Nursing Home vs Skilled Nursing Facility: An In-Depth Comparison
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There’s a big difference between the help you need with bathing, eating, and dressing, and the help you need recovering from a stroke. Nursing homes are where people usually go when they require high levels of assistance with non-medical, everyday living tasks. On the other hand, skilled nursing is what people may receive when they require medical care in cases such as recovering from a stroke.
However, spend just a bit of time researching nursing homes, and you’ll see many times that they’re referred to as skilled nursing facilities, or SNFs for short. Often, this term is misleading. To further complicate the issue, you may have also read about skilled nursing at home. Here’s an in-depth explanation that hopefully clarifies the issue.
Nursing Homes: Daily Non-Medical Care
Nursing homes provide their residents with daily care, but some residents are more independent than others. You can usually live in a nursing home even if you require frequent medical care — such as dialysis twice a week — because you are physically able to travel to your appointments as long as you have transportation.
Did You Know? According to the CDC, there are more than 15,600 nursing homes with over 1.7 million licensed beds in the United States.1
In many cases, family members help with transportation. Otherwise, you may have to arrange third-party services and incur out-of-pocket costs. Nursing-home personnel provide meals, do your laundry, clean your room, dispense your medication, and lead activities such as exercise classes, crafts, and scenic tours outside the nursing home.
Nurses’ aides provide much of the care at nursing homes. There may be a doctor on staff, but you generally shouldn’t expect it. Federal law requires that a registered nurse be present in Medicare- and Medicaid-certified nursing homes at least eight straight hours a day, seven days a week. It also requires a licensed nurse — who can be an RN or LPN — to be present 24 hours a day.
Pro Tip: Need help finding a nursing home that accepts Medicare or Medicaid? Check out CMS.gov to learn about Medicare-approved nursing homes in your area.
The cost of nursing home care can get expensive. You can pay for it out of pocket, but many people either put together an estate plan at least five years before they think they’ll have to enter a nursing home or spend down their assets to pay for the care until they are eligible for Medicaid.
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Skilled Nursing Facilities: Daily Medical Care as Needed
One major difference between nursing homes and SNFs is the range and depth of medical services available. Doctors, nurse practitioners, registered nurses, and other medical personnel, such as physical therapists and speech therapists, are commonly seen at SNFs. In a nursing home, you may never see a doctor in the building.
You usually go to an SNF after a hospital stay, and you could be a better fit for one if you need help with a medical issue such as:
- Stroke recovery
- Wound care
- Rehab after an illness or operation
- Terminal illness
- Serious memory issues
- Around-the-clock care
SNF personnel can help with daily living tasks such as feeding, using the bathroom, and getting dressed, just like they would at a nursing home. The folks who enter an SNF are often there for a short time. They go home or to assisted living or a nursing home when they recover. Some people in SNFs have chronic or terminal conditions, however, and stay for the long term.
If you’re in an SNF for up to 20 days, your costs should be under control and largely or entirely paid for by Medicare. They can get expensive, however, if you need long-term care. Even for short-term stays, you must meet a host of criteria. Medicare, for example, offers coverage only when you have Medicare Part A, a qualifying hospital stay, and time left on your benefit period. There are other Medicare requirements for an SNF stay as well.
In-Home Skilled Nursing: Necessary Medical Care at Home
It’s also possible to receive skilled nursing care right in your own home. For example, someone such as a registered nurse may visit you daily, or you might receive physical therapy or speech therapy at home. In-home skilled nursing care providers help with:
- IVs such as those for chemo
- Occupational, physical, and speech therapy
- Catheters
- Line dressing changes
- Feeding tubes and other forms of nutrition
- Mediports
- Wound care
- Blood draws and injections
- Health monitoring
- Training of family members to perform some procedures
The list above is not comprehensive, and the services offered vary, depending on agency and locality. If you require intermittent or even frequent care as ordered by a doctor, you are usually expected to go out to receive the care. This expectation is different if you are housebound, usually meaning you have severe mobility issues. In such cases, insurance and government programs are more likely to cover your costs.
A caregiver or nurse’s aide would help with daily living tasks such as cooking, bathing, and cleaning, and the tasks are separate from skilled nursing services.
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Skilled Nursing Facility vs. Nursing Home vs. In-Home Skilled Nursing
The chart below illustrates the comparisons we’ve touched on to make it easier to compare and contrast your options.
| Nursing home | Skilled nursing facility | In-home skilled nursing | |
|---|---|---|---|
| Medical care | Very limited, includes dispensation of medication; residents should be able to access medical services off-site when needed | Options can be varied at many SNFs | Many types of medical care usually available |
| Mobility assistance | Much assistance available to help residents get around | Much assistance available to help residents get around | Not typically available unless part of the medical condition; would often need to be provided separately |
| Privacy | Single rooms, but can share a room with a spouse if desired | Single rooms, but can share a room with a spouse if desired; if Medicare is paying, you may have to share a semiprivate room with another resident | You have more control over your privacy since you’re at home |
| Housekeeping | Yes | Yes | No, but can be arranged separately |
| Pets | No | No | Yes, if having pets isn’t risky |
| Entertainment and activities | Yes | Yes | No, but can be arranged separately |
| Meals | Yes | Yes | No, but can be arranged separately |
| Medicaid/Medicare | Yes, if assets meet the criteria | Must meet medical admissions criteria; fairly robust short-term coverage, possibly even $0 for 20 days; co-insurance for days 20 to 100; after day 100, typically no coverage; insurance may be able to help | Typically no, but there are exceptions such as if you’re housebound or if a doctor prescribed the services |
| Time period | Usually long-term | Can be either short-term or long-term | Can be either short-term or long-term |
Which Option Fits Your Needs Best?
In many cases, a doctor can help you make the decision between a nursing home and a skilled nursing facility. To help you find the best option, SeniorLiving.org offers an extensive directory of nursing homes and SNF providers. Be sure to look through the options, and feel free to call today.
CDC. (2023). Nursing Home Care.
