After an unexpected fall led to spinal cord injury, maybe your 65-year-old father hoped he’d be back to his routine in no time. His doctor, however, says it’s not safe for him to discharge home. His time in the hospital reveals ongoing leg weakness and a steep road to recovery to regain his mobility and strength.
For seniors barely recovering from illness or surgery, knowing where they need to turn to next can feel both daunting and urgent. Fortunately, skilled nursing care can provide the support needed for a safe recovery.
Here’s what to know about navigating short-term skilled nursing care, also referred to as skilled rehab, including what qualifies a patient for skilled nursing care, skilled nursing criteria and qualifications, how to qualify for this care and how to have it covered by Medicare.
[READ: How Much Does Medicare Pay for a Hospital Stay?]
What Is Skilled Nursing Care?
Skilled nursing care is nursing or therapy services provided or overseen by licensed health care professionals. Skilled nursing care is provided in a variety of settings, sometimes called skilled nursing facilities, nursing homes or long-term term acute care facilities, or the care can be provided at home. However, when the care is provided for a short time, it is typically referred to as “short-term rehab” or “skilled rehab.”
Skilled nursing services include:
— Medication management. A reminder to take an oral medication is not considered skilled nursing, but other administrations, such as IV medications or a medication that requires consistent titration, are considered skilled. Seniors are often battling chronic health conditions in addition to their short-term rehab condition and their pain. Combining medications requires a provider and pharmacist to oversee the medication interactions and a nurse to properly administer them.
— Nursing interventions. This area includes specialized care ranging from wound care and respiratory treatments to assisting with feeding tubes or administering insulin based on blood sugar levels.
— Therapy. Therapy may include physical therapy, occupational therapy and speech-language pathology. Physical therapy, for instance, may be incorporated to help someone improve mobility after a knee replacement. Occupational therapy may help an older adult with adaptive strategies for their daily activities, such as using a shower chair. A speech-language pathologist may help a senior improve their swallowing after a recent surgery.
— Ongoing monitoring and evaluation. This area could include services like lab draws to see if an antibiotic is effective in treating an infection.
— Other services and amenities. These aren’t exclusive to skilled nursing, but you may also receive services, such as help with daily hygiene or other activities of daily living, provided at lower levels of care. However, these services are considered custodial care on their own. Skilled nursing and rehab are the services that make a stay qualify as skilled nursing.
Skilled nursing facilities serve as an important bridge between hospital care settings and the home, adds Ahzam Afzal, Chicago-based co-founder and CEO of Puzzle Healthcare, a post-acute readmission prevention company.
The goal of skilled nursing after a hospital stay, Afzal says, is to prevent hospital readmissions. This is most effective right after a senior is discharged from the hospital. Often, the services provided in skilled nursing facilities are hard to receive at home immediately after a hospital stay, and this option allows providers to take action before any issues escalate.
[READ: 13 Questions to Ask Before You Leave the Hospital]
What Medically Qualifies a Patient for Skilled Nursing Care?
Most commonly, seniors receive their skilled nursing care at a skilled nursing facility or at an acute inpatient rehabilitation facility. Seniors who only need long-term custodial care should research state-specific nursing home requirements and look into other levels of senior living. Also note that Medicare does not cover custodial care.
There are a few elements that go into how a senior medically qualifies for skilled nursing care.
The skilled nursing criteria includes:
— Need for skilled care. Seniors must have a need for skilled nursing services that cannot be provided at a lower level of care. “The goal is to restore their baseline ability or to achieve maximum possible improvement,” says Jessica Corona-Irwin, a Columbiana, Ohio-based nurse and director of care delivery at Cayabo Care.
— Potential for improvement. There should be an expectation of improvement in the senior’s condition through the rehab services, Corona-Irwin says. If skilled rehab would not improve their condition, the senior might consider other options, such as long-term custodial care or palliative care.
— Completed interdisciplinary assessment. An interdisciplinary team of providers, nurses, social workers and therapists will evaluate the senior’s need for skilled rehab. They may base the assessment on the senior’s current physical and mental health, support they currently have available at home and their recovery goals.
Skilled nursing facility vs. acute inpatient rehabilitation facility
Here is a breakdown to compare if a senior may be medically eligible for a skilled nursing facility vs. an acute inpatient rehabilitation facility:
| Feature | Skilled Nursing Facility | Acute Inpatient Rehabilitation Facility |
| Eligibility | Patient is medically stable, may only tolerate mild to moderate therapy, or a slower functional improvement is expected. | Patient is medically stable but complex. Able to tolerate intense therapy, but high potential for rapid improvement |
| Common situations for admission |
— Uncomplicated orthopedic surgery, such as a hip or knee replacement — Stable post-surgical recovery, after procedures like an appendectomy (removal of the appendix) or cholecystectomy (removal of the gallbladder) — Chronic obstructive pulmonary disorder exacerbation |
— Stroke — Traumatic brain injury — Orthopedic surgery with multiple fractures or surgical complications — Amputations — Post-critical illness, such as sepsis — Major burns — Multiple trauma, such as several injuries from a car accident |
| Therapy intensity and type | Moderate therapy that may only require one discipline, up to one or two hours a day | At least three hours per day, five days per week, or 15 hours within a seven-day period. This is called the “three-hour rule.” |
| Skilled nursing qualifications | Skilled nursing needs are for recovery and support. | Skilled nursing needs are complex. |
| Expected length of stay | Usually around 20 to 30 days or more | Usually around 10 to 14 days |
Another setting for post-acute care is called a long-term acute hospital, which is for seniors who are medically complex but require hospital-level care for extended periods, usually around a month or longer. Skilled nursing facilities and acute rehab facilities, as mentioned above, are most common for short-term rehab after hospitalization.
