What Qualifies a Patient for Skilled Nursing Care?
What is Skilled Nursing?
Skilled nursing refers to a level of care needed by the patient that can only be provided by licensed nurses or other licensed healthcare professionals. Skilled nursing services can be provided in the home. However, a skilled nursing facility referral is for those who do not have the resources for the high level of care required at home. Many kinds of healthcare professionals may work at a skilled nursing facility. These include registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech therapists. These healthcare professionals work together to provide comprehensive care for all conditions/illnesses.
Why do Patients Typically Go to a Skilled Nursing Facility?
The primary goal of the nurses and therapists at a skilled nursing facility is to help their patients regain independence so that they are safe to return home. Remember, staying in a skilled nursing facility is transitional–it’s not supposed to be a permanent placement. Patients referred to a skilled nursing facility have recently had a serious medical event or accident/injury and need intensive care and rehabilitation.
An example is a person who undergoes a total knee replacement or heart surgery and needs professional care for recovery/rehabilitation beyond what can be provided in their home. Individuals recovering from brain injuries such as a stroke may also require the specialty care provided in skilled nursing facilities. Also, skilled nursing facilities help people who are amid a flare-up from chronic conditions such as autoimmune disorders requiring ongoing medical supervision.
Who Pays for Skilled Nursing Care?
Payment for time spent in a skilled nursing facility typically comes from multiple sources, including private insurance and Medicare. Knowing the rules and limitations of payment for SNFs is vital to ensure no interruption in care.
Medicare generally covers 100 days of skilled nursing care per benefit period. For this to be valid, the patient must have an inpatient stay in the hospital of at least 3 consecutive days, not including the day of discharge.
You will not be responsible for any payment for the first 20 days of your stay at a skilled nursing facility. After the initial 20 days, the facility collects a co-payment from you. After 100 days, Medicare no longer pays for this service, and the private individual is responsible for payment.
Most private health insurance policies cover stays in skilled nursing facilities for a short time. The extent of coverage of private insurance varies significantly.
For time spent in a skilled nursing facility that is longer than what Medicare or private insurance will pay for, you have options. Your best option is to investigate a long-term care policy. This type of policy offers benefits for services and items not covered by Medicare or private insurance. However, a long-term insurance policy must be in place before you need it. It is designed to prepare you for the future and instill peace of mind should you ever need it.
Other options for long-term treatment in a skilled nursing facility include Medicaid (only for individuals who meet income requirements), Medigap policies, and out-of-pocket payments.
Signs It’s Time for Skilled Nursing
You know your family member better than any medical professional ever will and know when they need more intensive care. This is particularly true if you live with them. Only you may notice some clear indicators that qualify for skilled nursing care. Some examples of these include:
- Difficulty eating
- Needing 24/7 support
- Needing assistance getting out of bed
- Daily wound dressings
- Daily injections
- Specific conditions like dementia or advanced Parkinson’s disease
The signs listed above are always more apparent to family members and help when deciding to transition to a skilled nursing facility.
Types of Skilled Nursing
Skilled nursing facilities provide more than nursing services. Skilled nursing care focuses on the patient’s unique needs and offers various healthcare services such as physical, occupational, and speech therapy.
Speech therapy primarily helps with difficulties in communication, swallowing, and feeding. Physical therapy focuses on restoring mobility, strength, and overall function. Occupational therapy teaches the patient how to perform activities of daily living within their current functional capability, leading to independent living. These three professions provide services beyond those that are listed here.
Also, skilled nursing provides medical management including administering injections, medication management, postsurgical/wound care, and more.
Skilled Nursing at Centers Health Care
If you live in New York state and are searching for a skilled nursing facility, Centers Health Care has you covered. We have many skilled nursing locations in NYC, the Bronx, Brooklyn, Buffalo, Carthage, Cooperstown, and many more.
We would be honored to care for you or your loved one in your time of need. See our locations or call us at 800-305-9151 for more information. We look forward to meeting you.
