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Skilled Nursing Facilities: A Primer

In-Home Medical Care for Seniors

Skilled nursing centers are emerging as a popular alternative to traditional senior care centers, giving U.S. seniors a viable option for long-term care needs. Better yet, skilled nursing services are covered by Medicare.

Make no mistake, skilled nursing care centers are growing fast.

According to the American Health Care Association and the National Center for Assisted Living https://www.ahcancal.org/research_data/Pages/Fast-Facts.aspx, there were 15,655 skilled nursing centers in the U.S. in 2016 (the last time official figures were available), with a total of 1.7 million beds.

Overall, the AHCA says, over 3.9 million American seniors reside in a skilled nursing home center each year. That’s a figure that should grow larger as more baby boomers (77 million altogether) enter into their 70s, 80’s and 90’s.

What is Skilled Nursing Care?

Largely defined, skilled nursing care is a medical care service provided by professional, licensed health care specialists like occupational therapists, registered nurses, and other highly trained health care services providers.

Typically, skilled nursing specialists provide direct care for ill or injured seniors for a short period of time, either in a skilled nursing facility or at the senior’s private residence, or at the home of a family member or other loved one. In the event the disabled senior suffers from a longer-term chronic issue, skilled nursing providers may provide longer health care treatment.

Skilled nursing care is a high level of medical care that must be provided by licensed health professionals, such as registered nurses (RNs) and physical, speech, and occupational therapists. These services can be necessary over the short term for rehabilitation from an illness or injury, or they may be required over the long term for patients who need a high level of care on a frequent or constant basis due to a chronic medical condition.

Like traditional nursing care, skilled nurses provide a way variety of treatments and care to senor patients, including physical therapy, injections, intravenous treatments, and other general medical care services.

Skilled Nursing Care and Medicare

Skilled nursing care is widely covered under Medicare, the predominant health care coverage vehicle for Americans over 65-years-of-age.

According to data from the Medicare Payment Advisory Commission

(MedPac.gov) http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch8_sec.pdf, Medicare recipients using skilled nursing care facilities “to provide short-term skilled nursing and rehabilitation services to beneficiaries after a stay in an acute care hospital.”

According to MedPac.gov, in 2018, approximately15,000 skilled nursing care facilities provided 2.3 million Medicare-covered stays to 1.6 million fee-for-service (FFS) beneficiaries. “Overall, Medicare FFS spending on SNF services was $28.4 billion in 2017, about 1% less than in 2016. Just over 4% of overall Medicare beneficiaries used SNF services in the same year.”

Even though a small percent of Medicare recipient use skilled nursing facilities, the number of nursing facilities is abundant across the U.S. This from MedPac.gov:

The number of SNFs participating in the Medicare program has been stable,” the commission noted in a report to Congress. “The vast majority (89 percent) of beneficiaries live in a county with three or more SNFs or swing bed facilities (rural hospitals with beds that can serve as either SNF beds or acute care beds), and less than 1% live in a county without one.”

The issue of Medicare providing cost coverage for skilled nursing care is also tied to the patient’s general practitioner. To qualify for Medicare coverage, a skilled nursing facility patient must get a not from his or her physician and provide that conformation to Medicare before any funds are released.

Technically, Skilled Nursing Facilities Aren’t Nursing Homes

There are significant differences between skilled nursing centers and traditional nursing homes, both structurally and financially. Mainly, skilled nursing care involves the shorter-term treatment of patients recovering from illness or injury, while nursing homes provide care to residents who are largely unable to live on their own due to severe memory loss or long-term physical problems.

Treatment and care at a nursing home can last for years, while care given at a skilled nursing center usually lasts, on average, for only several days (although special cases can and do require longer care.)

For more clarity, it’s helpful for seniors and their family members to view skilled nursing centers and nursing homes in different ways.

Skilled nursing is a service. There’s a good reason why the term “skilled nursing care” is used to describe the skilled nursing sector. It’s a term that designates service over a traditional nursing home. As MedicalResources.org https://www.medicareresources.org/glossary/skilled-nursing/

States, “Skilled nursing care is care provided by a registered nurse or a licensed practical nurse and which may be provided in a skilled nursing facility or in the patient’s home.

Skilled nursing care is often necessary as a patient rehabilitates from an illness or injury, but the care provided is above and beyond that which can be provided by certified nursing assistants (CNAs) or home health aides.”

On the financial side of the ledger, skilled nursing care can be covered by Medicare but is also widely covered by traditional health care insurance, as well. With Medicare, recipients are expected to only stay in a skilled nursing home center, and that’s with conditions. For example, Medicare won’t cover skilled nursing stays unless the patient has at least a prior three night impatient stay in a hospital. Only then will Medicare pay for additional care in a skilled nursing care facility – and Medicare will only pay for that care, on a sliding scale, for 100 days or less.

