Skilled Nursing vs. Nursing Home: Key Differences

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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There’s no wonder people can become confused between what skilled nursing and a nursing home can provide. The names sound similar, and complicated insurance rules dictate the length and cost of care. The fact is, skilled nursing and nursing home care are very different but they do share some similarities as well.

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We will sort it all out for you. Most people want to avoid a nursing home since care is costly and typically long-term. Also, the conditions in a nursing home may not be pleasant or comfortable. 

As you begin to understand these two medical facilities better, keep two guiding principles in mind: one, a nursing home is long term, and skilled nursing is short term. A nursing home is private pay or covered by Medicaid if you qualify. Medicare covers skilled nursing home care.

Is a Nursing Home the Same as a Skilled Nursing Facility?

On the surface, both clearly share nursing in the titles, and they do share much in common such as having different types of therapists available and other medical staff.

Both nursing homes and skilled nursing provide nurses as part of their care, in addition to aides, physical, occupational, respiratory, and speech therapists. They also provide 24-hour availability of nursing and aide service. Both of these also deal with complex medical interventions, including wound care, catheter care, and intravenous medications.

Nursing homes and skilled nursing facilities, however, do not share the same financial requirements, government assistance, and length of care provided.

In particular, skilled nursing targets short-term intensive rehabilitation for a specific illness or injury. Medicare requires a three-night stay in the hospital to qualify, but the length of time in skilled nursing also depends upon your insurance provider.

Insurance pays based on a detailed assessment of how you are doing in rehab and whether you have met goals. Traditional Medicare pays for up to 100 days in skilled nursing, and Medicare Advantage plans follow that model but may have co-pays.

As mentioned above, skilled nursing focuses on recovery and rehabilitation. The schedule is usually rigorous, with therapy provided several days a week. Since time is limited, therapy staff will push you to improve. Insurance coverage for skilled nursing tends to be complicated especially if you have a Medicare Advantage plan. Each discipline that treats you provides documentation that justifies continued treatment under your insurance plan.

By contrast, a nursing home is a long-term care facility for patients who can’t go home or to other alternative senior housing options. Medicare does not pay for nursing home care, so you will be responsible for payment until you exhaust your financial resources and apply for Medicaid.

In addition, a nursing home will not have intensive therapies. Minimal therapy is available in some situations, but the goal is to keep you safe and meet your medical needs. You will most likely share a room with another patient in a nursing home. In skilled nursing, you will probably have a private room.

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Skilled Nursing vs. Nursing Home: Types of Care Received

The level of care in skilled nursing is intensive and targets the condition that brought you there, to begin with. For example, if you break a hip, this is what you can expect in skilled nursing:

  • Physical therapy. Physical therapy intends to help you gain strength, endurance, and mobility. Many skilled nursing facilities have state-of-the-art equipment for physical therapy.
  • Occupational therapy. Occupational therapy teaches you adaptive strategies to manage your temporary disability to do things like cook, clean, and perform other tasks.
  • Nursing. Nursing will tend to your wound, check your vital signs and attend to any other medical problems you have, even if they are unrelated to your injury.
  • Aides. Aides will help you walk, get to the toilet, get in and out of bed and get dressed.
  • Speech therapy. Speech therapists work with patients who have swallowing problems and need assistance with modified diets.  

Nursing home care is sometimes referred to as “custodial” care, implying not as much effort towards recovery or improvement. Nursing homes also have all of the therapies that skilled nursing does, but therapy involvement will be limited since the assumption is that you have reached your physical potential but still need a high level of medical support.

Skilled Nursing vs. Nursing Home: Who Are They For?

When sorting out what kind of care is required, medical care providers and insurance providers need to figure out what will be the best for the patient. In particular, skilled nursing is for patients who: 

  • Have had surgery, or are recovering from an illness that required a three-night stay in the hospital. For most people in this situation, going home might be an option but would require a high level of support to be safe. 
  • Can tolerate therapy for five days a week for 60 minutes a session. 
  • Have the intention of recovering enough to be discharged to a lower level of care, whether this is home or assisted living. In many cases, patients still need help at home through home health or private pay home care.