[READ: How to Advocate for an Older Loved One in the ER or Hospital]
What Qualifies as Skilled Nursing Care for Medicare and Other Insurance?
Original Medicare Part A, or hospital insurance, covers up to 100 days of skilled nursing care in each benefit period when the care is for short-term rehab.
Here’s what Medicare requires:
— You recently had a qualifying hospital stay. This means you’ve been admitted to a hospital under inpatient status for at least three full days, not counting the day of discharge. Being admitted as observation status does not count toward the three days.
— You have a qualifying medical condition. You must need skilled nursing care due to a condition that was addressed during your hospital stay. However, that skilled nursing care doesn’t need to relate to the main reason for admission.
— You receive the skilled nursing care within a month.
— You must have days left in your benefit period to use. A benefit period starts the day you are admitted to a hospital or skilled nursing facility. A benefit period ends once you have been discharged and had 60 consecutive days without receiving inpatient care.
Most families know that Medicare covers skilled nursing, but what surprises many is how limited that coverage really is, says Christen Bergeron, Boston-based founder of Navigating Senior Living.
“Even though Medicare technically allows up to 100 days in a skilled nursing facility, in reality, the coverage often ends well before that, sometimes within the first few weeks to a month,” she explains. “Coverage can stop if rehab progress has plateaued or if a care need, such as wound care, can now be handled by a visiting nurse at home.”
Medicare limits
Medicare coverage varies depending on how long you have been receiving skilled nursing care.
— Days 1-20: Your copay is $0 if you meet the above qualifications.
— Days 21-100: Your copay is $217 per day if you meet the above qualifications.
— Day 101 and beyond: You are responsible for all Medicare Part A costs related to your skilled nursing care.
Remember that Medicare doesn’t cover long-term custodial care, such as help with daily activities like bathing or dressing.
Medigap coverage
Medigap is a supplemental insurance policy that helps cover out-of-pocket costs not covered by original Medicare (Part A and Part B). Plans are labeled as letters A through N.
The Medigap open enrollment period lasts six months, starting on the first day of the month you turn 65 and are signed up for Medicare Part B. If you’re past your open enrollment period, you may still be eligible for a Medigap policy, but it usually requires medical underwriting.
All Medigap plans cover Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used. Medigap plans C through N cover the skilled nursing facility coinsurance, with the exception of Medigap plans K and L covering 50% and 75%, respectively. (Medigap plans A and B do not cover the skilled nursing facility coinsurance.)
Medicare Advantage coverage
Medicare Advantage, also known as Medicare Part C, is a private insurance plan that bundles Medicare and other supplemental benefits into a single plan. Medicare Advantage coverage will vary significantly, as there are many more plan options compared to original Medicare. Check your plan language, daily limits, prior authorization coverage and coverage rules with member services.
Medicaid coverage
Medicaid is a joint federal and state program, so skilled nursing care coverage, including eligibility, limits and prior authorization requirements, varies by state. Check with your state to confirm your benefits.
Explore Top-Rated Skilled Nursing Facilities and Medicare Advantage Plans With U.S. News & World Report
If you or a loved one may need skilled nursing care, start researching options and seeking recommendations from medical providers and your community as early as possible. The more information you gather up front, the better prepared you’ll be to make informed choices and plan financially for when you qualify for skilled nursing care.
To find the best skilled nursing facilities near you, check out U.S. News’ top-rated nursing homes. In 2025, U.S. News evaluated more than 15,000 facilities throughout the country and rated most of them on short-term rehabilitation and long-term care. You can search for and filter results by selecting “High Performing in Short-Term Rehabilitation” or filter even further by selecting those that accept Medicare or Medicaid.
If you’re enrolling in Medicare Advantage or considering switching your plan, you can also start your search with U.S. News’ Best Insurance Companies for Medicare Advantage and Best Medicare Part D Companies. You can look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medicare supplement plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the Centers for Medicare & Medicaid Services and then adjusted for enrollment.
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What Qualifies a Patient for Skilled Nursing Care? originally appeared on usnews.com
Update 12/15/25: This story was previously published at an earlier date and has been updated with new information.
