A Skilled Nursing Facility (SNF) is a temporary residential medical facility providing comprehensive, medically necessary care after a hospital stay. The SNF serves as a bridge between acute inpatient care and a patient’s return home or transfer to a lower level of care. Patients admitted require a high level of daily medical oversight, often not possible in a home setting. This post-acute care setting focuses heavily on rehabilitation and recovery from a serious illness, injury, or surgery.
Defining Skilled Nursing Care
Skilled nursing care must be performed by, or directly supervised by, licensed medical professionals such as Registered Nurses (RNs), Licensed Practical Nurses (LPNs), physical therapists, or speech-language pathologists. This medically intensive care goes beyond general assistance with daily living activities, known as custodial care. Daily medical oversight differentiates an SNF from other residential facilities.
Examples of skilled care include complex wound care (involving deep tissue management or vacuum-assisted closure) and the administration of intravenous (IV) medications or nutrients. Patients requiring ventilator or tracheostomy care also fall under skilled nursing, as these procedures demand constant monitoring by licensed staff. Unstable medical conditions, such as severe diabetes or congestive heart failure, that require frequent medication adjustments or close observation of vital signs are also managed here.
A significant portion of skilled nursing care involves intensive rehabilitation therapies, including physical, occupational, and speech therapy. These services must be necessary to improve the patient’s condition or to safely maintain their current level of function. The goal is to restore the patient’s independence and mobility to the greatest extent possible so they can ultimately transition out of the facility.
The Role of Medicare Coverage
Financial coverage for an SNF stay is a major consideration, and Medicare Part A provides coverage under specific conditions. The care must be certified by a physician as medically necessary, requiring daily skilled nursing or rehabilitation services only provided in an SNF setting. This necessity must be directly related to the condition that required inpatient hospital treatment.
A foundational requirement for Medicare Part A coverage is a “qualifying hospital stay,” meaning the patient must have been formally admitted as an inpatient for at least three consecutive days. The day of discharge and time spent under “observation status” do not count toward this minimum. Admission to the SNF must generally occur within 30 days of the patient’s hospital discharge.
Medicare tracks coverage using a concept called a “benefit period,” which begins the day a patient is admitted as an inpatient to a hospital or SNF and ends after the patient has been out of both for 60 consecutive days. A patient can receive up to 100 days of SNF coverage within a single benefit period. For the first 20 days of a covered stay, Medicare pays the full cost for all approved services.
Starting on day 21, the patient becomes responsible for a daily co-insurance payment for days 21 through 100. The 100-day limit is not guaranteed; coverage can cease if the patient is no longer deemed to require daily skilled care, even if they have not reached the maximum. If coverage is denied because the care is no longer considered “skilled,” the facility must provide the patient with a formal written notice detailing the right to appeal the decision.
SNFs Versus Long-Term Care Homes
A common point of confusion exists between a Skilled Nursing Facility (SNF) and a standard Long-Term Care (LTC) home, often referred to as a traditional nursing home. The primary difference lies in the type of care provided and the expected duration of the patient’s stay. SNFs are fundamentally short-term facilities focused on recovery, with a clear plan to transition the patient to a less intensive setting, typically home.
LTC homes are designed for permanent or indefinite residence, providing custodial care for individuals with chronic conditions or disabilities. Custodial care involves assistance with activities of daily living, such as bathing, dressing, eating, and medication management, which does not require the continuous attendance of a licensed nurse. While many LTC homes employ skilled nurses, the daily focus of care is on long-term support rather than intensive, short-term rehabilitation.
Patients in an SNF are generally recovering from an acute medical event, such as a fractured hip or a stroke, and require rehabilitation to regain function. Patients in an LTC home are medically stable but require consistent support for basic living tasks due to physical or cognitive limitations. Understanding this difference is important because Medicare Part A covers short-term, medically necessary stays in an SNF, but it typically does not cover long-term custodial care in an LTC home.