The term skilled nursing facility and nursing home may often be used interchangeably. A skilled nursing facility is a short-term rehabilitation center for people who need continued nursing, and rehabilitation to recover.
Jump ahead to these sections:
- What’s the Average Stay For Someone in a Skilled Nursing Facility?
- What Does the Length of the Stay Depend On?
- What Happens After Someone’s Skilled Nursing Stay?
If your loved one has had a fall, suffered an accident, or is recovering from an acute illness, they may qualify for a stay in a skilled nursing home. Skilled nursing facilities can be considered a valuable transition in between leaving the hospital and heading back home.
The benefits of skilled nursing may be obvious, but the qualifications and criteria for the length of stay may be baffling. You may be surprised when you are told that your loved one is ready for discharge when you are convinced that they would benefit from a more extended stay. Facing a potential stay at a skilled nursing facility?
Read on ahead to learn more about what determines the length of time you can spend in such a facility, and how skilled nursing makes these decisions. Preparing for such a stay can help you anticipate the process and make plans for discharge in advance.
What’s the Average Stay For Someone in a Skilled Nursing Facility?
According to Skilled Nursing News, the average length of stay in skilled nursing is between 20-38 days, depending on whether you have traditional Medicare or a Medicare Advantage plan.
For those using Medicare, the current requirement to head to a skilled nursing facility is a three-night stay in the hospital. Medicare Advantage plans may urge these facilities to discharge a patient earlier than expected in the skilled nursing facility stay.
Some Medicare Advantage plans might also have a daily copay after the first 20 days up to a certain number of days, at which point they will cover costs again.
Traditional Medicare with a secondary form of insurance will pay up to 100 days of skilled nursing. The secondary or supplemental insurance policy handles co-pays after the first 20 days if you have one. If you don’t have a secondary insurance policy, you will be responsible for the copay after the first 20 days.
What Does the Length of the Stay Depend On?
Length of stay in skilled nursing depends on several factors, but they are all related. Skilled nursing requires active and consistent participation in recovery.
Advocating for yourself or your loved one can help extend the length of stay. Check with the staff frequently to see how rehab is going and track the number of days your loved one is under their care so you aren’t surprised by the discharge. You will need time to plan for support services once your loved one is home.
Unfortunately, insurance largely dictates the criteria for continued coverage while in skilled nursing.
The best approach is to call your insurance company and find out what guides their determination. You can also speak with the billing department at the skilled nursing facility as they are accustomed to dealing with various insurance companies and coverage requirements.
If your insurance benefits run out and you want to pay privately, you can, but expect it to be costly.
For both insurance companies and the facilities themselves, there can be some criteria that you will need to know about before going to a skilled nursing facility. In the interest of controlling costs, there are very strict criteria that must be met:
- A three-night hospital stay (except for some Medicare Advantage plans that may waive this requirement)
- Skilled needs that can’t be adequately provided at home or through outpatient services. However, some patients do decide not to go to skilled nursing and instead opt for home health.
- Skilled professional services include nursing, physical, occupational, speech, and respiratory therapies.
- The difference between skilled nursing and home health is the level of supervision, management, and monitoring and frequency of therapies. For example, home health may send in a physical therapist two to three times a week. A skilled nursing facility might offer five days a week.
You may have the impression that your loved one is making good progress in skilled nursing. When a patient no longer has a skilled need, however, they are discharged.
Being discharged does not necessarily mean that your loved one is “recovered.” It is possible that there are a host of other needs that will have to be addressed at home, which we will discuss in the next section.
Progress made or not made due to cognitive impairment
Before the average number of days is up, there might be another reason for discharge—lack of progress. Not showing improvement can be due to several factors.
One is cognitive impairment. Cognitive impairment won’t necessarily prevent someone from making progress, but it can certainly contribute. Without sufficient memory to learn and remember safe mobility exercises, it can be tough to make lasting progress.