Traditional nursing homes are for long-term care. Nursing homes and skilled nursing centers do provide direct health care, but nursing home centers provide that care for a significantly longer period of time than do skilled nursing home centers. Additionally, nursing home care isn’t available in a senior’s private residence, as is the case for skilled nursing services.

Technically, nursing homes are designated as “licensed healthcare residences”, meaning they are contracted to provide a more robust level of health care service over a longer period of time.

Skilled nursing centers do have those residence care time limits. That said, Medicare does not pay for long-term nursing home care but will cover skilled nursing home care. It is advisable to work with your senior care center on costs and financing, as coverage rules do vary on a state-by-state basis.

Skilled Nursing Centers – Services Offered

The term “skill” is highly appropriate when describing skilled nursing specialist and the critical services they provide.

That’s evident in the wide array of health care services skilled nursing specialists provide. In general, that medical care includes 24-hour and seven-days-a-week coverage for patients. From the day you enter into a skilled nursing facility, you can and should expect a comprehensive level of care that’s available from the beginning of your medical care journey to complete recovery.

That care is available to skilled nursing care patients who are only under care for several days or who require several months of professional medical care. In general, most skilled nursing care services are provided after the senior has undergone surgery, illness or an accident.

When you do enter a skilled nursing care facility, you can expect the following medical care services:

For the short-term. When seniors are admitted to a skilled nursing care center for short-term care (i.e., under a week or so), they’re given around the clock care by a licensed nursing professional. These services include post-surgery care, cardiac care, orthopedic care, stroke management care, pulmonary care, wound care, diabetes care, and organ transplant care, among other treatments.

During their stay, nursing care facilities also provide nutritional care and feeding, pain therapy and management, and intravenous therapy.

For the longer term. Skilled nursing treatment for patients who stay for a longer term – more than a week but less than 100 days is an approximate range – can expect different treatments and care.

That care and treatment includes physical speech and occupational therapies, home health care, and longer-term hospice care.

Additionally, skilled nursing care centers aren’t only about medical care – they’re about mental health and wellness, as well. In fact, skilled nursing care facilities also offer regular activities, patient-to-patient engagement opportunities, entertainment programs, art, writing, computer, and music classes, and a full schedule of daily events during a patient’s stay.

Questions to Ask a Skilled Nursing Facility Before Entering Into Care

For family members tasked with making the important decisions involving medical care and treatment for a senior relative, getting accurate information is no luxury when seeking good skilled nursing center care – it’s a necessity.

Getting answers to these serious senior care answers will give you the information needed to make a quality decision:

Are skilled nursing care centers regulated? Yes, all skilled nursing center facilities are licensed by state department of health agencies, and subject to approval by state regulators. Skilled nursing centers are required by law to regularly pass strict regulation and inspection mandates.

How do I know if a skilled nursing care facility is right for my senior family member? There are myriad reasons why skilled nursing care makes sense for a senior requiring continued professional treatment after a hospital stay. Cost is certainly a consideration in favor of skilled nursing, as it’s usually covered by Medicare.

Another factor is geographical in nature. In many cases, skilled nursing facilities make perfect sense for families who don’t reside in close proximity to a senior family member who requires skilled, professional nursing care.

What does our family doctor say? Having a good, reliable source of medical information is imperative as you make a decision about a senior family member’s future care – including at a skilled nursing care facility.

Your family physical can assemble information from all sources, including surgeons, clinicians, and other medical professionals who have provided direct care for the senior. Once the pertinent information from the senior’s medical care is in hand, the family physicians can recommend having the senior family member enter into a skilled nursing home; a nursing home; or return home to live in his or her residence.

Can I care for an ailing senior family member at home? That answer depends on the medical issues impacting the senior. By and large, though, if a senior family member is under hospital care for an injury or illness, and knowledgeable physicians recommend continued treatment, a skilled nursing care facility is a safe, solid, and cost-efficient option. Also, thoroughly review any skilled nursing care online review sites

What else should I know about skilled nursing care facilities? It’s highly advisable to ask trusted friends, neighbors, other family members, and medical professionals for referrals to good skilled nursing care centers.

When you begin engaging with an actual skilled nursing care center, ask staffers and managers about key issues like high employee turnover, how medications are handled (and who handles them), and how residents view the facility (asking other families with seniors at the center can be a big help.)

The fact is, a skilled nursing care facility, like any medical care center, needs to be thoroughly vetted before allowing a senior family member to enter into treatment.

Take that mentality with you when you seek medical help from a senior health center. Do that and you’re already a long way toward your goal of getting quality treatment from a skilled nursing care facility.

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