Skilled Nursing Facilities


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Skilled Nursing Defined

Skilled Nursing Facilities (SNF) may be freestanding, or part of a seniors community offering any or all of the following:

  • Congregate or Independent Living"

  • Assisted Living

  • A continuum of care.

  • The type of care that may be administered ONLY BY A NURSING HOME near you, is defined by state regulations. Generally "medical procedures" and assistive acts requiring a nurse to physically "handle" a patient are limited to nursing home providers, when not in a hospital. Changing bandages deep wounds is often only permitted in Nursing Homes as is turning a patient in bed, who cannot turn themselves.
    To learn where the line between a Nursing Home and Assisted Living is drawn in your state, see regulations in your state at seniorresource.com state resources. Also speak with the discharge planner at the hospital because they deal with the fine line between levels of care needed on a regular basis. They will know if a patient needs a Nursing Home, or can receive the care they require in Assisted Living.
    Both freestanding and senior multi-level campuses (those which offer different lifestyles and/or levels of care to meet resident's needs) with a nursing facility affiliated, generally accept residents for long term stays, as well as for short term recovery. Acceptance is based on availability, the nature of care needed, and ability to pay or their acceptance of Medicaid

    A Nursing Home may not accept an Alzheimer's patient, whose illness is too advanced for them to be safely accommodated in a an Assisted Living setting. If their behavior is disruptive to other nursing home patients, who do not have Alzheimer's, they may need to move into a specific Alzheimer's Nursing Home. The physical structure and layout of a home specific to Alzheimer's patients should better meet their needs, and staff training will better be able to deal with erratic or dangerous behavior.

    An Alzheimer's patient may be discharged post-surgery to a nursing home which accepts reimbursement from Medicare. As they recover and regain mobility they may exhibit inappropriate behavior for that nursing home. There may be no near-by nursing home that accepts Medicare reimbursement that is also prepared to accept and care for an Alzheimer's patient.

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    What to Look For In a Skilled Nursing Facility

    When difficult situations arise families may need to turn to social workers, case workers, hospital discharge planners, and yes, the internet to help them become educated about the options appropriate for their loved one. They may also need guidance to identify specific choices in their area. Unfortunately, choices for selecting a nursing home are often made in haste and under stressful situations.
    Don't just accept the recommendation of a professional. They may mean well and understand the level of care needed, but do not know your family, or your family member. They will know which homes will take Medicare, Medicaid, and which ones only take private pay patients. But must be comfortable with the care that will be, or is being provided for your loved one. So plan to do some of your own Nursing Home shopping. Ask around. Plan to visit and see how different homes "feel", "smell" and look for those who have happier residents. Follow the guidelines below to help you shop. Try to start shopping as soon as it seems you may need to place a loved one in a nursing home. That way you will be less stressed when you have to make the decision. If you make it in haste, it is possible to have to remake the decision later and relocate a loved one. If the first placement is hard, the second one is harder!

    There is no substitue for visiting the home in person!

    Federal regulations require any long-term care home or facility to provide 30 days written notice and an appropriate discharge plan if they determine a patient is inapporpriate to remain with them. They may not just tell you verbally "you have to relocate a loved one"!

