A skilled nursing facility (SNF) is a healthcare institution providing specialized medical treatment and rehabilitation services for patients who require intensive care after a hospital stay. These facilities are equipped with trained medical personnel, including physicians, registered nurses, physical and occupational therapists, speech pathologists, and audiologists, among others.

In a skilled nursing facility, patients receive round-the-clock care to assist with essential daily tasks, referred to as activities of daily living (ADLs) by Medicare. These activities include bathing, dressing, eating, and transferring from a bed to a chair.

Key Points to Remember

• A skilled nursing facility provides rehabilitation and medical services under the supervision of doctors, registered nurses, and other healthcare professionals.
• Most skilled nursing facilities accept coverage from private insurance, Medicare, and Medicaid.
• Medicare fully covers the first 20 days of a stay. From days 21 to 100, patients are required to pay coinsurance, and after 100 days, all costs must be covered by the patient.
• Unlike nursing homes, stays in skilled nursing facilities are generally temporary, aimed at recovery, while nursing homes offer long-term custodial care.

Difference Between a Skilled Nursing Facility and a Nursing Home

Skilled nursing facilities are designed to provide short-term care for patients needing medical rehabilitation following a hospital discharge. In contrast, nursing homes are long-term residential facilities that provide ongoing custodial care for individuals who need assistance with everyday activities on a 24/7 basis.

How a Skilled Nursing Facility Operates

Upon entering a skilled nursing facility, patients undergo an initial health evaluation, followed by regular assessments to monitor their physical and mental health, medication needs, and ability to manage daily activities like dressing and bathing.

Both skilled nursing facilities and nursing homes are prohibited from discriminating against residents based on race, ethnicity, religion, gender, or other protected characteristics. Violations of these laws can be reported to local long-term care ombudsmen or state regulatory bodies.

For instance, if someone believes their parent was unfairly denied admission to a skilled nursing facility in California due to their race, they could report the matter to the California Department of Public Health.

Additionally, a skilled nursing facility must provide residents with a written outline of their legal rights, which may differ from state to state.

Cost of Skilled Nursing Facilities

Medicare beneficiaries requiring post-hospitalization care in a skilled nursing facility may qualify for full coverage of their stay for the first 20 days, provided the facility is Medicare-certified and the patient meets specific eligibility criteria. From day 21 to 100, the patient must pay coinsurance, and after 100 days, Medicare ceases coverage entirely.

Assessments by the facility and Medicare determine whether the patient is responsible for some or all of the costs. After the 100-day limit, out-of-pocket expenses can be covered by private insurance or Medicaid for those eligible. In 2024, the daily coinsurance for days 21 through 100 is set at $204 per day.

Unlike some assisted living communities, skilled nursing facilities do not charge entrance or buy-in fees. All services and associated fees must be presented in writing to the patient or their caregiver before care begins.

Nursing homes, on the other hand, can be quite costly for extended stays. In 2021, the median annual cost of a private room in a nursing home was approximately $106,920, or about $8,910 per month, as reported by Genworth's long-term care survey.

Skilled Nursing Facilities vs. Long-Term Care

Long-term care facilities cater to individuals who need assistance with daily living but don't necessarily require the medical services offered in skilled nursing facilities. Typically, long-term care is for those seeking a permanent living arrangement, whereas skilled nursing facilities serve patients requiring short-term care until their health improves.

Are Skilled Nursing Facilities Inpatient or Outpatient?

Skilled nursing facilities operate as inpatient centers, similar to hospitals. Patients have their own bed, and occasionally, their own room, depending on availability and affordability.

Medicare Coverage for Skilled Nursing Facilities

Medicare Part A covers inpatient services at hospitals and skilled nursing facilities. To qualify, patients must meet the following conditions:

• A qualifying hospital stay
• A doctor’s recommendation for skilled care, such as IV therapy or physical rehabilitation
• The skilled nursing facility must be certified by Medicare
• The patient's condition should be one treated during their hospital stay, or a new condition that arises during their stay at the skilled nursing facility.

How Long Will Medicare Pay for Skilled Nursing Facility Care?

Medicare covers the full cost of the first 20 days in a skilled nursing facility. From days 21 to 100, patients must pay coinsurance. After 100 days, Medicare does not cover any further costs. Patients can explore alternatives such as long-term care insurance or Medigap to manage these expenses.

How Long Do Patients Stay in Nursing Homes?

A study conducted on 1,800 U.S. nursing home residents found that the median stay before death was around five months, while the average was almost 14 months. Around 53% of residents passed away within six months of their admission.

Differences were observed based on gender and wealth. Women generally had longer stays than men (with a median of eight months for women compared to three months for men). Residents with lower net worth also tended to stay longer in nursing homes compared to those with higher net worth.

Conclusion

Skilled nursing facilities are inpatient centers offering medical care and rehabilitation to patients who have recently been discharged from the hospital. These stays are generally short-term and Medicare covers the first 20 days. Unlike nursing homes, which are intended for long-term living, skilled nursing facilities focus on temporary care and recovery.