Skilled Nursing Facility

Patients are generally admitted to skilled nursing facilities after a short inpatient stay at the hospital. In order to be admitted to skilled nursing, patients require a referral from their overseeing physicians. Once the order is received, patients and their family members must fill out the admissions paperwork which will help the facility determine if the patient is a good fit for their level of care. Once the admission requirements have been met and the patient has been accepted, the patient and their family begin filling out the contract work.

The overall cost of stays at skilled nursing facilities varies depending on the company, the state or location, and the services utilized. On average, one room at skilled nursing costs approximately $300 per day or almost $9,000 per month.

However, rarely are patients expected to pay the full cost of medical services, room, and board out-of-pocket. In most cases, patients are referred to skilled nursing and then select a facility based on whether their insurance policy will cover it or not.

Skilled nursing is typically covered by medical insurance, either in part or in full. Medicare and Medicaid have details written in all of their available policies regarding services that are covered in skilled nursing and the duration in which they will cover those services.

For example, a patient may be referred to skilled nursing to receive rehabilitation for a 60-day period by a primary physician but then Medicare would need to go through their approval process to confirm coverage for that medically ordered period. If a patient has not met their rehabilitative goals within 60 days, then rehabilitative specialists in skilled nursing would need to recertify the need for additional time. That recertification is signed by the doctor and then goes through the insurance approval process again.

There are numerous services available at skilled nursing facilities. Patients may use some or all of these services based on their medical needs:

• Physical therapy
• Occupational therapy
• Speech pathology
• Recreational therapy
• Respiratory therapy
• Nursing
• CNA services
• Housekeeping and maintenance
• Nutrition
• Social work/case management
• Transportation services
• Psychology and counseling
• Wound care

All team members work together under a format called interdisciplinary teamwork. The patient and/or family take the lead on the team and all other disciplines work together collaboratively to create an optimal care plan to meet the patient’s rehabilitative and medical goals.

In some skilled nursing facilities, there are additional services available to create a more pleasant stay. This could include:

• Religious services
• Weekly games
• Arts and crafts
• Salon services
• Community outings
• Music or singing time
• Volunteer performance nights

Services and amenities are provided based on the facility and their staffing availability.

Medically licensed staff members remain onsite 24/7. This includes nursing staff such as practitioners, registered nurses, respiratory specialists, and CNAs to help perform medical and personal support services. During the 8-5 workday, other staff members are available including rehabilitative staff, social work, psychological services and counseling, wound care, volunteers, recreational staff, and nutritional staff.

All skilled nursing rooms generally come furnished with beds, nightstands, and additional seated furniture for guests and staff. Since skilled nursing is considered temporary and transitional care, patients shouldn’t expect to bring in a ton of their personal belongings. Some items are encouraged including those with sentimental value. Some items may be prohibited if they are considered a fire or an electrical hazard (personal hair dryers, curlers, heated blankets). Each prospective patient should consult with staff to determine what they are allowed to bring in prior to making the transition.

Skilled nursing services are usually suggested after a patient is already at the hospital for an inpatient stay. Family members or medical staff may notice some safety challenges with moving a patient from the hospital directly home, so transitional care offers the patient an opportunity to get stronger and healthier before returning to normal life. Here’s a little more on Cynthia’s story:

Cynthia is ordered for a two-week stay to rehabilitate her hip after surgery. Some of her goals include walking safely with her cane, showering herself without falling in the bathroom, and dressing herself without re-injuring her hip. Cynthia participates in physical and occupational therapy daily and has nursing staff tend to her incisions regularly to monitor any signs of infection.

Many of Cynthia’s goals may have been assessed at the hospital, but since hospital stays are getting shorter and shorter, there is very little time for rehabilitative staff to help Cynthia meet her goals. This is where skilled nursing comes into the picture to allow her more time to heal and to complete her self-care activities independently.

If a patient is transitioning from a hospital stay to skilled nursing, their inpatient medical staff typically work with them and their family members to provide them with available facility options. However, patients and family members can be proactive and select a facility based on their own preferences and needs. Here are some questions you can ask when evaluating a facility for you or a loved one:

• Will my medical insurance policy cover the stay?
• How have past patients rated their stay at this facility?
• Is the facility close enough for family members and friends to visit?
• What is security like at the facility?
• What is the staff per patient ratio?
• What are transportation services like?
• What is the visitor’s policy and schedule like?
• What type of services will I receive there?
• What is the food like?
• Does this facility have some fun services and amenities that I’d enjoy?

If possible, patients and their family members can sometimes tour the facility and meet staff members prior to committing to a stay.

Skilled nursing facilities (SNFs) provide transitional medical and rehabilitative care and provides patients and their family members with some extra time when they’re feeling apprehensive about returning home after a bout of illness or injury. Patients and their loved ones are encouraged to do their own research and explore their options to see which facility meets their unique needs.