What is a Skilled Nursing Facility?
A Skilled Nursing Facility (SNF) is a nursing home certified to participate in, and be reimbursed by Medicare and/or Medicaid.
States license nursing homes, making them subject to the State's laws and regulations. And they are also subject to federal laws and regulations because of their participation in Medicare and/or Medicaid.
Patients and residents in skilled care are there for a reason. Their medical and mental condition requires it. While nursing homes used to be thought of as one-way trips, more and more they are being used for the rehabilitation of hospital patients, for example, knee and hip replacement patients.
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants (CNA). Federal requirements mandate that a Registered Nurse (RN) be on site sight eight consecutive hours, seven days a week. A Licensed Nurse (LN) is required for the two remaining shifts, seven days a week. A full time director of nursing and a licensed nursing home administrator are other positions found in SNFs.
Who Pays?
- Medicare covers nursing home services for 20 to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. A physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis.
- Rehabilitation services for younger patients/residents, for example boomers not eligible for Medicare, may be paid by private insurance if they have it.
- Once Medicare eligibility expires or if a person enters a facility without a prior hospitalization, the following scenario is typical.
The resident pays out of pocket.
The resident without long-term care insurance qualifies for Medicaid, which then pays for care.
The resident has long-term care insurance that covers some or all of costs.
This is very much a simplified version as financing skilled care can be a maze that takes skill to navigate.
State surveyors inspect nursing homes for compliance with licensure (State regulations) and/or certification (Medicare and Medicaid regulations). Inspections vary widely by state depending on resources and individual state requirements.
The "Mininimum Data Set" assessment (MDS), now MDS 3.0, is a federally mandated process for comprehensive assessment of all residents in Medicare or Medicaid certified nursing homes. The MDS assessment is a screening assessment that forms the basis of a comprehensive assessment of each resident's functional capabilities and helps nursing home staff build a plan of care for residents. The MDS also yields "Resource Utilization Groups" (RUGS) which are used for all Medicare reimbursement to SNFs, and is used in many States as well.
The Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics. It is called Nursing Home Compare. They also publish a list of Special Focus Facilities - nursing homes with a history of serious quality issues.