However, with nursing homes, patients tend to require different types of care. They include the following:

  • A high level of medical care similar to being in a hospital setting.
  • They cannot live in another environment due to the complexity of their needs.
  • Complex care might include, but is not limited to:
    • transfers out of bed and in and out of a chair
    • ongoing wound care
    • catheter care
    • feeding and breathing tubes
    • intravenous medications
  • Can’t afford round-the-clock medical care at home or in assisted living. Private nursing is expensive and when nursing is augmented by home care, the cost can be prohibitive. 

Some patients start in skilled nursing and aren’t able to regain enough function to go home or assisted living, so their only option is a nursing home. Nursing home care can be a short-term intervention, but in most cases, it is long-term. If there is a chance of some additional recovery in a nursing home, advocate as much as you can for available therapies and keep a close eye on care.

Skilled Nursing vs. Nursing Home: What’s the Cost and How Do You Pay for Care?

Traditional Medicare, Medicare Advantage plans, and private insurance can pay for skilled nursing if the criteria for admission have been met. Payment is time-limited, and insurance dictates any patient co-pays that begin after the first 20 days of care.

The per day copay rate can add up quickly if you don’t have a supplemental policy. We recommend calling your insurance company or meeting with the business office to determine if and when copays will be due and how those are determined. Some people can afford to pay for continued skilled nursing after insurance has stopped paying. The cost can be several hundred dollars a day.

Nursing home costs are private pay until you have exhausted your financial resources and qualify for Medicaid. According to Genworth, the average monthly cost of care in a semi-private room in 2020 was $7756. Some parts of the country will be even higher. There aren’t many families that can sustain this cost.

Approximately 60 percent of nursing home residents are covered under Medicaid. Medicaid is a joint federal and state program to assist people who are low income. Each state determines eligibility. Medicaid will pay for 100 percent of the costs of nursing home care once you qualify. 

Skilled Nursing vs. Nursing Home: How Do Admissions Work?

Admissions for skilled nursing and nursing home care will depend upon several factors. The admission process is coordinated through the admissions director at the skilled nursing home and the medical staff at the hospital. For skilled nursing, admissions has to do with whether you meet Medicare criteria:

  • You have Medicare Part A with days left in your benefit period. 
  • You have a three-day qualifying hospital stay. Some patients want to go home and ask to be released before the qualifying three day stay. Doing this can be a mistake since you might get home and realize you can’t manage without significant assistance. 
  • The doctor believes you require skilled nursing care daily that is related to the condition that brought you to the hospital. Skilled nursing is not an option for people who have nowhere else to go. The purpose is to help you recover.
  • The skilled nursing facility is certified by Medicare. 

A nursing home level of care involves several complicated factors. Someone can’t just use a nursing home for their residence because there is no one to care for them. Nursing home qualifications will defer state to state, but these are the general nursing home admission guidelines:

  • A need for skilled nursing or rehabilitation services
  • A need for assistance with activities of daily living like dressing, bathing, and toileting
  • Assistance with other health-related care needs
  • Help with medications.
  • A diagnosis of dementia or mental health disorder alone without other health care needs may not qualify someone for admission to a nursing home. 

Skilled Nursing vs. Nursing Home Care

Skilled nursing is a valuable resource for patients who hope to rehabilitate and recover most if not all of the functioning. There are times, however, when a person’s condition dictates the need for a nursing home. As distressing as this idea might be, there are good and reliable nursing homes that can take good care of your loved one.


Sources:
  1. “Cost of Care Survey.” Genworth, 12 December 2020, www.genworth.com/aging-and-you/finances/cost-of-care.html
  2. “Skilled Nursing Facility (SNF) Care.” Medicare.gov, U.S. Centers for Medicare and Medicaid Services, www.medicare.gov/coverage/skilled-nursing-facility-snf-care
  3. “Medicaid’s Role in Nursing Home Care.” Kaiser Family Foundation, 20 June 2017, www.kff.org/infographic/medicaids-role-in-nursing-home-care

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