Understanding the difference between Long Term Care (LTC) and Skilled Nursing Care (SNC) is complicated because both often happen in the same building, typically called a nursing home. While these settings may look similar, the services provided, the reason for the stay, and the payment structure are fundamentally distinct. The primary distinction lies in the medical intensity of the care required, which dictates the duration and financial responsibility. Navigating these two types of care requires a clear understanding of their specific purposes.
Defining Skilled Nursing Care
Skilled Nursing Care requires daily medical services that can only be provided by or under the direct supervision of licensed medical professionals. This care is medically necessary and must be ordered by a physician. It is a high-level service environment focused on clinical intervention and rehabilitation.
The staff includes highly trained and licensed personnel, such as Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and specialized therapists. Examples of specialized services include intravenous (IV) medication administration, complex wound care, ventilator management, and intensive post-acute rehabilitation following a stroke or major surgery. Facilities providing this service must have a licensed nurse on duty 24 hours a day to meet the continuous need for medical oversight.
Defining Long Term Care
Long Term Care is primarily supportive or custodial care that assists individuals with the routine needs of daily living. This care is for people with chronic conditions or disabilities who require ongoing, non-medical help with personal tasks, focusing on maintaining their current level of function.
The core services revolve around assistance with Activities of Daily Living (ADLs), such as bathing, dressing, toileting, eating, and mobility. While nurses may be present for general health monitoring, Certified Nursing Assistants (CNAs) or aides provide the bulk of this assistance. Long Term Care can occur in various settings, including assisted living facilities, residential care homes, or institutional nursing homes.
Duration and Goal of Stay
The intended duration and ultimate goal are the clearest operational differences between these two care types. Skilled nursing is designed to be a temporary measure following a serious medical event, with the goal of maximum recovery and rehabilitation.
Stays in a Skilled Nursing Facility are typically short-term, often lasting from a few days up to a couple of months. The care is a bridge to help the patient transition from a hospital to their home or a lower level of care. Conversely, Long Term Care is for maintenance, stabilization, and permanent or extended residency. Stays are indefinite and can span many years, as the goal is to provide a safe, supportive environment for individuals with chronic needs.
Funding Sources and Payer Differences
The financing of care is one of the most confusing aspects for the public, largely because the government programs that cover each type of service are completely different. For Skilled Nursing Care, Medicare Part A is the primary payer for qualified short-term stays. Coverage requires the individual to meet strict criteria, including a prior qualifying inpatient hospital stay of at least three consecutive days, and the patient must continue to require daily skilled services. Medicare coverage is limited to a maximum of 100 days per benefit period. Private insurance plans also frequently cover short-term post-acute care and rehabilitation.
For Long Term Care, the financial picture changes significantly because Medicare explicitly does not cover custodial care. The primary financial burden for long-term custodial care falls to the individual and their family, often through private funds, sometimes referred to as “private pay.” Alternatively, individuals may use benefits from a private long-term care insurance policy. For those who meet strict financial and medical requirements, Medicaid becomes the largest public payer for long-term nursing home residency.