Nursing Home vs Long-Term Care

When a patient is discharged from the hospital, he might be sent to a Skilled Nursing Facility (SNF) instead of going home. The care provided in a SNF is more comprehensive than that provided in an extended care facility (aka nursing home), and Medicare pays substantially more for these services. While long-term care is considered to be supportive in nature, skilled nursing is generally designed to rehabilitate a patient so that he can return home if at all possible. Both of these services can be provided in the same building, but they are completely different types of care and are usually offered on different halls or sides of the building.

Skilled Nursing Facilities (SNF)

A patient who is able to participate in therapy up to two hours per day, six days per week is often discharged from the hospital to a skilled nursing facility (SNF). SNF’s provide services from physical therapists, occupational therapists and speech therapists on an inpatient basis. In addition to rehabilitation, residents who are newly fed by a feeding tube, require wound care or other services that must be provided by a registered nurse qualify for skilled services under the Medicare benefit.   Skilled Nursing Facilities don’t offer in-house doctors; if patients need to see a doctor they’re either transported to the doctor or the doctor makes a special visit to see them. Depending upon the type of services the patient receives, it’s possible that the doctors will see them in-house on a regular basis. For example, a patient who requires wound care services might be seen by the doctor on a weekly basis, or a ventilator patient will be seen in-house by a pulmonologist.   Depending upon the type of care the patient requires, payment for the skilled services can last up to 100 days (the full Medicare SNF benefit) with the copayment either paid out of pocket or by a Medigap policy. Medicare Advantage plans also pay for skilled services, although the copayments and deductibles vary according to the plan the senior has chosen. Private insurance policies such as TriCare or union benefits also offer skilled nursing benefits.   It’s possible for patients to require long-term skilled nursing services - patients with feeding tubes or other specialty care require an RN in the building at all times. They are able to remain in the facility after their Medicare benefit has been exhausted, with their long-term payment covering the cost of care.   Some SNF’s provide sub-acute services, such as ventilator assistance, for patients who no longer require a physician 24 hours each day but do require a higher level of care than offered by most nursing homes. These SNF’s provide respiratory therapists on-site to ensure that the patients’ medical needs are met – and they are licensed to bill Medicare and Medicaid at a higher rate than a regular SNF. Because their needs are so great, they are able to remain in the SNF on a long-term basis.   Although there are some skilled nursing facilities that stand alone, most are combined with long-term care nursing homes. By combining these levels of care, a patient can receive intensive therapies after being discharged from the hospital and remain in the facility afterward on a long-term basis.

Long-Term Care

A patient who can no longer remain at home because he requires 24-hour nursing care and monitoring is often admitted to a nursing home, also known as a long-term care center or extended care facility (ECF). These nursing homes provide their patients with assistance in an institutional environment. Nursing homes are professionally staffed with nurses, nursing aides, social workers, dieticians, etc. They aren’t required to have an RN on staff 24-hours per day, because they don’t provide specialty medical services. These staff members are able to provide clinical care as well as a formal activity program. Patients are able to remain in the nursing home until their death.   Most nursing homes combine long-term care with skilled nursing – this enables them to admit patients under a higher level of care (and the higher payments that Medicare offers), yet allows the patients to remain on a long-term basis. Once the Medicare Part A benefit has been exhausted, nursing homes are able to offer ongoing services called restorative care. This type of care is designed to help patients maintain their current level of functioning, and is provided by specially trained nursing aides who work under the direction of the therapy department. Most nursing homes also offer physical therapy under Medicare Part B, which is less intense and shorter in duration than the therapy services offered under Part A.   Nursing homes combined with skilled nursing facilities are staffed with a registered nurse 24 hours a day, and are able to care for medically complex patients such as those with feeding tubes or who require specialty nursing care. Like a SNF, nursing homes don’t have doctors in-house – if a patient needs to see their doctor they are either transported to his office or he’ll make a special trip to the facility see them. Nursing homes are able to accept most types of payment and are usually able to meet the medical needs of most patients.