The terms Skilled Nursing Facility (SNF) and Nursing Home are often used interchangeably, leading to significant confusion when families seek care options. This linguistic overlap obscures fundamental distinctions in the type of care provided and, perhaps more importantly, the financial responsibility for that care. While both types of facilities may exist under the same roof, federal regulations define them by their different levels of service and distinct funding structures. Understanding these differences is necessary for individuals to make informed decisions about post-hospital recovery and long-term care needs.
Defining the Facilities and Level of Care
The primary difference between a Skilled Nursing Facility and a traditional nursing home lies in the intensity and nature of the medical services required by the patient. A Skilled Nursing Facility is a designation for a facility or unit that provides highly technical, physician-ordered care that must be administered by licensed professionals. This level of service is considered medically necessary and involves procedures that require the expertise of Registered Nurses (RNs), Licensed Practical Nurses (LPNs), or licensed therapists. Examples of skilled care include complex wound care, the administration of intravenous (IV) medications, daily injections, and intensive physical, occupational, or speech therapy that aims to restore function. The care delivered in an SNF is comparable to the level of nursing support a patient would receive in a hospital setting.
In contrast, the traditional function of a nursing home is to provide long-term custodial care, which focuses on assisting residents with Activities of Daily Living (ADLs). Custodial care includes help with bathing, dressing, eating, mobility, and personal hygiene, services that do not require the continuous involvement of licensed medical personnel. While a nursing home resident may have chronic medical conditions requiring medication management, the core level of care is non-medical and supportive.
A single physical building is often licensed to operate both an SNF unit and a long-term custodial care unit, sometimes referred to as a dually-certified facility. The SNF section is certified to deliver the higher level of medical care and rehabilitation, while the rest of the facility provides the long-term maintenance and residential services. This structure means the distinction is often a matter of the patient’s status and location within the building, rather than a difference between two separate buildings.
Duration of Stay and Patient Goals
The expected length of stay and the ultimate objective for the patient differ between the two care settings. Care in a Skilled Nursing Facility is short-term and rehabilitative, designed as a transitional step following an acute medical event or hospital stay. The goal is patient recovery, stabilization, and discharge back to a lower level of care, such as their own home or an assisted living facility.
The duration of a stay in an SNF is typically limited, often ranging from 20 to a maximum of 100 days per benefit period, depending on the patient’s progress and medical necessity. Coverage continues only as long as the patient requires daily skilled services and is actively progressing toward their recovery goals. If a patient’s condition plateaus, meaning they stop making progress in rehabilitation, the period of skilled coverage will cease, even if they have not reached the 100-day limit.
A traditional nursing home, conversely, is intended for long-term or permanent residence for individuals who cannot safely live independently due to chronic conditions or advanced age. The patient’s objective in this setting is maintenance, comfort, and safety, not rehabilitation and discharge. For these residents, the facility serves as their home, providing consistent supervision and assistance with daily living activities for an indefinite period.
How Payment Differs
The distinct funding mechanisms for each type of care represent the most significant difference for individuals and their families. Skilled Nursing Facility care is primarily funded by Medicare Part A because it is defined as short-term, medically necessary treatment following a hospital stay.
To qualify for Medicare coverage, the patient must have had a qualifying inpatient hospital stay of at least three consecutive days, not counting the discharge day. Furthermore, the patient must be admitted to a Medicare-certified SNF within 30 days of leaving the hospital, and a physician must certify that they require daily skilled nursing or rehabilitation services.
Medicare covers 100% of the cost for the first 20 days of a covered SNF stay after the qualifying hospital period. From day 21 through day 100, Medicare pays for all covered services except for a daily coinsurance amount, which the patient is responsible for.
Medicare does not cover long-term custodial care in a nursing home, regardless of how necessary the care is for the patient’s daily functioning. Payment for this long-term residential care must come from other sources, which are typically private pay, long-term care insurance, or Medicaid.
Medicaid is a joint federal and state program that covers long-term nursing home care for individuals who meet specific income and asset limits. Because long-term custodial care is not covered by Medicare, families relying on government assistance must often deplete their personal savings and assets to meet Medicaid’s strict financial eligibility requirements. This financial distinction is important, as the common misconception that Medicare will pay for a permanent nursing home stay often leaves families financially exposed. The financial planning required for a long-term nursing home stay is entirely different from the short-term, medical coverage provided by an SNF.