Whether it’s a spouse, grandparent, sibling or dear friend, we all want what’s best for those we love. That’s why truth be told, we normally don’t think about skilled nursing facilities until the care they need is too much for ourselves or a caregiver to provide. Looking at skilled nursing facility placement, whether for a short stay post surgery or a more permanent arrangement, can be overwhelming.
Is it the right time? What is skilled nursing? How much will it cost? These are great questions! While answers may very slightly depending on the exact situation, here is some basic information that you can feel con dent using when looking into making this important decision.
What is skilled nursing?
A skilled nursing facility is designed to help care for patient’s who have needs which require 24-hour, 7 days a week nursing care including tube feeding, complex wound care, IV antibiotics, and daily therapy.
Candidates for skilled nursing are both those who have planned surgeries/ procedures (hip or knee replacement etc.) and those who have an acute and unplanned medical issue (UTI, sepsis, cellulitis, etc…) At the hospital, the patient will be assigned to a case manager who will be responsible for letting the patient and family know that skilled nursing is recommended, ask which facility they prefer and work with the facility of choice to facilitate the admission. Of course, always feel comfortable stopping in to see the Admission Coordinator at your local skilled nursing facility to ask any questions, discuss concerns and get a clear picture of how the admission process will look.
Not all skilled nursing residents are there for short-term rehabilitation from a surgery or illness. Some residents are there under what is called long-term care. Long-term care (LTC) is designed to care for those who will need round the clock nursing care for the foreseeable future. Usually, these residents have a terminal condition, disability, or illness which impacts their ability to safely manage activities of daily living. These types of admissions will also go through the Admission Coordinator at the skilled nursing facility, so they should be able to answer any and all questions you may have.
While most skilled nursing facility patients come after a hospital stay, it is possible to admit from home. If your loved one has met the qualifying hospital stay within the last 30 days, they may
be able to admit with help from their primary care provider. It is best to start by calling the skilled nursing facility of choice to review your options. They will walk you through the process from there.
How is it covered?
Medicare covers skilled nursing care as long as the patient meets what is called a “qualifying hospital stay”. This means that your loved one was an inpatient in a hospital for three consecutive midnights. It’s important to note that an emergency room visit, observation stay, and outpatient services do not count towards the qualifying stay. If the qualifying hospital stay is met, Medicare will pay for up to 100 days (as long as the patient meets skilled criteria). The rest 20 days are paid for 100% by Medicare, days 21-100 will have a co-pay; for 2017 the amount is $164.50 per day. If the patient has a supplemental insurance or Medicaid, that plan will often pick-up the co-pay for them.
Some people choose to have an insurance company manage their Medicare bene ts. Examples of these types of plans include Healthnet, Care Oregon, MODA and Regence MedAdvantage.
For someone who has these insurances, the qualifying hospital stay can be overridden if the insurance company feels it’s warranted. The assigned case manager at the hospital will work with the insurance company to get authorization. If the patient is coming from a doctor’s office or from home, the admissions coordinator along with the patient’s Primary Care Provider can work together to try and request an insurance authorization.
For someone looking for Long-Term Care placement, Medicaid is the most common payer. Anyone who doesn’t have Medicaid would most likely pay privately.
It’s important to remember that there are people who work in this profession/ industry and it’s their job to make sure this process isn’t any more dif cult than it needs to be. Never hesitate to call your local skilled nursing facility’s admissions coordinator to nd out if skilled nursing is the correct route to take for your loved one.
Article Provided by:
Hearthstone, Avalon Health Care Group