Skilled nursing facilities (nursing homes)

PostedFebruary 8, 2023

UpdatedFebruary 13, 2023

Byidfuiveirbuwoikwx

Summary

Skilled nursing facilities, also sometimes known as nursing homes, are hospital-like facilities for people who need continuous monitoring and medical care. This article describes the services that a skilled nursing facility provides and the qualifications for being admitted to one. It then briefly lists costs and some key sources of funding.

About skilled nursing facilities

Skilled nursing facilities, also sometimes known as nursing homes, are hospital-like facilities for people who need continuous monitoring and medical care. This could include such things as:

receiving intravenous medications
having bed sores treated
doing physical therapy
using a ventilator
getting end-of-life care

Skilled nursing facility residents may have their own room or a shared one. If they are able, they may eat in a common dining area and participate in daily recreational activities. If they are unable, meals, snacks, and games and activities are brought to them.

A certified nursing facility is required to have a licensed practical nurse present 24 hours a day and a registered nurse on duty for at least eight hours a day every day of the week.¹ Doctors must be either on site or on call around the clock.

A major set of reforms brought in by the federal government in 2022 contained measures to increase staffing, reduce crowding, and improve oversight in skilled nursing facilities.²

Qualifying for a skilled nursing facility

An older adult will only be admitted into a skilled nursing facility if their medical issues are serious enough that they are given an official status called “Nursing Home Level of Care,” or NHLOC. People with the NHLOC designation are eligible for a Medicaid-funded stay at a nursing home. The criteria are set by each state, and the person’s doctor needs to verify that the person’s medical condition meets those criteria.

Though the criteria for NHLOC vary from state to state, usually an older adult will qualify if they are unable to care for themselves in two or more ways and would be a danger to themselves if they weren’t getting help. The four ways a person would be unable to care for themselves are:

Medical: They need help with devices such as catheters or needles.
Cognitive: They have memory impairment or are unable to process information.
Behavioral: They cannot control their actions or moods.
Functional: They are unable to perform multiple activities of daily living (ADLs) such as eating, dressing, bathing, or toileting.

Caregivers and family members should keep in mind that a person receiving care who is unwilling to move into a skilled nursing facility generally cannot be forced to do so. Considerable evidence will need to be presented that this is the only safe and viable option.³ Although the person with medical power of attorney (MPOA) can make decisions about where the person receiving care lives, this decision-making power doesn’t start until the person is unable to make or communicate their own decisions. Often the only way that a caregiver can force a mentally capable person to move into a skilled nursing facility is by becoming the person’s legal guardian.⁴

Costs and ways to pay

In 2021, the average price for a semi-private room in a skilled nursing facility was $275 a day, or about $8,300 a month.⁵ Costs for memory care are usually significantly higher.⁶

Although Medicare doesn’t generally cover stays in skilled nursing facilities, it may cover up to 100 days of rehabilitation for medical conditions such as stroke or hip fracture, if the person was in the hospital for at least three days.⁷ In addition, Medicaid often covers low-income older adults who meet the state’s NHLOC criteria. And in states that have signed onto Medicaid’s “medically needy” option, people who have extensive health problems but whose incomes are above the usual Medicaid limit can receive Medicaid funding for nursing facilities by “spending down” their extra money on certain approved medical expenses.⁸

The federal government’s Nursing Home Toolkit offers useful advice about who qualifies for Medicaid benefits and how to apply for them. Experts recommend asking an eldercare lawyer or social worker for help in applying. In addition, the Older Americans Act requires each state to have a Long-Term Care Ombudsman who can help with application problems, as well as handle any complaints about a skilled nursing facility.

Related information

Adult day care

Assisted living facilities

Balance care responsibilities

Create a care plan

Engaging an attorney

Guardianship

Overview of home health assistance

Investigate long term care options

Medical power of attorney

Nursing homes and memory care

Paying for long term care