The healthcare landscape following a hospital stay involves many facilities offering different types of post-acute care. People often use the term “rehab” broadly, which can lead to confusion about the specific services a patient will receive and the regulatory environment of the facility. Skilled Nursing Facilities (SNFs) and Inpatient Rehabilitation Facilities (IRFs) are designed for fundamentally different levels of medical stability and therapeutic need. These settings are separated by specific clinical requirements and legal definitions established by federal health agencies. Clarifying these distinctions helps patients and families choose the environment best suited for recovery.
Understanding the Skilled Nursing Facility
A Skilled Nursing Facility (SNF) is a medical institution primarily engaged in providing residents with skilled nursing care and related services, or rehabilitation services. This setting is designed for individuals who require medical care performed by or under the supervision of licensed nurses or therapists. The legal framework for these facilities is codified in federal law, such as 42 U.S.C. § 1395i-3.
SNFs provide services including intravenous medication administration, complex wound care, and management of medical conditions requiring round-the-clock licensed nursing coverage. While rehabilitation is offered, it is generally less intensive than in other settings. The patient’s primary need is often the skilled nursing care component, though therapy services help patients regain function.
These facilities serve a dual purpose: short-term rehabilitation following a hospital stay, and long-term care residences for individuals needing ongoing custodial care and medical supervision. Physician oversight is mandated, but a physician is typically required to visit and examine the patient only every 30 days while receiving skilled care.
Understanding Inpatient Rehabilitation Facilities
An Inpatient Rehabilitation Facility (IRF) is a specialized hospital or unit focusing on intensive, coordinated rehabilitation. This setting is designed for patients recovering from major medical events such as stroke, spinal cord injury, or brain injury. The primary mission of an IRF is to provide a highly structured environment where patients can achieve significant functional improvement in a short period.
A defining feature of an IRF is the requirement for an intensive rehabilitation therapy program, often called the “3-hour rule.” This means the patient must tolerate and receive at least three hours of therapy per day, five days per week, or a minimum of 15 hours over a seven-day period. The therapy must involve at least two different disciplines, such as physical, occupational, or speech-language therapy, aimed at restoring the patient’s ability to perform activities of daily living.
IRFs operate under specific regulatory standards, outlined in federal regulations like 42 CFR § 412.25. A rehabilitation physician (physiatrist) must provide direct medical supervision and lead the multidisciplinary team. This physician is required to see the patient in person at least three times a week to manage complex medical issues and adjust the intense treatment plan.
The Core Differences in Patient Criteria and Service Intensity
The difference between these two settings lies in the intensity of required services and the patient’s ability to tolerate them. The IRF is a high-acuity, hospital-level setting for patients who can actively participate in rigorous, intensive therapy. The SNF is a sub-acute setting that focuses on skilled nursing care and a less demanding, variable therapy schedule.
Medical oversight frequency highlights this difference. In an IRF, a physiatrist must provide daily oversight and a face-to-face visit three times per week for continuous medical management during rapid functional recovery. In an SNF, the physician visit requirement is significantly less frequent, typically a visit every 30 days while the patient is receiving skilled services.
Patient placement is determined by assessing clinical needs and potential for functional gain. The IRF is appropriate for patients with high potential for swift, significant recovery who need a coordinated, multidisciplinary team approach. Patients who are too medically fragile, have low endurance, or cannot tolerate three hours of daily therapy are more appropriately placed in an SNF.
These clinical and regulatory distinctions directly affect how each facility is paid by government programs. Both IRFs and SNFs operate under separate Prospective Payment Systems (PPS) established by Medicare. The IRF PPS reimburses for higher resource intensity and specialized hospital-level care, while the SNF PPS covers the costs of skilled nursing and moderate rehabilitation services. This regulatory separation confirms that an IRF is not considered the same as a Skilled Nursing Facility.