It’s overwhelming enough helping your mom get discharged from the hospital after a fall. Then, what if her doctor doesn’t think it’s safe for her to return home? As you scramble to find somewhere for her to go, you’re inundated with unfamiliar senior living terminology: What is a skilled nursing facility? What is a nursing home? Are they the same?
The answer isn’t so straightforward. In some situations, the terms “nursing homes” and “skilled nursing facilities” are interchangeable. In others, they can mean two distinct levels of care. Read on to learn about the subtle differences between the two names.
Nursing Home vs. Skilled Nursing Facility
Nursing homes and skilled nursing facilities differ depending on the specific care needed and the duration of that care. Care can be either short term (temporary) or long term (sometimes permanent). Let’s start with the latter.
Long-term nursing home care
Let’s say your mom fell because of worsening Alzheimer’s disease and has experienced continued difficulty keeping her balance. The fall caused minor scrapes and bruises, but her doctor thinks now she requires around-the-clock medical supervision.
In this situation, your mom would mainly receive what’s known as “custodial care.”
Custodial care includes:
— Aid with activities of daily living, or basic tasks needed for independent living, like toileting or grooming.
— Basic health care that unlicensed professionals can provide, like putting on a knee brace or administering eye drops. The type of care unlicensed professionals can provide varies by state.
— Support for instrumental activities of daily living, or complex skills needed to live independently, like preparing meals.
— Supervising the resident self-administering over-the-counter medication, like Tylenol.
[READ Long-Term Care Facilities: Types and Costs]
Short-term skilled nursing care
Let’s say your mom’s fall caused her to need a hip replacement. After surgery at a hospital, she may require short-term skilled nursing care, such as physical therapy and IV pain medication.
At a skilled nursing facility, she would likely receive custodial care as well as a higher level of care, or “skilled nursing.”
Skilled nursing care includes:
— Care that is performed by a licensed professional. This kind of help can include catheter care or tracheostomy care
— Specialized therapy, such as physical, occupational or speech therapy
— Additional health monitoring, like vital signs, labs or cardiac monitoring
The main distinction with short-term skilled nursing care is that Medicare coverage may be an option (more on that later on). Often, a short-term skilled nursing stay leads to longer-term nursing and custodial care.
[RATINGS: Best Nursing Homes.]
Nursing home and skilled nursing facility buildings
Both short-term and long-term nursing homes and skilled nursing care are usually offered in the same building. However, there might be specific wings or locations for each type of care and various assortments of medical professionals that oversee them. These professionals and caregivers may refer to the building as either a “skilled nursing facility” or a “nursing home” — hence the confusion over the two terms.
“Nursing homes were once referred to as ‘homes for the aged,’ and they primarily provided custodial, or nonmedical, care,” explains Mark Sanchez, the administrator for United Hebrew, a campus of elder care facilities in New Rochelle, New York.
Now, though, the terms are also often used interchangeably because most modern facilities must integrate skilled nursing care as the needs and acuity of the aging population have risen.
“Fewer facilities offer nursing home or custodial-only care,” Sanchez adds. “Today, they often include services such as physical, occupational and speech therapy, as well as more intensive health care. These are all services under the skilled nursing umbrella.”
This means that seniors have the option available to receive the highest level of care needed at any given time.
Paying for Nursing Home or Skilled Nursing Facility Care
Payment options are usually one of the first items of business for loved ones after considering what type of care their senior needs.
[READ: How to Pay for Nursing Home Costs.]
Medicare
As Medicare is a health care plan, coverage focuses on care that stems from a health problem that started in the hospital. It also includes rehabilitation that requires a need for skilled nursing as part of a recovery process. This is the scenario where the term “skilled nursing facility” is most often used.
The requirements for Medicare coverage include:
— A three-day inpatient hospital stay within the past 30 days
— Remaining days in the benefit period that are available to be used
— A medical provider determining that you have skilled nursing needs
Medicare covers up to 100 days of skilled nursing services. In each benefit period, you’ll pay $0 for the first 20 days, then a coinsurance amount ($204 per day in 2024) for days 21 to 100. You’re responsible for all expenses after 100 days.
Medicare does not cover ongoing care needs, indefinite skilled nursing needs or custodial care alone.
Medicaid
Medicaid, unlike Medicare, is a joint federal and state program for low-income individuals. If your loved one qualifies for Medicaid, they may use these funds as a means to help pay for some of their long-term care needs.
Long-term care insurance
Depending on the policy, long-term care insurance may provide some nursing home coverage in exchange for monthly premiums. Each policy has unique premium payment cost, length of coverage and benefit periods.
How Will Senior Care Change in the Future?
The number of individuals over 65 is expected to nearly double by 2060 in the U.S., according to the Population Reference Bureau, so the market for senior living environments will likely continue to pivot to meet these needs.
According to Sanchez, the market is also catering to people who have comorbidities, or more than one health condition. The Centers for Disease Control and Prevention confirms that nearly 1 in 5 adults over 55 years old has three or more chronic conditions.
“It is more common and comprehensive to use the term ‘skilled nursing facility.’ At the same time, we’ve seen a rise in nonskilled nursing care provided in other residential settings, such as assisted living communities,” Sanchez explains.
What Should Family Members Know?
It’s key to start off with a thorough assessment of what type of care your senior family member needs. This should be a shared decision process with your loved one, their medical provider and their family.
Needs are determined by:
— Mental health conditions, especially in the case of Alzheimer’s disease and dementia
— Physical health conditions and comorbidities
— The preferred care environment of the senior
When it comes to the spectrum of care available, people often start at a lower level of care. This type of care may be provided at assisted living communities, which can be more affordable and offer a more social environment. If they can receive that care at assisted living communities or an adult family home, they can save money. A nursing home, on the other hand, tends to be one of the most expensive care options (a private room can run more than $9,000 per month, according to Genworth Financial’s 2023 Cost of Care survey).
The next most important thing is to prepare early. Most people don’t face the cluttered world of senior care until they have a life-altering event. When decisions are made in stress and haste, it can make getting the right level of care for the right price much more difficult. So, do your research and outline your budget so you can make an informed decision without pressure.
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What Is the Difference Between a Skilled Nursing Facility and a Nursing Home? originally appeared on usnews.com
Update 08/01/24: This story was previously published at an earlier date and has been updated with new information.
