Skilled Nursing Facilities: Your Definitive Guide

If you’ve been searching for the best nursing home near you, there’s a good chance you’ve been mistakenly searching for the wrong type of care. The term “nursing home” entered our vocabulary sometime after World War II, when physicians realized that patients who needed long-term medical care were better off receiving it outside of hospitals.

As time went on, we started to associate nursing homes with group homes for seniors, but we also developed more degrees of specialization in terms of how we care for older adults. Although many of us will use the term “nursing home” when we refer to senior living in general, few senior communities use the term “nursing home” to describe themselves.

Communities that provide care administered by licensed health professionals will use the term “skilled nursing facility”. And if you've already started to explore your options, you may even hear these communities referred to as "SNF's" (sometimes mistakenly spelled "sniff") but don't worry - these are both just abbreviations. So while "nursing home" tends to be a more generic term for senior living communities that provide a higher level of care, a skilled nursing facility is something altogether different.

SNFs, as we'll refer to them from now on, deliver the most extensive care available outside of a hospital. This care is provided by registered nurses (RN) and/or licensed practical nurses (LPN), and includes medical treatments and monitoring. These medical treatments may include intravenous therapy, wound care, injections, catheter placement, to name just a few examples. Skilled care may also include services provided by other licensed health professionals, such as respiratory, speech, physical, and occupational therapists. And this is probably far more comprehensive than what you might have been thinking of if you just searched for “nursing home near me.”

Skilled nursing facilities can be a great option if you or your loved one need daily skilled assistance to treat, manage, or observe a condition, and evaluate medical care. They typically offer:

• Physical, speech, and occupational therapy services
• Mobility assistance
• Post-hospitalization rehabilitative services
• Custodial care to assist residents with activities of daily living (ADLs), such as bathing and dressing

Short-term: A SNF helps senior residents recover after a significant health event (such as a stroke or heart attack, or even planned surgery) while also offering a community where they can be with others who share similar experiences.

Long term: SNFs are also wonderful permanent residences for those who have ongoing complex medical care or a chronic medical condition that requires more highly trained staff. Like any other senior living solution, the staff at SNF facilities work hard to build community and engage their residents.

The average cost for a private room at a SNF in the US is $9,034 per month, according to a Genworth 2021 Survey. The cost of a semi-private room at a skilled nursing facility can average $7,908 per month. Note that this will change city by city and state by state.

Compared to an assisted living facility, SNFs are typically much more expensive, and the reason is simple: complexity of care. SNFs staff are generally comprised of more highly qualified staff, like a registered nurse, licensed nurses, and overall have a higher level of direct supervision and support.

Assisted Living

Assisted living communities refer to residential care designed for seniors who are still fairly independent, but may require some general assistance with activities of daily living (ADLs) like preparing food, dressing, and bathing (sometimes called “custodial care”). Often, when someone searches for a “nursing home,” they’re thinking of the type of care found in an assisted living community. In contrast, a skilled nursing facility is designed for individuals who need round-the-clock medical care.

skilled nursing vs. assisted living features

Assisted living provides assistance with:

• ADLs
• Medication management
• Meals
• Housekeeping
• Skilled nursing offers all these and:
• Ongoing palliative and preventative long-term care
• Post-hospitalization rehabilitation services
• Physical therapy, speech therapy, and/or occupational therapy

Home Health Care

Home health care involves nurses and other medical professionals traveling to your home to provide daily medical care (not to be confused with in-home care, which is simple help with ADLs and other household tasks). As this involves licensed professionals traveling every day and bringing in medical equipment and materials, it is a service that can quickly become expensive. However for some seniors receiving health care at home is the most comfortable option.

Independent Living

An independent living community is a senior living option for active adults that want to live in a community of other seniors while still enjoying their independence and privacy. Typically, there is no care offered here, unless it is an independent living neighborhood within a Continuing Care Retirement Community (CCRC). If it is a CCRC or Life Plan Community, there will often be care available at the assisted living level and even the skilled nursing facility level, so that seniors can age in place there.

