Skilled Nursing Facility Care

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. In 2008, according to Health and Human Services, the average costs in the United States are:

$187/day for a semi-private room in a nursing home
$209/day for a private room in a nursing home

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 Part A. They will cost you:

Days 1 - 20: $0 for each day
Days 21 - 100: $128 for each day
Days over 101: You pay 100%. If you are covered by a Medicare Advantage (HMO or PPO) or a MediGap 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)

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 and Medicaid Services website 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 health or MediGap 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.

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