Skilled Nursing Facilities (often abbreviated to "SNF" and pronounced "sniffs") are live-in facilities that provide medical care and treatment that has been prescribed by a doctor. They are also known as convalescent homes or nursing homes.
SNFs provide services to patients who are recovering from surgery and who require short-term rehabilitation as well as to others who require long term medical supervision and nursing care. Some of these facilities also offer specialized care for Alzheimer's patients as well as short term respite care for disabled or frail individuals when a family member needs a break from providing home care.
Typically, SNFs provide around-the-clock nursing care, assistance with activities such as walking, eating, bathing and toilet use. They also usually include rehabilitation programs such as speech, occupational, and physical therapy. In addition, most provide activities and social services for residents.
Skilled nursing facilities are usually paid for by Medicare, Medicaid, Medigap, Long-Term Care Insurance (LTCI) policies or private funding. Medicare usually covers initial costs for a limited period of time. Once Medicare coverage has been exhausted, payment may be covered by Medigap insurance, LTCI policies, Medicaid, private payment or a combination of these resources.
Medicare coverage for skilled nursing facilities is limited to 100 days per spell of illness. The first 20 days are covered in full while the remaining 80 days are covered but require a daily co-payment. Currently, the co-payment amount is $141.50 per day. Please note that this rate is subject to change annually. Coverage is provided only so long as the patient needs daily skilled nursing care or speech, occupational or physical therapy on a daily basis.
Services covered include:
- Doctor's visits
- Doctors visits
- Skilled nursing care
- Prescription Drugs
- A semi-private room
- All meals, including any special diets that are required
- X-ray and lab services
- Speech, occupational and physical therapy
- Some medical equipment and supplies, including prosthetic devices
Medicare coverage in SNFs is subject to very strict limitations.
- The patient must have been in a hospital for three consecutive days, not including the day of discharge.
- They must be admitted to the SNF no later than 30 days after discharge from the hospital.
- SNF services must be directly related to the medical condition that was treated while in the hospital.
- The patient must need daily skilled nursing care or rehabilitation services.
- The Physician must specify that the patient requires daily skilled nursing care and that these services must be provided on an in-patient basis. The physician must re-certify the patient's needs at the 5th and 14th day following admission as well as every 30 days after that.
- Medicare must review the care plan and approve the continuing requirement for skilled nursing care. Please note that Medicare must also approve the length of stay. A full 100 days of care are not automatically approved.
After Medicare coverage expires, additional coverage through Medigap insurance, LTCI policies, or Medicaid may provide coverage for longer stays.