A skilled nursing facility gives an individual access to round-the-clock, specialized healthcare along with assistance and activities for daily living. These facilities have trained medical professionals to provide in-patient treatment and rehabilitation. A financial advisor could help you create a financial plan for your healthcare goals and needs. Here’s a breakdown of services, costs and insurance.
What Is a Skilled Nursing Facility?
A skilled nursing facility provides high-level, professional medical services by skilled workers like doctors, registered nurses, speech therapists, occupational therapists and physical therapists. A long-term care facility, like a nursing home and a skilled learning facility, are not the same classification of healthcare facility. They may have overlapping services, but they serve two different purposes in the healthcare industry. The residents of a skilled nursing facility may be short-term or long-term and they are at the facility due to an illness or an injury for which they need rehabilitation. Usually, they are short-term residents.
Nursing homes or long-term care facilities are often used for patients who live there because they have become elderly and unable to care for themselves. Often, they have no family or they have a family too far away. Their family also may be unable to care for them. The employees are usually not skilled at a nursing home. They may consist of one registered nurse for eight hours per day plus a plethora of nurses aides. The residents are usually long-term.
What Services Does a Skilled Nursing Facility Offer?
You are usually transferred from a hospital stay for illness or injury to a skilled nursing facility. A common misconception is that skilled nursing facilities are just for the elderly. That is not the case. There are many patients who are not elderly but have been involved in a serious accident, have a wound that needs to be cared for or many other health conditions. Services include assistance in further recovering from accidents or illnesses such as:
- Stroke rehabilitation
- Rehabilitation after automobile accidents
- Cardiac rehabilitation
- Pulmonary and respiratory therapy
- Occupational therapy
- Speech therapy
- Wound care
- IV infusions
- Prosthetics
- Terminal illness care
Patients usually come to a skilled nursing facility from:
- Stays in the hospital due to surgery for which they need extended care
- Hospital stays for injury from car accidents
- Hospital or home because they need specialized medicines that can’t be provided at home
- Hospital stays for traumatic brain injury
What Does Skilled Nursing Care Cost?
If you or a loved one have to enter a skilled nursing facility, it is important to understand the costs of skilled nursing and how you can pay for it. If you look at the median costs of skilled nursing, you will find a rather wide range in costs. Texas has the lowest cost of skilled nursing in the U.S. at $4,950 per month for a semi-private room. The highest median cost in the U.S. is Alaska at $36,900 per month with the same accommodations.
You may have a short-term need for skilled nursing. About 25% of skilled nursing patients are there for three months or less. You may have a longer need for skilled nursing or even a lifetime need depending on your medical condition. Around 30% of skilled nursing patients have some sort of long-term need. Since most people have a medium to a long-term need for skilled nursing, the next thing to do is look at how they can pay the bill. Skilled nursing may cost more than either a nursing home or an assisted living facility because if you are in skilled nursing, you have a great need for certain types of specialized care.
Taking an average of costs across all 50 states, a skilled nursing facility will cost about $275 per day, $7650 per month and $93,075 per year, assuming you stay in a private room.
Three Ways to Pay for Skilled Nursing Care
Sometimes, the terms “skilled nursing facility” and “nursing home” are used interchangeably. They should not be. They are two separate types of facilities each with a different purpose. Coverage of the costs of the two types of facilities is also different.
Medicare. A patient goes to a skilled nursing facility, usually after a hospital stay, if they are not quite ready to go home because they have some lingering healthcare needs. Medicare states that it will pay for skilled nursing at a skilled nursing facility for a limited time as long as the patient meets the eligibility requirements.
The eligibility requirements are that you have been hospitalized for three days. Here are the patient’s payment responsibilities under Medicare:
- $0 for the first 20 days of each benefit period
- $185.50 per day for days 21–100 of each benefit period
- All costs for each day after day 100 of the benefit period. You also have to have
You also have to have Medicare Part A with days left in your benefit period. The doctor has to determine that you need skilled nursing at a skilled nursing facility. You also have to go to a skilled nursing facility approved by Medicare. If the doctor orders any therapy or skilled nursing that your facility doesn’t provide, you have to pay for it. Medicare only pays for 100 days of skilled nursing each benefit period and only if your doctor prescribes it. If you need more than 100 days, you have to pay out-of-pocket.
Medicaid. Depending on the state where the skilled nursing facility is located, Medicaid is more lenient with regard to eligibility. Even though Medicaid is a federal government program, the states are given leniency with regard to setting their eligibility requirements. They do, however, have to at least follow the federal government eligibility requirements.
Medicaid states that it will provide skilled nursing care to every eligible recipient that allows them to “attain or maintain the highest practicable physical, mental and psychosocial well-being.” That statement covers just about anything you need for recovery.
Private pay. If you need to stay in a skilled nursing facility longer than 100 days and you have Medicare, you will have to pay for it yourself. Medicaid, in most cases, will pick up the cost. If you don’t already receive Medicaid, you will have to apply for it. You may run into a problem there if you have assets because Medicaid will require liquidating your assets, except usually the family home, in order to pay for the care. If you do have to pay for part of your care, many people use either a home equity loan or reverse mortgage.
Bottom Line
Skilled nursing facilities provide valuable services that anyone could need during their lifetime. Unless you are already a Medicaid recipient, you may run into cost and payment issues. Specifically, you may have to pay for part of your care. Many people liquidate their assets so Medicaid will pay their costs, but Medicaid has a 60-day look back provision, which means that you can’t have liquidated assets less than 60 days in advance of your admission to a skilled nursing facility.
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