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, medical professionals use the terms “nursing homes” and “skilled nursing facilities” interchangeably. In others, they can mean two distinct levels of care. Read on to learn about the subtle differences between the two types of senior care.
Nursing Home vs. Skilled Nursing Facility: Is There a Difference?
Nursing home care usually means long-term custodial care, or help with activities of daily living. Skilled nursing care usually refers to short-term care that requires more advanced training to provide, such as giving IV medications or physical therapy after surgery.
The confusion begins because not everyone’s care needs are one-size-fits-all. While some long-term nursing home residents only need custodial care, others need nursing care for the remainder of their lives.
Nursing home vs. skilled nursing facility: Are the two terms related?
“Nursing homes were once referred to as ‘homes for the aged,'” explains Mark Sanchez, administrator for United Hebrew, a campus of elder care facilities in New Rochelle, New York.
Now, though, the terms nursing home and skilled nursing facility are 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.
Because of this overlap, nursing home care 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.
[READ Long-Term Care Facilities: Types and Costs]
What Is a Nursing Home?
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 benefit from custodial care, or help with activities of daily living.
What is nursing home care?
The main function of a nursing home is to provide custodial care, or nonmedical help with daily functioning.
Custodial care includes services such as:
— Aid with activities of daily living, or basic tasks needed for independent living, such as 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, such as Tylenol
[RATINGS: Best Nursing Homes.]
What Is a Skilled Nursing Facility?
Let’s say your mom’s fall was severe enough to require a hip replacement. After surgery at a hospital, her doctor recommends short-term skilled nursing care, such as physical therapy and IV pain medication. The term is particularly used when referring to short-term rehab care after a surgery or injury.
What is skilled nursing care?
Skilled nursing facilities are a higher level of care than nursing homes, so while they still provide custodial care, they also provide skilled nursing services. “SNFs are designed to deliver short-term, medically intensive care for patients who require rehabilitation after a hospital stay, surgery or acute medical event,” says Vince Baiera, a San Diego-based nurse and post-acute care partner at Relias.
Care provided in a skilled nursing facility includes:
— Care that is performed by a licensed nurse. This may include all types of nursing care, from someone who needs catheter care after a recent prostatectomy to tracheostomy care after prolonged intubation in the hospital.
— Specialized therapy, such as physical, occupational or speech therapy
— Additional health monitoring, like vital signs, labs or cardiac monitoring, which may be necessary while recovering from a hospital stay, or for monitoring certain conditions, like newly diagnosed abnormal heart rhythms
“A cornerstone of SNF care is rehabilitation services tailored to help patients regain mobility, independence and functionality,” Baiera says.
Often, a short-term skilled nursing stay leads to longer-term nursing and custodial care.
Qualifying for a Skilled Nursing Facility
To medically qualify for a skilled nursing facility, your family member will need a recommendation from a medical provider or documentation that they need nursing tasks to manage their lifestyle or health condition.
“Skilled nursing care is crucial for those who need daily skilled nursing services tailored to their specific situations. Whether it’s meticulous wound care, careful medication administration or intensive therapy sessions, these services become even more vital following significant medical events like major surgeries, strokes or severe injuries,” says LeShaun Williams, a family nurse practitioner at the Center for Better Aging in Chicago.
Does Medicare pay for skilled nursing care?
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.
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 for days 21 to 100. You’re responsible for all expenses after 100 days.
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 does not cover ongoing care needs, indefinite skilled nursing needs or custodial care alone.
Does Medicaid pay for skilled nursing care?
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.
[READ: How to Pay for Nursing Home Costs.]
Is a Skilled Nursing Facility or a Nursing Home a Better Fit?
Start off with a thorough assessment of what type of senior care your family member needs. This should be a shared decision process with your loved one, their medical provider and their family. Decide whether a family member would benefit more from custodial care alone or if they would also benefit from skilled nursing care.
Williams recommends considering:
— The complexity of the medical conditions, such as how many conditions they have, and how these interact with each other. For example, having heart failure and chronic kidney disease at the same time requires intense care management.
— The need for skilled services, such as intricate medication management or specialized wound care
— Their ability to participate in rehabilitation
— Their recovery time, or if recovery is expected at all
— A medical provider’s recommendations
When it comes to the spectrum of care available, people often start at a lower level of care, such as assisted living communities or an adult family home, or group home, in order to save money. A nursing home, on the other hand, tends to be one of the most expensive care options. For example, a private room in a nursing home can run more than $9,000 per month, according to Genworth Financial’s 2023 Cost of Care survey.
Explore Top-Rated Senior Living Facilities With U.S. News & World Report
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.
Check out the Best Nursing Homes with U.S. News & World Report. To help find the best match for a loved one, in 2024 U.S. News evaluated more than 15,000 facilities throughout the country and rated most of them in two different areas, short-term rehabilitation and long-term care.
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What Is a Skilled Nursing Facility vs. a Nursing Home? originally appeared on usnews.com
Update 10/30/24: This story was previously published at an earlier date and has been updated with new information.
