The confusion surrounding the terms “Skilled Nursing Facility” (SNF) and “rehabilitation” is common for people navigating post-hospital care. While both settings provide necessary post-acute care, they are fundamentally distinct facilities with different regulatory requirements and primary patient goals. The difference lies in the intensity of the therapy, the type of medical oversight, and the source of payment, which ultimately determines where a patient is best suited to recover. Understanding these distinctions is important for patients and families transitioning from the hospital to the next level of care.
The Role of Skilled Nursing Facilities
Skilled Nursing Facilities (SNFs), often located within a nursing home, focus primarily on providing daily medical treatments that require the expertise of licensed healthcare professionals. The term “skilled” refers to services so complex they must be safely and effectively performed by or under the supervision of a registered nurse or a licensed therapist. These facilities are designed for patients who are generally medically stable but still require a level of care that cannot be managed at home.
The care provided in an SNF includes a wide range of medical services, such as complex wound care, intravenous medication administration, monitoring of unstable conditions, or tube feedings. Physical, occupational, and speech therapy are often provided, but they are generally less intensive and specialized than in an Inpatient Rehabilitation Facility. The primary goal is patient stabilization and the management of medical conditions during the transition from a hospital stay to a lower level of care or home.
A patient in an SNF typically receives therapy for shorter sessions, often ranging from 30 to 60 minutes per day, five to seven days a week. This level of rehabilitation is often referred to as sub-acute care, focusing on maintaining or slowly improving the patient’s condition while medical issues are resolved. The average length of stay in an SNF is generally longer than in an IRF, sometimes lasting between 20 and 30 days or more.
The Intensive Focus of Inpatient Rehabilitation
An Inpatient Rehabilitation Facility (IRF) is a specialized hospital setting dedicated to intensive rehabilitation. The focus of an IRF is rapid, significant functional improvement in daily living activities following a severe event like a stroke, spinal cord injury, or major trauma. Patients admitted to an IRF must be able to tolerate and benefit from a highly rigorous therapy schedule.
The defining characteristic of an IRF is the intensity of its therapy regimen. A patient must receive at least three hours of combined physical, occupational, and/or speech therapy per day, five days a week. The care team, which includes a rehabilitation physician, sets the expectation for patients to make measurable progress quickly. This intensive approach often leads to substantially better functional outcomes.
The average length of stay in an IRF is notably shorter, often around 10 to 14 days, reflecting the goal of achieving maximum functional recovery and returning the patient home as soon as possible. The patient’s ability to tolerate this high volume of daily therapy is a major deciding factor in the placement decision.
Key Differences in Staffing and Environment
The operational and environmental differences between the two settings reflect their distinct missions. SNFs are often freestanding facilities or attached to long-term care nursing homes, providing a more residential setting. The primary staff focus in an SNF is on skilled nursing care, featuring a high ratio of Registered Nurses and Licensed Practical Nurses to manage complex medical needs.
IRFs are often dedicated units within a hospital or stand-alone specialty hospitals, designed to feel more like an acute medical setting. The staffing model prioritizes specialized rehabilitation professionals, featuring a high ratio of physical, occupational, and speech therapists. A rehabilitation physician (physiatrist) must see the patient at least three times a week and oversees the entire interdisciplinary team. In an SNF, a physician is generally required to see the patient only every 30 days, providing less intensive medical oversight.
Understanding Coverage and Payment Rules
The financial structure, particularly under Medicare, is a major factor that reinforces the distinction between SNFs and IRFs. Medicare Part A covers SNF care, but coverage requires a “qualifying hospital stay” of at least three consecutive days as a formally admitted inpatient immediately preceding the SNF admission. This three-day stay requirement does not apply to IRF coverage.
Medicare Part A coverage for an SNF stay is limited to 100 days per benefit period, with a tiered payment structure. The first 20 days are covered at 100% after the hospital deductible is met. A significant daily co-payment begins on day 21 and continues through day 100. Medicare Part A covers an IRF stay similarly to an inpatient hospital stay, with a deductible and a benefit period that is not limited to 100 days in the same way the SNF benefit is.
The payment mechanism dictates the type of care provided. IRFs are compensated for the intensive, multidisciplinary therapy they deliver, while SNFs are paid for providing daily skilled nursing services. This difference in reimbursement means the patient’s medical necessity and ability to participate in intensive therapy are directly tied to which facility Medicare will cover.