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What is a Skilled Nursing Facility?
A skilled nursing facility, or SNF for short, is a facility in which one can receive intensive medical oversight outside of the hospital setting. Often looked at as a shorter-term care environment than classic long-term care, a skilled nursing facility is often the next stop after a serious hospitalization. For people who have endured major illness or injury, sometimes it is necessary to live in a more structured environment with skilled care and oversight to recover to an appropriate level to be safe back in the home environment.
Services in Skilled Nursing
Skilled nursing facilities offer a variety of healthcare services that help get you back on your feet. With 24 hour a day nursing oversight, higher level care needs can be met while not keeping you stuck in the hospital environment. Nursing care is provided by way of medication management, illness oversight, contact with physicians and external providers, management of any wound care, and any IV or tube feeding needs.
Skilled nursing facilities also typically have physical therapy, occupational therapy, and speech therapy onsite with an onsite therapy environment to receive therapy services and recuperation of skills lost due to illness or injury. This typically includes a gym area for therapy services to help you get your strength and coordination back, as well as re-teach you any daily tasks and skills you may need to recover after a major illness.
Physician oversight is a key difference between skilled nursing and a nursing home. Skilled nursing often has regulatory requirements that specify how often a physician must see a patient that has been admitted into skilled care. There is also on-call physician care for 24/7 urgent care needs and management of illnesses. Typical physician oversight in skilled nursing far exceeds the level of physician oversight provided in nursing home settings, and it is a major, key component to differentiating between the two.
Skilled Nursing Patients
The patients in a skilled nursing facility are often post-acute or sub-acute. This means that oftentimes, a patient will discharge to the skilled nursing setting straight from the hospital, but still have care needs that supersede what can be overseen in the home. Patients who are usually referred to a skilled nursing facility for a time are patients who have experienced major illness or injury causing a deficit in what they were previously capable of doing.
Patients in skilled nursing have oftentimes either been in a serious accident or experienced a type of illness like stroke or a long hospitalization due to a severe illness that has deconditioned them to a point that recovery and rehabilitation is necessary. Other times, a patient may be able to get around just fine as they were previously, but require long-term medication use that is difficult to manage in an outpatient setting, like a long-term intravenous antibiotic therapy. These patients require the skilled oversight of nursing and therapy staff to get them back to home.
Skilled Nursing Accommodations
The accommodations in skilled nursing are typically a step up from the accommodations seen in traditional nursing home settings. Nursing homes typically have shared rooms with no selection of who you share the space with, and a suite-style environment for the bathroom use with 1-3 other people. The skilled nursing accommodations are typically better than these, with private rooms usually available to skilled nursing patients along with a personal bathroom accommodation as well. The staffing ratio for certified nursing assistants is usually better in skilled nursing as well, meaning there are more people available to provide you assistance when needed.
The difference in room accommodations is due to a difference in payment for the services provided. Typically, skilled nursing is funded by Medicare funding for those who qualify for it due to age or debilitation. Medicare does not fund long-term care that is seen in the nursing home setting however, and Medicaid funding typically does not cover private room accommodations.
What is a Nursing Home?
A nursing home, in contrast to skilled nursing, is an environment that provides long-term healthcare and daily care needs to individuals with ongoing illness or who have reached an age where they can not provide their own activities of daily living care independently. While some people who are not very advanced in their needs may qualify for an assisted living facility, those who fall outside of the assisted living community requirements- either from too high a level of care or too medically complex- will find themselves in need of a nursing home environment.
Services in a Nursing Home
Services in a nursing home are typically provided by a nurse on staff who can provide medication oversight and treatments like wound care. Services also include certified nursing assistants who provide all daily living needs like bathing, clothing, hygiene and food-related needs. Nursing home care typically does not provide services like therapy to their residents, as they are oftentimes already at the highest-functioning level that they will achieve.
Physician oversight is still provided, though the frequency of visits is often much less often than in skilled nursing. Skilled nursing patients are considered more fragile and less stable, and therefore require much more frequent oversight. Nursing home patients, on the other hand, are fairly stable by nature of their progression, and therefore are usually seen on regular, infrequent intervals by the physician unless something of an urgent matter arises.
Nursing Home Patients
Patients in a nursing home need to be referred by a hospital or physician in order to be evaluated for nursing home placement. Each state has different guidelines for who qualifies for a nursing home placement, but typically patients who are eligible to reside in a nursing home meet a level of care requirement that makes them not suitable to live at home any longer. Typical things that would require nursing home level of care would be a decrease in mobility level to the point where total assistance is required for getting out of the bed into a chair, into a wheelchair, or getting around in the wheelchair.
Another consideration for nursing home patients is cognitive capability. Sometimes a patient can be mobile and physically stable, but have a diagnosis like dementia. The decline that occurs with a dementia diagnosis can be gradual or it can be swift, and a patient in moderate to severe decline with dementia almost always requires long-term nursing home level of care to manage their needs.
Nursing Home Accommodations
Most nursing home accommodations are similar no matter the location. Typical nursing home environments have separate units- some with memory care specialization in them, some with basic care needs. A typical nursing home environment will have two people per room and share a bathroom with another room adjacent to it. Regulatory requirements are that only one gender may share a room or a bathroom, so it will be all male or all female wings for the adjoining bathrooms and rooms.
Nursing home environments are usually funded through Medicaid programs in each state, which requires a spend-down of personal assets prior to being able to be funded by Medicaid. As such, the accommodations for long-term care patients in a nursing home environment are usually shared and difficult to procure a private living space due to funding limitations. There are always exceptions to this rule however, and each facility has their own regulations in regards to this.
Knowing what your individual needs are is the most important factor in evaluating skilled nursing versus nursing home care. Keep in mind that many facilities are diversifying and offer both levels of needs within one building. Contacting local facilities to see what services each level of care can provide will give you the best insight into what is available to you in your particular situation.