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What Is a Skilled Nursing Facility?
Skilled nursing homes and skilled nursing care facilities, or SNFs (pronounced "sniffs"), are health care facilities that are licensed and inspected by the State Department of Health Services. They offer both short and long-term care options for those with temporary or permanent health problems too complex or serious for home care or an assisted living setting.
Skilled nursing care facilities are most appropriate for the very sickest of patients. In addition to medical care by licensed health care providers, patients in skilled nursing care facilities can receive almost any kind of rehabilitative therapy. Services will vary in skilled nursing care facilities, but generally the following services are provided:
- Medical treatment prescribed by a doctor
- Physical therapy
- Speech therapy
- Occupational therapy
- Assistance with personal care activities such as eating, walking, bathing, and using the toilet (custodial care)
- Case management
- Social services
Some SNFs offer:
- Specialized care programs for Alzheimer's or other illnesses/conditions
- Short-term respite care for very frail or disabled persons when a family member requires a rest from providing care in the home
What Do These Services Cost?
Services in a skilled nursing facility are costly and vary from area to area.
How Do I Qualify For Coverage?
To qualify for coverage in a skilled nursing care facility, your doctor must decide that you need daily skilled medical care. In addition you must:
- Have Medicare Part A and have hospital days left in your benefit period
- Have had a hospital stay of three days or more, not including the day you left the hospital
- Enter the SNF within 30 days of leaving the hospital. If you leave the SNF, you may re-enter a SNF within 30 days with out another qualifying hospital stay
- Need the services for a medical condition that:
- Was treated during a qualifying 3-day hospital stay, or
- Started while you were receiving Medicare-covered skilled nursing facility care. For example, you are in the skilled nursing facility because you had a stroke but while there you develop an infection that requires skilled medical care.
- Medicare will only pay for services provided by facilities approved and/or certified by Medicare.The services are covered by Medicare
The services are covered by Medicare Part A. If you are covered by a Medicare Advantage (HMO or PPO) or a MediGap/Medicare Supplemental plan, call your plan and ask what services they will cover and what you must do to qualify for SNF coverage. You may have more coverage through this plan.
Medicare Coverage for Skilled Nursing Care:
Medicare will pay for the following services:
- Doctors' visits
- Nursing care
- Semiprivate room rates
- All meals (including special diets)
- Physical, occupational and speech therapies
- Lab and X-ray services
- Prosthetic devices
- Prescription drugs
- Some medical supplies and equipment
For more information:
- Medicare-approved providers of these services will be able to answer your questions and help guide you through the approval process.
- You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours, 7 days a week, including some federal holidays. TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.
Will I Receive Good Care in a Skilled Nursing Facility?
Most skilled nursing facilities provide good care. However, before you choose a skilled nursing facility, do your homework. Your State Department of Health Services does an annual inspection of each SNF in the state. The results are posted on the Internet at the Centers for Medicare & Medicaid Services website at www.cms.gov, and should be posted at the facility for your review. The reports will show how each facility's care and safety record compares to state and national averages for quality of care. Do not hesitate to ask any facility that you visit what kind of procedures and inspection policies they have in place to ensure their patients are safe and receive good quality of care.
What Do I Need to Consider When Choosing a Nursing Home?
It is important to choose a nursing home that will meet your personal and medical needs and also be affordable. Before you decide on a nursing home, make a point of visiting it and asking questions while there. You should make sure the chosen facility is approved by Medicare or is contracted with your Medicare Advantage or MediGap/Medicare Supplemental plan. Most importantly, include family members and your doctor in the decision process. You can get a free Medicare guide for choosing a nursing home by calling 1-800-MEDICARE (1-800-633-4227) 24 hours, 7 days a week, including some federal holidays. TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.
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