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Nursing Homes | Skilled Nursing Facility
QUICK OVERVIEW: Skilled Nursing Facilities are also known as SNFs, Nursing Homes and also Convalescent Homes. These live-in facilities provide physician prescribed medical treatment to those who are unable to care for themselves. These nursing care homes focus on patients who have health problems requiring convalescent and/or restorative services. Some patients require short-term physical rehabilitation while recovering from surgery; others in the skilled nursing facility may require long-term nursing and medical supervision.
APPROPRIATE FOR: The senior who
- Needs full assistance with personal care services
- Is bedridden or unable to position themselves in their bed
- Needs intensive rehabilitative Physical, Occupational, Speech, and/or Respiratory therapy
- Requires 24-hr skilled nursing care due to hospitalization or complex physical or cognitive conditions for a temporary or a long-term stay
- Is unable to ambulate (get around) without the assistance of a cane, walker, scooter or wheelchair
- Suffers from an advanced stage of Alzheimer's or Dementia, combative or severely confused
- Requires tube feeding or is on an IV
- Needs intensive wound care management
- Has to be on a vent or needs tracheotomy care
- Is terminally ill and requires Hospice (end of life) care
SERVICES PROVIDED: Skilled Nursing Facilities provide 24 hour nursing care, rehabilitation services such as physical, speech and occupational therapy; assistance with Activities of Daily Living (ADLs) like eating, walking, bathing and using the toilet; coordinated management of patient care; social services; and recreational activities. In addition, some Skilled Nursing Facilities provide specialized care programs for Alzheimer's, Parkinson's or other illnesses. Some skilled nursing homes provide short-term respite care for frail or disabled persons when a member of the family requires some personal time or rest from providing care in the home.
COST RANGE: $3,600 - $6,000 per month
FUNDING SOURCES: Private pay, Long-term Care Insurance (LTCI), Managed Care (HMOs), Veteran's Benefits, Medicare, Medigap & Medicaid. Medicare initially covers most skilled nursing care at a facility. Once Medicare coverage stops, your options are Long-term Care Insurance (LTCI), Medicaid, private pay or a combination of sources.
PRIVATE PAY SOURCE:
| Coverage | Conditions & Limits |
| -All- | -None- |
LONG-TERM CARE INSURANCE (LTCI) SOURCE:
| Coverage | Conditions & Limits |
| - Depends on policy, some cover in-home care based on impairment of Activities of Daily Living (ADLs) - Some policies pay benefits in a skilled nursing facility, but the $ coverage depends on the policy. - For information on how to determine what kind of LTCI policy is best, consult with one of our Advisors For Seniors | - Depends on the policy, as some only cover Skilled Nursing care for a limited number of days, daily amount, total dollar amount, etc., - For information on how to determine what kind of LTCI policy is best, consult with one of our Advisors For Seniors |
VETERAN'S BENEFITS SOURCE:
| Coverage | Conditions & Limits |
| - The Department of Veterans Affairs (VA) provides skilled nursing care to eligible veterans through VA and Community Contract facilities. - Veterans who do not meet eligibility criteria may still be eligible for nursing care when space and resources are available. - We recommend you consult with on of our Advisors For Seniors (i.e., Veterans Organizations) | - Veteran must meet these eligibility criteria:
- Skilled nursing care for non-service connected veterans is limited to 6 months |
MANAGED CARE (HMO) SOURCE:
| Coverage | Conditions & Limits |
| - Managed Care policies cover everything that Medicare covers (see Medicare Option). - Some require a 50% co-payment for days 21-100 - In addition, no prior hospital stay is required
| - The skilled nursing facility must be certified by Medicare, and - Client/resident must get services pre-authorized from - We recommend you consult with one of our Advisors For Seniors |
MEDICARE SOURCE:
| Coverage | Conditions & Limits |
| - First 20 days in a Medicare-approved skilled nursing facility - Days 21-100: Medicare pays for all covered services except for an annually adjusted daily coinsurance rate of $128/day (2008) - 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 - We recommend you consult with one of our Advisors For Seniors (i.e., Medicare/Medicaid Consultants or Eldercare Attorney's)
| - There are strict limitations to Medicare coverage in skilled nursing facilities. - Beneficiary must be in hospital for 3 consecutive days, not counting day of discharge - Must be admitted to skilled nursing facility within 30 days of hospital discharge - Services must be related to condition that was treated in hospital - Must require daily skilled nursing or rehabilitation services - Must be determined that services can only be provided on an inpatient basis - Doctor must specify need for daily skilled care services; and - Doctor must re-certify need at day 5 and day 14 after admission, and every 30 days thereafter - Medicare must review and approve continued need for skilled care services - Skilled nursing stay must be 100 days or less; and - Medicare must approve the length of stay (100 days are not automatically granted) |
MEDIGAP SOURCE:
| Coverage | Conditions & Limits |
| - 8 of 10 basic Medigap policies (Medigap Plans A-J) cover the coinsurance $ amount of days 21-100 of skilled nursing care. Medigap Plans K-L cover a portion of the coinsurance $ amount. - Three states have their own Medigap plans. Massachusetts' core plan doesn't cover skilled nursing facility coinsurance, but a supplemental plan does. Skilled nursing facility coverage is provided in Minnesota both with basic and extended basic plans and in Wisconsin with the basic plan | - There are many limitations. We recommend you consult with a GeriCareFinder Advisory Resource (i.e., Eldercare Attorneys, Medicare/Medicaid Consultants, etc.) |
MEDICAID SOURCE:
| Coverage | Conditions & Limits |
|
- Skilled nursing facility service costs and medical equipment deemed necessary by a doctor (usually a person will need help with at least two Activities of Daily Living (ADLs) - To hold a bed usually a one- to two-week period, if a resident requires temporary hospital care - For a leave of absence of up to 18 days per year for visits with family or friends | - There are many limitations. We recommend you consult with a one of our Advisors For Seniors |
