Skilled Nursing Care Facilities
A nursing home or skilled nursing facility (SNF) is a place of residence for people who require constant nursing care and have significant Activity of Daily Living (ADL) deficiencies. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness. In the US, nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse. In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002.
Who is an appropriate candidate for a skilled nursing facility?
Each senior's need for care or assistance is unique. Some individuals may have a short-term need, perhaps caused by a fall and a broken hip that necessitates a short hospitalization followed by rehabilitation. After a one- or two-month Nursing Home stay, the senior may be able to return home and continue receiving some services such as physical therapy from a home health care agency, if necessary.
Other people have more long-term needs, possibly due to Alzheimer's, extreme frailty, or a stroke. In this case, care is necessary on an ongoing basis.
A skilled nursing facility is for an individual who meets one or more of the following criteria:
- Cannot take care of themselves because of physical, emotional, or mental problems;
- Can no longer care for their own personal needs, such as eating, bathing, using the toilet, moving around, or taking medications (custodial care);
- Requires more care than can be provided by their caregiver, and cannot live alone;
- Might wander away if unsupervised;
- Has extensive medical needs, such as round-the-clock Skilled Nursing care;
- Is going to be discharged from the hospital and requires temporary Skilled Nursing care before returning home or to a residential facility;
- Has been recommended for a Nursing Home by a physician.
What services does a skilled nursing facility provide?
Nursing Homes/Skilled Nursing Facilities offer an array of services, ranging from skilled nursing care (such as rehabilitation or care performed by licensed nurses) to non-skilled, or custodial care. Nursing Homes provide a room, all meals, some social activities, personal care and 24-hour nursing supervision and access to medical services.
Basic Nursing Home Services generally include:
- A clean, furnished room (private or shared)
- Dietary services: nutritious meals and snacks, in accordance with medical requirements
- Housekeeping and linen service
- Personal (custodial) care
- Therapeutic recreation and activities
- Transportation (some)
- 24-hour onsite medical staff (registered nurses (RNs), licensed practical nurses/licensed vocational nurses (LPNs/LVNs), and nurses' aides)
- Resident evaluation and care planning
For an additional fee, many Nursing Homes provide:
- On-call physician services
- Rehabilitation services: occupational, physical, respiratory and speech therapy
- Pharmacy, laboratory and radiology services
- Dental services
- Special care units (see next section)
- Personal care items
- Laundry service
How does a nursing home differ from an assisted living facility?
Assisted Living Facilities offer help with activities of daily living (personal or custodial) care, but no or very limited medical care. An Assisted Living Facility also places greater emphasis on personal privacy and autonomy than does a Nursing Home. A Nursing Home/skilled nursing facility has medical staff available onsite 24 hours per day.
Continuing Care Retirement Communities provide housing, services and Nursing Home care in one location, enabling seniors to remain in a familiar setting as they grow older. Many seniors enter a Continuing Care Community while they are healthy and active, knowing they will be able to stay in the same community and receive Nursing Home care should this become necessary. If a senior requires Nursing Home care for a while and then becomes well enough to again live independently, they can move back to an Independent Living arrangement without leaving the Continuing Care Community.
People in nursing homes generally, but not always, live in double occupancy rooms. There is usually a nursing station in each hallway of a nursing home for the nurses (Licensed Practical Nurses, with a minority of Registered Nurses, generally in a supervisory role) who monitor resident health and administer medications. Nursing assistants (Health Care Assistants in the UK) play a key role maintaining residents' hygiene, assiting residents with activities of daily living, and performing other basic nursing skills. A housekeeping staff in a nursing home is responsible for ensuring that the rooms, beds, towels, bathrooms, and other facilities are kept sanitary. Physical therapists and occupational therapists attempt to help the residence regain certain abilities. Assistive technology such as wheelchairs, standing frames, and pateint lifts are often used. Social workers help with personal issues such as billing and transitions back to the home environment.
In the US, Medicare reimburses an elderly person for nursing home stays for skilled nursing care and rehabilitation purposes after the elderly person has been in the hospital for three or more days (technically 3 midnight stays). Medicare pays 100 percent of the cost for the first 20 days of stay. From day 21 through day 100 there is a copayment for each day. Medicare does not pay after the 100th day. Also, if during the 100 days the person has gotten as well as the nursing home staff believes she will get, Medicare no longer reimburses. Medicare never reimburses for purely custodial care. Medicaid does reimburse for custodial care but a person may only qualify for Medicaid if she has extremely limited income and assets.
In the US, nursing home costs can run to $350 and up daily. Charges are usually determined by how much assistance the nursing home resident needs with the activities of daily living (ADLs).
For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see Nursing Home Compare in the link below). Homes in England are regulated by the Commission for Social Care Inspection.
Can a skilled nursing facility handle special needs?
Some Skilled Nursing Facilities can handle the following special needs:
- Kidney dialysis treatment
- Alzheimer's and dementia care
- Respiratory care
- Parkinson's care
- Terminal illnesses (Hospice Care) in cooperation with a separate Hospice agency that visits the facility to provide specialized care
- Chronic psychiatric care
In addition, most Nursing Homes provide:
- Respite Care (care so that caregivers can take a break)
- Interim medical care (after a hospital stay)
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently.
Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small sets of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Pioneer Network, the Eden Alternative, and the Green House Project.
What does a skilled nursing facility cost?
Skilled nursing facility care is expensive, and the cost continues to rise. The average daily cost of a private room in a Nursing Home was $192/day or $70,080 a year, according to the 2004 MetLife Market Survey of Nursing Home and Home Care Costs. This is a more than $4,000 annual increase over the prior year. The cost of a shared Nursing Home room averaged $169 a day, or $61,685 a year.
In addition to a private or semi-private room and the care options you choose, where you live also affects how much you'll spend for Nursing Home care. Alaska reported the highest rates for a private room in a skilled nursing facility, at $204,765 a year or $561 a day on average. The lowest rates were found in Shreveport, Louisiana, at $36,135 a year or $99 a day.
Payment options for Skilled Nursing Facilities include:
- Private pay
- Long-term care insurance
- Medical assistance (Medicaid)
See our Financing Options section for more information.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Nursing homes" and from the Center for Healthy Aging.