Skilled Nursing Facilities

• Individuals recovering from a surgery, stroke, or serious illness
• People with complex medical conditions requiring ongoing nursing care
• Those who need rehabilitation services such as physical, occupational, or speech therapy
• Individuals with advanced dementia requiring full-time medical supervision
• People who can no longer be safely cared for in assisted living or memory care
• Those needing long-term custodial care with significant medical needs

• Following a hospital stay for surgery, stroke, fracture, or illness
• Focus on recovering function and returning home
• Includes intensive physical, occupational, and speech therapy
• Medicare typically covers this for a limited time (up to 100 days with qualifying hospital stay)
• Goal is to maximize independence and transition back to home or lower level of care

• For individuals who cannot return home due to ongoing medical or functional needs
• Provides permanent or indefinite residential care
• Focuses on maintaining quality of life and managing chronic conditions
• Primarily paid through Medicaid for those who qualify
• May also include hospice and end-of-life care

Skilled nursing facilities offer a wide range of medical services including:

• 24/7 registered nurse (RN) and licensed practical nurse (LPN) coverage
• Physician visits on a regular schedule
• Medication management and administration
• Wound care and complex dressing changes
• IV therapy and infusion services
• Tube feeding and nutritional support
• Respiratory therapy and ventilator care
• Catheter and ostomy care
• Diabetes management
• Cardiac monitoring
• Pain management
• Hospice and palliative care

One of the key strengths of SNFs is their comprehensive therapy programs:

• Restoring strength, balance, and mobility
• Fall prevention
• Recovering from orthopedic surgeries (hip, knee replacements)
• Stroke recovery

• Relearning daily living skills
• Adaptive equipment training
• Cognitive rehabilitation
• Home safety planning

• Swallowing difficulties (dysphagia)
• Communication disorders
• Cognitive-communication therapy
• Post-stroke speech recovery

SNFs are required to maintain specific staffing standards:

• Registered Nurses (RNs) must be on duty at least 8 hours per day
• Licensed Practical Nurses (LPNs) provide around-the-clock nursing coverage
• Certified Nursing Assistants (CNAs) assist with personal care and daily needs
• Social workers help with discharge planning and family support
• Dietitians manage nutrition and special dietary needs
• Activities staff provide social and recreational programming
• Physicians visit regularly and oversee medical care

• Private or semi-private rooms
• Common dining and activity areas
• Therapy gyms and rehabilitation spaces
• Nursing stations centrally located
• Some facilities offer specialized units for: 
  • Memory care and dementia
  • Ventilator and respiratory care
  • Wound care
  • Cardiac care
  • Oncology and cancer care

Skilled nursing facilities are among the most heavily regulated healthcare settings:

• Licensed and regulated at the state level
• Certified and inspected by Centers for Medicare & Medicaid Services (CMS)
• Subject to annual inspections and surprise surveys
• Required to meet federal standards for quality of care
• Five-Star Quality Rating System. CMS rates every SNF from 1 to 5 stars based on: 
  • Health inspections
  • Staffing levels
  • Quality measures

Skilled nursing care is among the most expensive forms of senior care:

• Semi-private room: Average $7,000 to $8,500 per month nationally
• Private room: Average $8,000 to $10,000+ per month
• Costs vary significantly by location and facility

• Medicare covers short-term skilled nursing after a qualifying 3-day hospital stay: 
  • Days 1–20: Medicare covers 100%
  • Days 21–100: Medicare covers costs above a daily coinsurance amount
  • After day 100: No Medicare coverage
• Medicaid covers long-term care for those who meet financial and medical eligibility requirements
• Long-term care insurance can cover significant costs
• Private pay out of pocket savings or assets
• Veterans benefits may be available through the VA

Key factors to evaluate:

• CMS Five-Star Rating check at Medicare.gov/care-compare
• Staffing levels and turnover rates
• State inspection reports and any deficiencies or violations
• Rehabilitation program quality and therapy hours provided
• Cleanliness and overall environment
• How staff interact with residents during your visit
• Specialized services relevant to your loved one's needs
• Family visitation policies
• Discharge planning process and support for returning home
• Proximity to family for regular visits

Federal law protects the rights of skilled nursing facility residents including:

• The right to dignity and respect
• The right to participate in care planning
• The right to privacy
• The right to voice grievances without retaliation
• The right to visitors at reasonable hours
• The right to manage personal finances
• Freedom from abuse, neglect, and exploitation
• The right to refuse treatment

Many short-term residents successfully return home or transition to a lower level of care. Discharge planning typically includes:

• Home safety assessment
• Home health services arranged
• Outpatient therapy referrals
• Durable medical equipment setup
• Caregiver training and education
• Follow-up physician appointments scheduled

Skilled nursing facilities play a critical role in the senior care continuum, providing a vital bridge between hospital care and home, as well as a compassionate long-term home for those with the highest care needs.