Let’s begin by making it clear that for the most part, these facilities are NOT those of decades ago that conjured up images of terrible care and people being warehoused to waste away – at least not the majority of them. Today’s skilled nursing homes are live-in facilities that provide medical treatment prescribed by a physician following a hospital stay after surgery or other medical procedures and/or for those patients requiring long-term nursing and medical supervision. Some SNFs offer very specialized care programs for Alzheimer’s patients, and many also provide short-term care for ill, frail or disabled persons when a family member requires respite - a personal break and rest from providing full time home-based care for a loved one.

All skilled nursing facilities are required to meet both State and Federal laws and requirements, and there are State-based Ombudsmen whose job it is to advocate for patients and provide support as an outside third party.  But there are differences among various SNFs, and just as with cars, hotels, adult communities, and assisted living facilities, not all skilled nursing facilities are created nor run equally.

So what ‘s different about becoming a resident of a SNF versus an assisted living facility?  For starters, in an assisted living facility, the concept of maintaining independence is still a core goal, and assistance is provided as needed, rather than simply given.  Skilled nursing facilities on the other hand, provide twenty-four hour nursing care, and a more frequent hands-on approach for patients than is generally provided at higher functional levels.  Most SNFs today also provide in-house rehabilitation services such as physical, speech and occupational therapy; assistance with personal care activities such as eating, walking, bathing and using the toilet; coordinated management of patient care; social services; and activities.  The caregiver to patient ratios in SNFs are mandated by State laws, and in most facilities provide a much higher level of personnel than do assisted or independent facilities.

It is important to note that while skilled nursing facilities have moved heavily into providing short-term rehabilitation services, usually covered under Medicare after a 3-day hospital stay, long term custodial care is NOT covered under Medicare.  The limits for length of stay in a SNF for rehabilitation are strictly governed under Medicare’s rules and guidelines.  If a patient is being placed in a SNF for full time services, not rehabilitation, and is not on Medicaid or some form of State welfare, the costs for room and board have to be paid by the patient, his or her family, or offset by long term insurance.  Nursing homes are costly, averaging about $7000 per month nationwide.

SNFs are mandated by law to have a medical director on staff, and while not required, most residents are seen by the facility doctor under Medicare rules covering the payment of costs as if the patient were seeing his own personal doctor outside the facility.

Another key point to be made here is that in many cases originating with a hospitalization, are followed by an order for rehabilitation in a SNF.  Obviously this applies only to medical conditions that respond to therapy, not end stage diseases. While in the SNF, if the patient shows any signs of improvement, therapy is continued and paid for by Medicare, according to the rules of Medicare coverage, and the length of stay in a SNF is limited.  Once a patient fails to either show improvement, is determined to be non-responsive to therapy efforts, or exceeds the limits allowed by Medicare, those benefits stop and private payment is required if he or she is to remain in the SNF.

The primary methods for payment for skilled nursing facility care and SNF rehab are Medicare, Managed Care, Medigap Insurance, Medicaid, long-term care insurance, Veterans Benefits or private payment. Remember, Medicare does not pay for long-term custodial care at home or in a SNF.