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What Is the Difference Between a Skilled Nursing Facility and Nursing Home?


Skilled nursing facilities and nursing homes are similar in that they help seniors who are unable to care for themselves at home independently. However, there are many differences you should be aware of before deciding on which one is best for your older loved one.

Type of Care Offered to Seniors

Skilled nursing facilities provide medically-based services. The facility may include physical and occupational therapists, speech pathologists, and audiologists. Registered Nurses (RNs) and doctors are on staff around-the-clock for assistance as needed.

Nursing homes do not provide medically-based services. While there may be a nurse on staff, that person isn’t required to be available 24 hours a day. The services provided to residents are to assist with daily living skills, provide meals, and offer a safe place for seniors to live until they need a higher level of care, such as one that a skilled nursing facility provides.

Insurance Coverage

Most insurance companies will not pay for nursing home care. A few private insurance companies will cover the cost of nursing homes, but many people do not carry those policies due to high premiums. Some insurance companies will allow seniors to pay for nursing home costs with a life insurance policy, but that isn’t always the best choice, so it’s essential to consider the advantages and disadvantages.

Since skilled nursing facilities are meant to stabilize a person’s health like a hospital would do, Medicare does cover some of the costs.

Medicare covers the following services:

  • Meals
  • Skilled nursing care
  • Semi-private room (this means having a roommate)
  • Physical and occupational therapy
  • Medical social services
  • Medications
  • Medical supplies and equipment
  • Ambulance transportation if needed
  • Dietary counseling

Medicare will only pay for all costs up to 20 days. After 20 days, Medicare will only pay for some of the costs.

  • $0 per day for Days 1-20
  • $167.50 per day for Days 21-100
  • No Medicare coverage for Days 100+

After 100 days, Medicare considers the stay as non-medical custodial. In other words, they no longer view it as a medical necessity.

Medicaid is for individuals who meet specific guidelines, which include having an income and assets below a certain amount. If a person has Medicaid, they may be able to use it to cover costs from a Medicaid-certified nursing home if it is medically necessary. Doctors and RNs are the only people who can determine medical necessity.

Medicaid will pay for nursing care from a skilled nursing facility, but only if the person does not have Medicare or has reached the limit of what Medicare will cover. For instance, if a person needs to stay past 100 days at the facility for continued medical care.

Skilled Nursing Facility vs. Nursing Home

Skilled nursing facilities are best for people who need rehabilitation after leaving the hospital. Nursing homes are best for people who are no longer able to live independently on their own. While Medicare and Medicaid will cover the cost of a skilled nursing facility and some nursing homes, it is when the stay is necessary for medical reasons.

We understand it can be challenging to decide which senior living option is best for your older loved one. At A1 Senior Care Advisors, we help people in your situation by matching their loved one up with the best senior living solution. Our services are free to you, so there is no reason not to call us for help. You can reach us at 425-324-5592.

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