Years ago my mom went into the hospital for back surgery. She remained there for several days and reached a point where the doctor felt he could discharge her.
It was plain to see, however, that mom was FAR from being able to return home! She was weak, she was on multiple medications for pain, and she needed to receive physical therapy.
It was decided that her next stop was to go to a “skilled nursing facility” (SNF).
If you’re like me, I had no idea what that was! It appeared to be some type of facility that would nurse her back to health until she was ready to go home. And, in a nutshell, that’s right.
She was admitted into a SNF and stayed for a couple weeks. They cared for her and provided the physical therapy and skilled care she needed. It was more peaceful than a hospital, less noise and interruptions, and nursing staff was there to care for her when needed.
You may be wondering about how a skilled nursing facility compares to other facilities such as a “rehabilitation hospital” or a “long term care facility”. These words are thrown around often and can be confusing.
Details and Definitions
What’s the difference between a Skilled Nursing Facility, a Rehabilitation Hospital, and a Long Term Care Facility?
Skilled Nursing Facility definition: A medical center that offers 24-hour care by licensed professionals. It’s generally after a hospital stay and it’s designed to prepare the patient to return to their home or back to their long-term care facility.
There’s bed and board, physical therapy, occupational therapy, speech therapy, social services, medications, supplies, equipment and other services necessary for the health of the patient. There is at least one physician that oversees the care of each patient.
People may need this level of care following an illness or surgery. Here is a list of conditions that might qualify someone for skilled care:
- Wound care
- Medications that must be given by injection vs. by mouth
- IV therapy
- Physical, occupational and speech therapy
- A need for a person to be on a monitor, such as a heart monitor
Rehabilitation Hospital definition: Often referred to as “inpatient rehabilitation hospitals” these are devoted to the rehabilitation of patients with various neurological, musculoskeletal, orthopedic and other medical conditions.
Simply put, these are geared toward patients with:
- brain injury
- spinal cord injury
Long-Term Care Facility definition: Long-term care generally refers to non-medical care (ie, custodial care) for patients who need assistance with basic daily activities. These activities are referred to as “The 6 ADL’s” (activities of daily living) and are:
- getting dressed
This is what you might call a nursing home. When your loved one can no longer remain safe and cared for, a LTC facility is a natural next step.
Will Medicare pay for any of this??
Good news…it DOES cover a skilled nursing facility and an inpatient rehabilitation hospital!
Medicare Part A covers care in a skilled nursing facility (SNF) for up to 100 days during each spell of illness. If coverage criteria are met, the patient is entitled to full payment for the first 20 days. The next 80 days the patient pays a co-pay.
Medicare should pay for skilled nursing facility care if:
- The patient received inpatient hospital care for at least three days and was admitted to the SNF within 30 days of hospital discharge.
Be certain that the patient was admitted to the hospital by the treating physician as aninpatientand not under “observation status‘. Observation days in the hospital do notcount as inpatient days and will not satisfy Medicare requirements for SNF coverage.
- A physician certifies that the patient needs SNF care.
- The beneficiary requires skilled nursing or skilled rehabilitation services, or both, on a daily basis.
- The skilled nursing facility is a Medicare certified facility.
Medicare Part A pays similarly for a rehabilitation hospital stay. A patient needs to have been in a hospital for at least 3 days. It will cover the costs up to 100 days. Medicare pays for the first 20 days at 100%. For the next 80 days you pay a co-pay.
If you go into the hospital at least 3 days after one benefit period has ended, a new period starts. You can have as many periods as you need.
Unfortunately, long-term care is a different story.
Long-term care facilities are cash-pay. No Medicare. (gulp)
Ultimately, LTC is not “medical” care. As explained earlier, the staff is there to help with basic personal tasks of every day life. Physicians and therapists may VISIT the facility and care for the patients but that’s not the role of the staff.
People can buy Long-Term Care Insurance (for a hefty premium) to cover the costs of their care. Most choose not to.
Instead, many people think of Medicaidas their long-term care insurance, and in fact, it pays for the majority of nursing home care in the U.S.
To become eligible for Medicaid, you must become “impoverished” under the program’s guidelines. These guidelines focus on a person’s monthly income and their total assets.
Sadly, some nursing homes won’t accept Medicaid patients at all. Medicaid doesn’t reimburse as much as a good ol’ fashioned cash-pay patient. It all comes down to the almighty dollar! However, the law forbids them from evicting a patient if they become dependent on Medicaid once they are in their care.
The Bottom Line
When my mom needed additional care after a hospital visit, a skilled nursing facility was the best choice for her. Your parent may require the same or perhaps something better suited for their needs. Fortunately, there are options available!
Your parent’s doctor and the hospital social worker can be your two greatest allies. They will work together with you to transition your loved one onto the next best step.
I know this can be overwhelming. I’ve felt it myself! But I believe knowledge is power and my objective is to break down these overwhelming concepts into small, digestible bites.
Reading and seeking answers can help put you in control of the situation, which can, in turn, create a sense of peace. Ultimately its up to you to get on board and prepare yourselves to navigate the journey!