Skilled Nursing Facility

Skilled nursing facilities are also known as a SNF (pronounced “sniff”), or nursing home. They provide two basic levels of care: custodial and skilled care. Residents may be temporary or long term. Temporary stays are usually for rehabilitation purposes after a major surgery, injury, or illness. Long-term stays are usually for those who can no longer live alone and require a higher level of care than can be provided at home or in assisted-living facilities or board-and-care homes.

Skilled care in a SNF is usually short term and continuous only so long as measurable gains are made. However, some circumstances require ongoing skilled care such as those who require a ventilator or other tubes or mechanical means for nutrition and life support. An episode of illness or injury may also be cause for skilled care on a temporary basis in a SNF for those who usually just require custodial care.

Skilled care can be provided by a nurse or physical, occupational, or speech therapist. Licensed physicians prescribe and supervise all skilled care in a SNF. This may be your parents' PCP or physician supervising all care at the facility. Registered nurses supervise a staff of licensed practical or vocational nurses who provide twenty-four-hour medical care.

Custodial care in a SNF is also supervised by the licensed physician and a registered nurse, but it is usually provided by nursing assistants. An RN or LP/VN manages and dispenses medications. Custodial care consists of activities such as bathing, dressing, feeding, grooming, transferring and assistance with ambulation, and toileting or incontinence care. If the resident needs some skilled care as a result of illness or injury, or develops a decubitus or bedsore due to immobility, skilled care will be ordered and provided.

Who Pays for Skilled Care?

Skilled care is covered by Medicare and most private insurance using Medicare's guidelines. Under Medicare's guidelines, the skilled care must be preceded by a minimum qualifying hospital stay of three days. Admission to the SNF must be within thirty days of the qualifying hospitalization. The first twenty days are paid at 100 percent; after that, there is a daily deductible. (This may be covered by Medigap insurance.) There is a maximum of 100 SNF days for a qualifying hospitalization and diagnosis.

The patient must show measurable gains, also known as rehab potential, toward independence in the documentation by the RN or therapist. If at any time before the 100-day maximum stay the measurable gains or skilled-care need ceases, reimbursement will end. Custodial care will be included and covered during a skilled-care stay.

Long-term-care insurance policies may provide coverage of care in a SNF. Read the small print, as there may be restrictions. Some Medicare Advantage or HMO plans advertise they will cover long-term care in a SNF. Again, read the small print, as there are restrictions.

Those who qualify for Medicaid may also qualify for coverage of long-term care in a SNF. Not all SNFs accept Medicaid, and those who do usually have a limited number of “Medicaid beds.”

Costs can average $192 per day for a private room in a SNF (over $70,000 per year) and $169 per day (over $61,000 per year) for a shared room, according to a MetLife survey in 2004. These costs showed an increase of $4,000 over the previous year and are expected to continue to increase. These are for basic custodial services; additional services can increase total costs, and costs can vary by location.

With the advent of assisted-living facilities, the number of long-term nursing-home residents has declined in recent years. Those who become increasingly frail and need more care than caregivers can provide at home or in an assisted-living facility may need to move to a SNF. This includes those who require twenty-four-hour care and supervision, become bedbound, or require maximum assistance to transfer to and from a wheelchair.

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