MyGericare

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:

  • Require skilled nursing care for a service-connected condition; or
  • Have a service-connected disability rating of 70% or more; or
  • Have a service-connected disability rating of 60% and be considered unemployable

- 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