A skilled nursing home (SNH), often referred to as a skilled nursing facility, is a residential healthcare setting that provides a high level of medical care and rehabilitation services. These facilities are designed for individuals who require professional attention that cannot be managed at home or in an assisted living environment. The term “skilled” refers to services that must be performed by or under the direct supervision of licensed healthcare professionals, such as Registered Nurses, Licensed Practical Nurses, and various licensed therapists. The purpose of an SNH is typically to transition a patient from an acute hospital stay back to a less intensive setting or their own home following a significant illness, injury, or surgery.
Defining the Skilled Care Requirement
The core function of a skilled nursing home is to deliver complex medical and therapeutic services that require specialized training and licensure. These services go beyond basic personal assistance and focus on medical recovery and stabilization. The presence of licensed personnel twenty-four hours a day allows for continuous observation and immediate intervention for patients with unstable or complex health needs.
One common category of skilled care involves intensive rehabilitation therapies, which include physical, occupational, and speech-language pathology services. Physical therapy focuses on regaining strength and mobility, while occupational therapy helps patients relearn how to perform activities of daily living, such as dressing and feeding themselves. Speech therapy addresses communication difficulties and swallowing disorders that may arise from a stroke or neurological event.
Beyond therapy, skilled nursing encompasses a range of complex medical procedures that must be executed by a nurse. This includes the administration of intravenous (IV) medications, fluids, or nutritional support, which requires precise monitoring to prevent complications. Additionally, sophisticated wound care, particularly for deep pressure ulcers or post-surgical incisions that necessitate sterile dressing changes, is a qualifying skilled service.
Other services that qualify as skilled care involve managing and monitoring conditions that require round-the-clock assessment. This includes monitoring unstable cardiac conditions, managing complex pain requiring licensed nurse oversight, or continuously observing a patient’s changing condition after a stroke or major surgery.
Admission and Discharge Criteria
Admission to a skilled nursing facility is governed by strict criteria, particularly for coverage under Medicare, the most common payer for short-term stays. For a patient to qualify for Medicare Part A coverage, a prior qualifying hospital stay of at least three consecutive days as an inpatient is required. Time spent in the hospital under “observation status” or as an outpatient does not count toward this three-day minimum.
Once this prior stay is established, the patient must be admitted to the SNH generally within 30 days of their hospital discharge. The primary criterion for admission is “medical necessity,” meaning a physician must certify that the patient requires daily skilled nursing or skilled rehabilitation services. The services must be needed seven days a week for nursing care, or at least five days a week for therapy services alone.
Skilled nursing stays are typically temporary and goal-oriented, focusing on recovery and rehabilitation. The average stay for a patient receiving short-term rehabilitation is often short, sometimes less than 20 days, though Medicare coverage can extend up to 100 days in a benefit period. Discharge occurs when the patient has reached their maximum rehabilitation potential or when they no longer require daily skilled services.
The transition out of the SNH is initiated once the patient is deemed safe to return home, move to an assisted living facility, or transfer to a different level of long-term care. Medicare can cover skilled services required to maintain the patient’s current function or slow deterioration, even if the condition is stable or chronic. The discharge plan is a collaborative process that aims to place the patient in the least restrictive environment that meets their ongoing needs.
Differentiating Skilled Nursing from Long-Term Care
Skilled nursing facilities (SNFs) and traditional nursing homes describe two distinct levels of care with different purposes. An SNF is primarily focused on sub-acute medical care, intensive rehabilitation, and the patient’s eventual return home or to a lower level of care. It operates with a medical model, featuring higher staff ratios of licensed nurses and therapists to manage complex health issues.
Long-term care (LTC) or custodial care, by contrast, is for individuals who require ongoing assistance with routine activities of daily living (ADLs). These ADLs include bathing, dressing, eating, and mobility, and this assistance does not require the continuous involvement of licensed nurses. LTC residents are typically medically stable but cannot safely live independently due to chronic conditions or cognitive decline.
The funding models for the two types of care also differ significantly. Short-term skilled nursing care is often covered by Medicare Part A or private insurance for the duration of the medically necessary stay. Long-term custodial care, however, is generally not covered by Medicare and is usually paid for privately by the patient or through Medicaid for those who qualify.
It is common for a single physical structure to contain both a skilled nursing unit and a long-term care unit, which contributes to public confusion. The patient population, regulatory requirements, staffing levels, and the focus of the care provided within each unit are separate and distinct. The SNH side focuses on recovery and discharge, while the LTC side supports chronic needs and permanent residency.