    Skilled Nursing Facility Checklist

    Skilled Nursing Facility Checklist

    Basic Information
    A bed is available
    The Skilled Nursing Facility is Medicaid-certified.
    Non Medicare patients allowed
    The SNF provides the skilled care you need, and a bed is available.
    The SNF has special services if needed in a separate unit (like dementia, ventilator, or rehabilitation).
    Good reputation in the surrounding community
    The SNF is located close enough for friends and family to visit.
    The surrounding community is inviting and safe.
    Resident Appearance
    Residents are clean, appropriately dressed for the season or time of day, and well groomed.
    Living Spaces
    The SNF is free from overwhelming unpleasant odors.
    The SNF appears clean and well kept.
    The decor pleasing and warm
    The temperature in the SNF is comfortable for residents.
    The Skilled Nursing Facility has good lighting.
    Noise levels in the dining room and other common areas are comfortable.
    Smoking isn't allowed or may be restricted to certain areas of the SNF.
    Furnishings are sturdy, yet comfortable and attractive.
    The relationship between the staff and the residents appears to be warm, polite, and respectful.
    All staff wear name tags.
    Staff knock on the door before entering a resident's room and refer to residents by name.
    The SNF offers a training and continuing education program for all staff.
    The SNF does background checks on all staff.
    The guide on your tour knows the residents by name and is recognized by them.
    There's a full-time Registered Nurse (RN) in the SNF at all times, other than the Administrator of Director of Nursing.
    The same team of nurses and Certified Nursing Assistants (CNAs) work with the same resident 4 to 5 days per week.
    CNAs work with a reasonable number of residents.
    CNAs are involved in care planning meetings.
    There's a full-time social worker on staff.
    There's a licensed doctor on staff. Is he or she there daily? Can he or she be reached at all times?
    The SNF's management team has worked together for at least one year.
    Residents' Rooms
    Residents may have personal belongings and/or furniture in their rooms.
    Electric beds available.
    All rooms have private bathrooms?
    Each resident has personal storage space (closet and drawers) in his or her room.
    Each resident has a window in his or her bedroom.
    Residents have access to a personal phone and television.
    Residents have a choice of roommates.
    Water pitchers can be reached by residents.
    There are policies and procedures to protect residents' possessions.
    Hallways, stairs, lounges, & bathrooms
    Exits are clearly marked.
    There are quiet areas where residents can visit with friends and family.
    The SNF has smoke detectors and sprinklers.
    All common areas, resident rooms, and doorways are designed for wheelchair use.
    There are handrails in the hallways and grab bars in the bathroom.
    Menus & Food
    Residents have a choice of food items at each meal. (Ask if your favorite foods are served.)
    Nutritious snacks are available upon request.
    Kitchen clean and orderly
    Does a registered dietician, or professional service, plan meals
    Staff help residents eat and drink at mealtimes if help is needed.
    Residents, including those who are unable to leave their rooms, may choose to take part in a variety of activities.
    Religious services, or transportation to churches offered
    The SNF has outdoor areas for resident use and staff help residents go outside.
    Are there special outings
    The SNF has an active volunteer program.
    Safety & Care
    The SNF has an emergency evacuation plan and holds regular fire drills.
    Residents get preventive care, like a yearly flu shot, to help keep them healthy.
    Residents may still see their regular doctors.
    The SNF has an arrangement with a nearby hospital for emergencies.
    Care plan meetings are help with residents and family members at times that are convenient whenever possible.
    Provide in-house physical therapy
    The SNF has corrected all deficiencies (failure to meet one or more Federal or state requirements) on its last state inspection report.

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    Your rights in a Skilled Nursing Facility

    Federal law specifies that SNF residents have these rights:

  • Freedom from discrimination

  • To be treated with dignity and respect

  • Freedom from abuse & neglect

  • Freedom from restraints

  • Informed of services & fees

  • To manage your own money

  • Personal Privacy

  • Property protection

  • Choice of living arrangements

  • Medical care information and choice of doctor

  • Private Visitors

  • Medically related Social services

  • Make a complaint

  • Protection against unfair transfer or discharge

  • Additional Skilled Nursing Facility Resources

    Additional Nursing Home Resources

    Is your medical information

    available to your caregiver??

  • A Personal Health Record for Caregivers

  • Keep track of all your medications and allergies

  • Carry your legal directives such as DNR, living will with you!

  • Attach your x-rays, test results and more!

  • Keep track of all your insurance claims in one place

  • Here is how you can make it happen!

    Other Resources

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    Find Skilled Nursing in Your State

    Medicare - Skilled Nursing Facility

    Medicare - Skilled Nursing Facility

    People with Medicare are covered if they meet all of these conditions:

  • You have Part A and have days left in your .

  • You have a qualifying hospital stay.  

  • Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff. If you're in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they're offered.

  • You get these skilled services in a SNF that's certified by Medicare.

  • You need these skilled services for a medical condition that was either:

    • - A hospital-related medical condition.

    • - A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition.

    Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you're getting observation services in the hospital, you're considered an outpatient—you can't count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay

    Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.
    Medicare-covered services include, but aren't limited to:

  • Semi-private room (a room you share with other patients)

  • Meals

  • Skilled nursing care

  • Physical and occupational therapy*

  • Speech-language pathology services*

  • Medical social services

  • Medications

  • Medical supplies and equipment used in the facility

  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF

  • Dietary counseling

  • *Medicare covers these services if they're needed to meet your health goal.