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Nursing Home vs Skilled Nursing

There’s a big difference between the help you need with bathing, eating and dressing compared with 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, and some residents are more independent than others. You can usually live in a nursing home even if you must get frequent medical care, for example, twice-weekly dialysis. This is because you are physically able to travel to your appointments as long as you have transportation. In many cases, family members help with this transportation. Otherwise, you may have to arrange third-party services, and they might incur out-of-pocket costs. The personnel at nursing homes provide meals, do your laundry, clean your rooms, dispense your medications and lead activities such as exercise classes, crafts and scenic tours outside of the nursing home.

Nurses’ aides provide much of the care. There might be a doctor on staff, but you generally shouldn’t expect this. Federal law does generally require that a registered nurse be present in Medicare and Medicaid-certified nursing homes at least eight hours straight a day, seven days a week, and that there be a licensed nurse, who can be an RN or LPN, present 24 hours a day. You can pay for nursing home care out-of-pocket, but it gets expensive. Many people either do estate planning 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.

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 in SNFs. In fact, doctors, nurse practitioners, registered nurses and other medical personnel, such as physical therapists and speech therapists, can be common sights in SNFs. In a nursing home, you might never see a doctor step inside.

You usually go to an SNF after a hospital stay, and you could be a better fit for an SNF versus a nursing home 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

The personnel at SNFs can help with daily living tasks such as feeding, using the bathroom and getting dressed like they would at a nursing home. Often, the folks who enter an SNF are there for the short term. They go home, to assisted living or to a nursing home when they recover. That said, some people in SNFs do have chronic or terminal conditions and stay for the long term.

If you’re in an SNF for the short term, up to 20 days, your costs should be under control and largely or entirely paid for by Medicare. However, in the long term, SNFs can get expensive. Even for short-term stays, you must meet a host of criteria. For example, Medicare helps pay only when you have Part A, a qualifying hospital stay and time left on your benefit period, and there are other requirements to meet.

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. If you are housebound, usually meaning severe mobility issues, that is different. In such cases, insurance and government programs are more likely to cover your costs.

As for daily living tasks, such as cooking, bathing and cleaning, someone such as a caregiver or nurse’s aide would do them, and they are separate from skilled nursing services.

Comparisons

You probably have a good idea by now of the similarities and differences among nursing homes, SNFs and in-home skilled nursing. Here’s a chart to illustrate the comparisons we’ve touched on.

 

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 and deep 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, can share a room with spouse if both want to Single rooms, can share a room with spouse if both want to. 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 arrange separately
Pets No No Yes, if having pets isn’t risky
Entertainment and Activities Yes Yes No but can arrange separately
Meals Yes Yes No but can arrange separately
Medicare/ Medicaid Yes, if assets meet criteria Must meet medical admissions criteria. Fairly robust short-term coverage, possibly even $0 for 20 days. Co-insurance for days 20-100. After day 100, typically no coverage. Insurance may be able to help Typically no, but there are exceptions such as if you’re housebound and 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 helps you make the decision as to whether you will be okay in a nursing home or if you have medical needs for skilled nursing care. We have an extensive directory of nursing homes and SNF providers. Look through the options, and feel free to call today.

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Scott founded Select Home Care Portland in 2009 and has been helping seniors live their best life at home or in their local senior community ever since. As an advocate for seniors, the primary philosophy has been to listen, educate and provide… Learn More About Scott Witt

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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