Memory Care

Memory care communities are senior living communities designed and staffed specifically for senior residents with Alzheimer’s disease and other dementia-related illnesses. However, they do not provide the 24-hour nursing care that a SNF can offer. SNF staff are often trained and equipped to handle patients with dementia or Alzheimer’s for as long as they need the added medical care, but SNFs are not designed or intended for long-term stays.

Rehabilitation

Inpatient rehabilitation facilities (IRF) are intended for those who need a higher level of rehabilitation following traumatic injuries and surgeries. While they offer a similar set of services as skilled nursing, they differ in the intensity of their therapeutic services and care program.

More simply, rehabilitation centers are intended for acute care, while skilled nursing facilities are intended for subacute care (“acute care” refers to needing brief and immediate treatment for severe illness, injury, or recovery from surgery). It’s common for people who have been in an inpatient rehabilitation facility (IRF) to transfer to a skilled nursing facility if they no longer require acute care, but are not yet ready to return home. Some facilities provide both rehabilitation and skilled nursing care.

Hospice

Skilled nursing facilities are generally intended for senior residents who need subacute medical care for non-terminal conditions. Hospice care provides end-of-life care and support for the patient and their loved ones. While skilled nursing care is focused on treatment and rehabilitation, hospice focuses on pain relief and comfort, it is not trying to cure the illness. In most cases, SNFs can support a transition to hospice or other palliative treatment.

Fortunately, high-quality skilled nursing communities can be found all over the country, and they never shy away from answering questions. To get you started, here are some basic questions you can ask prospective skilled nursing providers.

• What services and level of care does your skilled nursing facility offer?
• Are all services included in the basic monthly rate, or do some of them cost extra?
• What personal assistance do nursing home residents receive? How often do they receive it?
• How many meals are provided each day? Can you accommodate special diets (gluten-free, kosher, etc.)?
• What happens if a senior resident requires a more intensive level of care than you typically provide?
• Do senior residents have private or semi-private rooms?
• What housekeeping, maintenance, and laundry services do you provide? How often do you provide them?
• What are the skilled nursing facility requirements for admission?
• How do I pay for skilled nursing?
• Can I use Medicaid and/or Medicare?

Make sure you know the care and service requirements for you or your loved one to help determine the best skilled nursing facility fit. Your doctors can help you understand what type of care options to look for, and in some cases, a hospital social worker might be available to help you find and vet SNFs nearby.

Medicare Part A will cover short-term skilled nursing care provided in an approved SNF under certain conditions:

• You have Part A coverage and have days left in your benefit period to use.
• You have a qualifying 3-day hospital stay before entering the SNF.
• Your doctor has decided that you need daily skilled care that must be provided by, or under the supervision of, therapists or skilled nursing staff.

Medicare coverage for skilled nursing facilities can extend up to 100 days. To be covered by Medicare, care must be treating a hospital-related medical condition, or a condition that started while you were in a SNF for a hospital-related condition.

While skilled nursing often comes after you or your loved one has experienced some sort of unexpected medical event, if you realize that a SNF is in the near future, you should start discussing financing options to cover costs. In addition to Medicare, here are some ways that you or your loved one can pay for skilled nursing:

• Medicaid: The Medicaid program will cover skilled nursing care for income-eligible seniors at state-certified and Medicaid approved skilled nursing facilities.
• Long-Term Care Insurance: Long-term care insurance (LTC) is insurance for seniors that will cover a variety of expenses associated with long-term stays, such as a hospital visit or at a skilled nursing facility.
• Veteran Benefits: The VA provides long-term care services that senior veterans can use to cover skilled nursing care. To be eligible for coverage, you must be signed up for VA healthcare, the VA must agree that you need skilled nursing services to help with your ongoing treatment and personal care, and the service is provided in an approved facility near you.
• Pay out-of-pocket: Often families will pull from their savings or contribute a portion of their income to cover the cost of skilled nursing. If you or your parent have a house that will no longer be lived in (for example, you plan to move into an assisted living community once you no longer need skilled nursing), you might consider selling it, taking out a reverse mortgage, or using the home as a rental property.
• Program of All-Inclusive Care for the Elderly: PACE is a federal program that helps people meet their health care needs within their community instead of going to a care facility. To be eligible, you must be 55 or older, live in a PACE organization service area and need “a nursing home-level of care”.