The staff in skilled nursing will do their best to work with people who have cognitive impairment. There are cases where repetition and reinforcement (especially after getting home) can make a significant difference in someone’s ability to improve.
Lack of progress due to refusal
For whatever reason, some patients can’t or won’t participate in therapy exercises. Therapy staff in skilled nursing facilities are usually quite good at motivating and inspiring people to work towards recovery.
Sometimes, all of their efforts are not enough, and your loved one or parent may refuse help. It can become even more challenging when your loved one with dementia may refuse help or therapy. If after repeated attempts, someone refuses therapy work, they will be discharged due to a lack of participation.
What Happens After Someone’s Skilled Nursing Stay
The best-case scenario after skilled nursing is that your loved one goes home and resumes their normal activities. Although that does happen, it is not the norm. As people get older, recovery times take longer. If someone is not in the best medical condition to begin with, recovery can be slow going.
Support at home is critical in these situations to avoid another injury. Fortunately, support is available. In extreme cases, a nursing home may be the only option to keep someone safe.
Home with assistance
The idea behind skilled nursing is for someone to go home with the addition of supportive services if needed. These services are the following:
- Home health. Home health is a valuable resource to use after skilled nursing. Keep in mind that the Medicare requirement states you must be homebound, meaning no driving. There are other requirements too, but most people get the order for home health before being discharged home. Home health is very time-limited, so get the most of it that you can.
- Private duty care. Under Medicare, home health can not provide “custodial” services like companionship, transportation, cooking, and shopping. But private duty can. Private duty, or sometimes called personal care, has privately paid caregivers to fill in those gaps. The downside is that you will have to pay between $20-$40 an hour for this service.
- Private nursing. Once your loved one is discharged from home health, they may have continued nursing needs. It is possible to hire a nurse privately to set up medications, check vital signs, and provide some oversight on a medical condition.
Despite all of the efforts of a skilled nursing facility to get someone back home, sometimes it doesn’t work out. Your loved one has reached a point where they may be unable to head back home without significant help that might be better offered in assisted living.
The advantage of assisted living is that many of the services you would have to set up at home to keep someone safe are already available in assisted living. Also, you can still arrange for home health in assisted living as an extra layer of support.
Assisted living includes some nursing, aide service, meals, transportation, and other amenities. A nurse from assisted living will do an evaluation to make sure they can meet your loved one’s needs before they will accept a transfer from skilled nursing.
If your loved one is being discharged from skilled nursing and you need to find an assisted living with very little time, it can be daunting. Finding care for an aging adult in these situations will take some time and effort, but try not to rush yourself. You want to make the best choice the first time around.
A nursing home or long term care facility is for people who need maximum care and assistance. In cases where little progress is made in skilled nursing, or the progress made is not enough to go home safely, a long-term care facility may be the only option.
Nursing homes have 24-hour nursing and can provide a maximum level of assistance, such as a two-person transfer or help with eating and toileting. Unfortunately, Medicare does not pay for nursing homes as it does for skilled nursing. That being the case, you will have to pay privately or your loved one will have to qualify for Medicaid. The only other option to pay for a nursing home is through a long-term care insurance policy.
The recommendation of a nursing home can be disappointing to hear. However, it is possible that with enough care and time, your loved one can eventually leave a nursing home for assisted living.
How Long Can You Stay in a Skilled Nursing Facility?
The time spent in skilled nursing may not seem like nearly enough. Understanding how the process works and decisions are made will keep you on your toes to ensure the best outcome.
Time will be short, so we recommend advocating for and motivating your loved one to maximize their stay.
- Flynn, Maggie. “Shorter Stays Bring Rewards Under PDPM-But Only to a Point.” Skilled Nursing News, 26 March 2019, www.skillednursingnews.com/2019/03/shorter-stays-bring-rewards-under-pdpm-but-only-to-a-point/
- “Skilled Nursing Facility Care.” Medicare.gov, www.medicare.gov/coverage/skilled-nursing-facility-snf-care