Guide to Choosing a Skilled Nursing Facility

by Preeya D'Mello

What is Post-Acute Care

Post-acute care is all the health-related services that patients receive after, or in some cases instead of, care at the doctor’s office or hospital.

Types of Post-Acute Care

Home Health Care – agencies that send medical professionals to patients’ homes so patients can receive skilled nursing and rehabilitation without going to a hospital or residential facility. Common services provided through home health care are wound care, physical therapy, and injections.
Skilled Nursing Facilities – short-term residential healthcare locations for patients who no longer need to be in a hospital but require a higher level of medical care than can be provided at home. Common services provided at a skilled nursing facility include physical/occupational rehabilitation, speech and language therapy, and complex wound care.
In-Patient Rehabilitation Facilities – residential healthcare locations that provide intensive hospital-level care for patients with complex conditions such as spinal cord diseases or traumatic brain injuries. Common services provided through inpatient rehabilitation facilities include physical therapy and stroke rehabilitation.
Long Term Care Hospitals – long-term residential locations that offer the same level of round-the-clock care as traditional hospitals or intensive care units, but over a longer period of time (usually a month). Common services provided at long term care hospitals include ventilator care, intravenous (IV) therapy, and dialysis.

More Details About Skilled Nursing Facilities

A skilled nursing facility (SNF) is a temporary residential facility that offers around the clock high level medical care and rehabilitation. SNFs provide long-term or short-term assistance to help patients regain independence and return to their home or an assisted living center following an injury or hospital stay.

Short-Term Care

Wound care
Stroke recovery
Physical/occupational therapy
Post-hospital/post-surgery care
Speech-language pathology services

Long-Term Care

Custodial care
Terminal illness care (hospice)
Diabetes management
Catheter and colostomy care
Medication administration
(needle, IV) and blood transfusions
Durable medical equipment
(walker, wheelchair, oxygen equip.)

How to Start Your Skilled Nursing Facility Search and What To Look For

Understand Your Medical Needs
- Meet with a medical professional to make sure that a skilled nursing facility is the best follow up care option for you or your loved one.
- A skilled nursing facility is the best fit for patients requiring long-term or short-term intensive medical care or 24/7 assistance.
- If the patient does not have any significant medical needs and instead requires custodial care, an assisted living facility or non-medical home healthcare may be more appropriate.
- If the patient has a specific medical need (diabetes, chronic disease, wound care, etc.), you can narrow down your search by evaluating SNFs based on what specialty care they can provide.
Verify Your Insurance Coverage
- Using repisodic, you can search SNFs in your insurance network by geographic region and compare the facilities based on photos, patient reviews, and Medicare quality data.
- The insurance verification is simple to complete and does not require any sensitive personal information.
Compare Facilities Based on Quality Measures
- Different qualities to compare are how many of the residents at a given facility showed marked improvements during their stay, how many were re-hospitalized, how many had a fall that resulted in a major injury, and how many were successfully discharged.
- repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.
Visit the Locations (if possible)
- Talk to current employees and residents about their experience. Evaluate the facility’s cleanliness, entertainment options, and medical condition specialization.
- Ask the staff members how different situations are handled and how the patient will fit in at this location. Below is a checklist of common and important questions to ask when visiting a SNF.

Things to Consider when Visiting a Skilled Nursing Facility

Basic Information
- Medicare/Medicaid certification
- Provides necessary skilled care, special services, and has an available bed
- Visiting hours
- Residents are clean and appropriately dressed
Living Spaces
- No unpleasant odors
- Facilities are clean and well kept
- Noise levels
- Smoking is prohibited or restricted to certain areas
- Facility is well furnished
- Temperature is comfortable and there is good lighting
Staff
- Good relationships with residents
- Staff members knock on doors before entering
- Background checks
- Full-time registered nurse (RN) available at all times
- Rotations of nurses and staff members working with a given resident
- Reasonable ratio of staff members to patients
- Certified nursing assistants (CNAs) are involved with care planning meetings
- How often is a licensed doctor available
- How long has the management team worked together
Residents’ Rooms
- Residents may have personal belongings
- Personal storage space
- Adequate windows and natural light
- Access to personal phone and television
- Roommate selection
- Protection of personal possessions
Common Spaces
- Exits are clearly marked
- Visiting areas are quiet and well kept
- Appropriate safety features (emergency evacuation plan, smoke detectors, sprinklers, etc.)
- All areas are wheelchair accessible
- Handrails and grab bars
Dining and Activities
- Choice of foods
- Nutritious snacks
- Assistance in eating
- Variety of activities offered
- Outdoor areas for residents to use
- Volunteer programs
Safety and Care
- Preventative care (flu shots, etc.)
- Residents may see their regular doctors
- Coordination with local hospitals in case of emergencies
- Care planning meetings are scheduled with residents and family members
- Facility has corrected all deficiencies from last state inspection

Paying for Skilled Nursing Care

When selecting a SNF, it’s important to consider your payment options and understand what your insurance policy will and will not cover. There are three main types of insurance policies that provide varying degrees of coverage with regards to skilled nursing facilities.

Medicare

Medicare Part A will pay for up to 100 days of skilled nursing care in a licensed skilled nursing facility as long as the patient had a qualifying 3-day inpatient hospital stay and the skilled services provided are related to that hospitalization. The specific number of days that Medicare Part A will cover in a skilled nursing facility is primarily determined by the patient’s attending physician.
If a patient qualifies for Medicare Part A skilled nursing coverage, then Medicare covers all costs for the skilled nursing facility stay for the first 20 days. Starting on the 21st day of a skilled nursing stay, the patient is responsible for a co-payment for the remainder of the stay, up to 100 days.
Although a co-payment is necessary for stays extended to 21 or more days, many commercial insurance Medicare Supplemental policies (also known as “Medigap” policies) will usually cover some or all of the co-payment costs. If a patient does not have such co-payment coverage but qualifies for Medicaid, then Medicaid may pay for the co-payment. If an individual does not have insurance or Medicaid coverage for the co-payment, they will be directly responsible for the co-payment.

Medicare Advantage

Patients who are covered under a Medicare Advantage Plan instead of the traditional Medicare plan will have policies and coverage very similar to the Medicare coverage policies described above.

Private, Commercial, and Employer Sponsored Insurance

These plans vary widely in their coverage and policies for skilled nursing facilities. The majority of plans typically provide some sort of coverage for short stays in post-acute care/skilled nursing facilities if the services are necessary following a hospital stay.
Private insurance companies will usually only pay for skilled nursing services for providers that are considered “in-network.” Some policies will cover services from providers that are “out-of-network,” but they usually do not cover as much of the cost and can leave patients with additional out-of-pocket costs. For this reason, it is imperative that patients verify if a skilled nursing facility is part of their insurance network.

Remember, health insurance payment options and programs that cover skilled nursing facility services are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for. repisodic encourages all patients to consult with their insurance company or administrator for final determination of what post-acute care or skilled nursing services their policy covers.

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