whether your loved one stays at a skilled nursing facility or a nursing home, the staff will have a high level of medical training. You can ask specific facilities for details on areas of expertise and medical specialties. Both types of facilities rely on the expertise of trained nurses and doctors to help patients/residents.

How Can I Get My Loved One’s Skilled Nursing Facility Expenses Covered?

Ask the skilled nursing facility your loved one is staying at for a breakdown of costs. Make sure you read the fine print to understand each expense, what programs will cover them, like Medicare, and which your loved one will have to pay for. Of course, you can always reject specific services that are not medically necessary, such as fees for extra TV channels or an in-room phone. 

You can also speak with experts at the free Eldercare Locator hotline. They will provide you with contact information of trained professionals who can help you navigate caregiving questions in your loved one’s local geography.

Where Can I Find More Information on Skilled Nursing Facilities? 

Several resources can help support your skilled nursing facility research and decision-making process. Among them are:

• The ABCs of Medicare: Who's Covered? What's Covered? What's Not?: Get a walkthrough of everything you need to know about services Medicare can fund for your loved one in this Carewell post.

• Skilled Nursing Facility Care: Find more details on covered services and payments available for skilled nursing facilities from the federal government’s Medicare website.

• How Can I Pay For Nursing Home Care?: Learn more about the options available to caregivers to ensure their loved one gets proper treatment.