We hear so often from families that their loved ones are in a hospital setting after experiencing a fall or decline in health and will require rehabilitation in a Skilled Nursing Facility (SNF).
Did you know the terms Nursing Home and Skilled Nursing Facility are not the same?
The goal of a SNF is for a person to receive skilled care such as physical therapy, occupational therapy, and speech therapy to gain strength and return to their desired living setting safely and independently. Skilled care also consists of managing, treating, observing, and evaluating a person’s care. Professionals providing skilled care are Physical and Occupational Therapists, Registered Nurses, and Speech Language Pathologists. The average length of a short-term rehabilitation stay is approximately 30 days.
The primary difference between Nursing Homes and Skilled Nursing Facilities are the required medical attention and the length of stay.
• Nursing Homes are more of a permanent living setting for people in need of 24/7 care.
• Skilled Nursing Facilities are a temporary residence for patients undergoing medically-needed rehabilitation.
When your loved one is admitted to a SNF, be sure to connect with the social worker of the facility to help with coordination their care and services during their stay. The social worker or business office manager can also assist with billing, insurance, and appeal questions.
My loved one has Medicare coverage only; will this pay for their SNF stay?
• Medicare can cover an SNF under Part A skilled care. There are many requirements and not all SNFs and Nursing Homes are covered by Medicare because specific criteria must be met.
• There are additional benefits for Medicare called Medicare Supplement Plans that may also offer SNF benefit. You or your loved one will want to check with their individual insurance plan to inquire if it meets SNF coverage criteria.
Medicare Part A has specific criteria that must be met for coverage.
1. Medicare-Certified Facility: Care must be provided in a Medicare-Certified SNF and you will want to ask this upon admission.
2. Three-Day Prior Hospitalization: Prior to admitting into SNF, resident must have a hospitalization as inpatient (not observation) for at least 3 consecutive days, not counting discharge date. Be sure to check status with the Hospital Discharge Planner and Case Manager on that unit.
3. Admit to SNF within 30 days of discharge from the hospital.
What happens when my loved one is admitted to SNF for short-term rehabilitation and SNF staff inform the resident their skilled nursing and therapy benefit is ending?
1. Patients are informed they have “plateaued” with their therapy and no longer meet criteria for skilled care.
2. They are informed by staff that Medicare is ending due to no longer being eligible for Medicare benefits and they will have to start paying out of pocket per day.
Medicare issues a notice, which SNF social worker staff provides to the resident. This is called a Notice of Non-Coverage. If you have been informed your loved one’s Medicare coverage is ending in the SNF, you may connect with ADRC of Brown County and speak to a specialist to discuss your options.
ADRC of Brown County has a “No Wrong Door” approach and referrals can be directly from the facility staff, residents, or loved ones. We look forward to talking with you and hearing your story to provide you the best options to meet you and your loved one’s needs. Give us a call at (920) 448-4300.
