Skilled nursing facilities provide round the clock nursing care to help patients recover from challenging health issues as quickly as possible.

What is a skilled nursing facility?

Skilled nursing facilities, or SNFs, provide around-the-clock medical expertise and services for individuals recovering from an illness, injury or hospitalization and who require a higher level of care than can be provided in the home setting.

Skilled nursing facilities employ licensed professionals, such as registered nurses and physical, speech, or occupational therapists, to provide short-term and long-term services. There is usually a licensed physician on premises as well to help patients regain independence and return to their home or an assisted living center following an injury or hospital stay.



What types of services are offered in skilled nursing facilities?

The services in skilled nursing facilities are provided by licensed professionals. Understanding the quality, type, and diversity of the services offered in a skilled nursing facility is an important part of making an informed decision about what facility to trust with you or your family member.

Short-term care services may include wound care, post-surgery care, or speech pathology services.

Long-term care services may include diabetes management, colostomy care, or medication administration through an IV.


What is the difference between a skilled nursing facility and a nursing home?

Although the words “nursing home” and “skilled nursing facility” are often used interchangeably, they are different. Skilled nursing facilities are for patients who require a high level of medical care for a short period so that they can rehabilitate and return to the home setting. Nursing homes are for individuals who can no longer live independently in their homes and require long-term support and assisted living solutions.


How to Select A Skilled Nursing Facility

There are four main steps to selecting a skilled nursing facility.

1) Understand Your Medical Needs

Meet with a medical professional to make sure that a skilled nursing facility is the best follow up care option for you or your loved one. A skilled nursing facility is the best fit for patients requiring long-term or short-term intensive medical care or 24/7 assistance. If the patient does not have any significant medical needs and instead can receive rehabilitation care in the home setting, home health care may be more appropriate. If the patient has a specific medical need (diabetes, chronic disease, wound care, etc.), you can narrow down your search by evaluating facilities based on what specialty care they can provide.

2) Verify Your Insurance Coverage

When selecting a skilled nursing facility, it’s important to consider your payment options and understand what your insurance policy will and will not cover. Most insurance policies cover medically required stays in skilled nursing facilities – for example, Medicare will pay for up to 100 days stay at a skilled nursing facility. However, each policy is different. repisodic.com allows you to contact providers to verify whether or not they accept your insurance.

3) Compare Facilities Based on Quality Measures

Quality measures are strong indicators of the quality and level of care and rehabilitation you will receive at a facility. Different qualities to compare are how many of the residents at a given facility showed marked improvements during their stay, how many were re-hospitalized, how many had a fall that resulted in a major injury, and how many were successfully discharged. repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.

4) Visit the Locations

By visiting the skilled nursing facility, you can evaluate cleanliness and entertainment options and talk to employees and current residents about their experience. Ask the staff members how different situations are handled and how you or your loved one will fit in at this location.

Checklist of Things to Consider

Medicare.gov has a list of suggested things to consider when selecting a skilled nursing facility:

Basic Information

  • Is the facility Medicare/Medicaid certified?
  • Does the facility provide necessary skilled care and special services?
  • Is there an available bed?
  • Are there visiting hours? What are they?
  • Are residents clean and appropriately dressed?

Living Spaces

  • Are there any unpleasant odors?
  • Are the facilities clean and well-kept?
  • Are the noise levels appropriate?
  • What are the restrictions on smoking?
  • Is the facility well furnished?
  • Is the temperature comfortable?
  • Is there good lighting?

Staff

  • Does the staff have good relationships with the residents?
  • Do staff members knock on doors before entering?
  • Are background checks conducted on staff members?
  • Is a full-time registered nurse (RN) available at all times?
  • What are the rotations of nurses and staff members working with a given resident?
  • Is there a reasonable ratio of staff members to patients?
  • Are certified nursing assistants (CNAs) involved with care planning meetings?
  • How often is a licensed doctor available?
  • How long has the management team worked together?

Residents’ Rooms

  • Are residents allowed to have personal belongings?
  • Is there personal storage space?
  • Do the rooms have adequate windows and natural light?
  • Do residents have access to personal phone and television?
  • What is the roommate selection process?
  • How much protection is available for personal possessions?

Common Spaces

  • Are exits are clearly marked?
  • Are the visiting areas quiet and well-kept?
  • Are there appropriate safety features (emergency evacuation plan, smoke detectors, sprinklers, etc.)?
  • Are all areas wheelchair accessible?
  • Are there handrails and grab bars in common spaces?

Dining and Activities

  • Is there an appropriate variety and choice of foods?
  • Are there nutritious snacks?
  • Does the facility offer assistance in eating?
  • Are a variety of activities offered?
  • Are there outdoor areas for residents to use?
  • Are there volunteer programs?

Safety and Care

  • Does the facility offer preventative care (flu shots, etc.)?
  • Are residents allowed to see their regular doctors?
  • How does the facility handle emergency situations?
  • Are care planning meetings scheduled with residents and family members?
  • Has the facility corrected all deficiencies from last state inspection?

If you determine that a skilled nursing facility is the right choice, the next step is to search the facilities in your area and identify those that are covered under your insurance plan. repisodic helps you search and compare skilled nursing facilities by location and provides insightful quality data, patient reviews, and facility ratings to help you find sites that best fit your needs.



How to Pay for a Skilled Nursing Facility

When selecting a SNF, it is important to consider your payment options and understand what your insurance policy will and will not cover. Because skilled nursing facilities provide medical care, their services are covered by health insurance, including Medicare, Medicaid and private insurers. A patient’s individual insurance policy determines what skilled nursing services are actually covered and paid for.

There are three main types of insurance policies that provide varying degrees of coverage with regards to skilled nursing facilities.

Medicare

Medicare Part A will pay for up to 100 days of skilled nursing care in a licensed skilled nursing facility as long as the patient had a qualifying 3-day inpatient hospital stay and the skilled services provided are related to that hospitalization. The specific number of days that Medicare Part A will cover in a skilled nursing facility is primarily determined by the patient’s attending physician.

If a patient qualifies for Medicare Part A skilled nursing coverage, then Medicare covers all costs for the skilled nursing facility stay for the first 20 days. Starting on the 21st day of a skilled nursing stay, the patient is responsible for a co-payment for the remainder of the stay, up to 100 days.

Although a co-payment is necessary for stays extended to 21 or more days, many commercial insurance Medicare Supplemental policies (also known as “Medigap” policies) will usually cover some or all of the co-payment costs. If a patient does not have such co-payment coverage but qualifies for Medicaid, then Medicaid may pay for the co-payment. If an individual does not have insurance or Medicaid coverage for the co-payment, they will be directly responsible for the co-payment.

Medicare Advantage

Patients who are covered under a Medicare Advantage Plan instead of the traditional Medicare plan will have policies and coverage very similar to the Medicare coverage policies described above.

Private, Commercial, and Employer Sponsored Insurance

These plans vary widely in their coverage and policies for skilled nursing facilities. The majority of plans typically provide some sort of coverage for short stays in post-acute care/skilled nursing facilities if the services are necessary following a hospital stay.

Private insurance companies will usually only pay for skilled nursing services for providers that are considered “in-network.” Some policies will cover services from providers that are “out-of-network,” but they usually do not cover as much of the cost and can leave patients with additional out-of-pocket costs. For this reason, it is imperative that patients verify if a skilled nursing facility is part of their insurance network.

To Summarize

Remember, health insurance payment options and programs that cover skilled nursing facility services are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for. repisodic encourages all patients to consult with their insurance company or administrator for final determination of what post-acute care or skilled nursing services their policy covers.


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