By Sylvana Rinehart, Certified Concierge Care Advisor
We have been hearing or reading a lot about Nursing homes over the past six months due to them being the first locations with Covid-19 outbreaks, as well as having several prominent facilities close down. I chose to write this article to help clarify some key points regarding long-term care facilities and the difference between Skilled Nursing Homes and Nursing Homes, forms of coverage, and general misperceptions surrounding that type of care. For starters, there is often a challenge because the terms are used interchangeably. Clarity in the beginning is key. Many clients will start by telling me that the only option for their loved is to go into a nursing home. Once we start talking and digging deeper, I gain a better understanding of the care needs as well as the psychosocial needs, and assets. Together we are then able to clarify what they had in mind by a “Nursing Home” and work towards a workable course of action.
What do we mean when we use the term Long-Term Care Facility? Long-Term Care Facilities are basically divided into two categories based on the amount of time and care required for each resident. The two are Skilled Nursing Facility (SNF) and Nursing Home Care. Let’s first look at care.
A Skilled Nursing facility provides medical assistance, meal preparation, as well as specialized staff such as rehabilitation specialists, speech-language pathologists, and audiologists. Skilled Nursing care is usually provided for rehabilitation of patients who do not require Long-Term Care services. The key word here is rehabilitation for a specific need. That is why they are also referred to as Post-Acute Care or Rehabilitation Care that is usually provided following a hospital stay. They are a source of transitional care between a hospital, and a prior level of care, like one’s home or Assisted Living. Consider an elderly woman who falls and breaks a hip, then goes to the hospital for hip surgery to reset the bones. She is then discharged to a Skilled Nursing Center for a short recovery stay before going back to her prior living arrangement. Their main focus is to get her mobility back with Physical and Occupational Therapy.
Nursing Home care is similar in that residents receive care with the presence of Certified Nurses, meal preparation, and non-medical assistance like bathing; however, they do not have Physical Therapists and other professionals found in Skilled Nursing (SNF). They have medical oversight and a Director of Nursing who is a Registered Nurse. These facilities then provide a more permanent type of care and is often referred to as Custodial Care for the elderly.
Are there differences In Coverage? There are important differences in medical coverage between these two care options that often lead to confusion. Outside of private pay and insurance programs there are two main sources of payment sources for Long-Term Care: They are Medicare and Medicaid. For seniors, SNF’s are mostly paid for by Medicare and one’s secondary insurance. Continuing the example of our elderly lady above, with a three-night stay in the hospital for her hip surgery, after a Medicare Review she becomes eligible for Medicare which will cover her room & board, therapy, and medications at a Skilled Nursing.
Nursing Homes are generally covered by Medicaid, which is when one has outlived his or her resources. As mentioned above, a patient can get care, room and board in a Nursing Home but has to qualify to be able to live in one. To make things a little more complicated for us all, we sometimes have Skilled Nursing and Nursing Homes under the same roof – separated by a floor or a wing. You might have heard of or read about “low Medicare reimbursement” meaning that the state makes it difficult for these facilities to get paid for the care they provide. In order to offset their expenses, they tend to reduce their Long-Term Care beds. Some Skilled and Nursing Homes have reduced their Medicaid beds, making it hard for our indigent population in need of care. Luckily, in Washington, we have Adult Family Homes who will take Medicaid and provide high levels of care.
How to choose a Skilled Nursing? When faced with choosing SNF for a loved one, there are several important questions to ask:
- How many days of therapy do they provide? It should be a minimum of five or more days.
- Do they have a nursing home section that takes Medicaid?
- Does the Skilled nursing take Medicaid? This is only for those who think they might need to go on Medicaid after having had therapy.
- Do they have private rooms?
- Look at www.Medicare.gov site which will provide a lot of information.
Your role: No matter how good the facility is, each patient should have an advocate that remains involved and concerned. During COVID-19 times, it can be stressful for the patient because they might not be able to be with their loved ones in the rooms. They still must meet separated by a transparent barrier, like a window or a glass door. Staff, in addition to their regular duties, have to be attentive to State regulations to prevent outbreaks and everything takes more time and effort to accomplish. It will be up to you to make sure that they know about your loved one’s needs if they fall outside of the realm of the main reason for the rehabilitation. Let’s take our dear elderly lady who is in Skilled Nursing to learn to walk again with her new hip. Family suddenly finds out that she is having some issues with depression and signs of cognitive decline she did not previously exhibit. If the Power of Attorney doesn’t insist on speaking with the nurse and the attending physician, the situation could deteriorate because their focus lies on the hip rehabilitation.
As can often be the case, we may get confused by new terms and industry changes. The key is asking questions and seeking clarity from professionals. We at Concierge Care Advisors are here to help you navigate these and many more issues surrounding senior care.