A skilled nursing facility — commonly called an SNF or nursing home — is a licensed residential care facility that provides around the clock medical supervision, skilled nursing care, and personal care assistance to people who require a higher level of care than can be provided at home or in an assisted living facility. Skilled nursing facilities serve two main populations — people who need short term rehabilitation following a hospitalization and people who need long term custodial care due to chronic illness, disability, or advanced age.
Understanding what skilled nursing facilities provide, how they are regulated, how they are paid for, and what to look for when choosing one can help families make more informed decisions during what is often a stressful time.
What skilled nursing facilities provide
Skilled nursing facilities provide a comprehensive range of medical and personal care services including:
Medical and nursing services:
- Around the clock registered nurse and licensed practical nurse coverage
- Physician oversight and visits
- Medication administration and management
- Wound care and pressure ulcer prevention and treatment
- IV therapy and tube feeding
- Monitoring of chronic medical conditions
- Post-surgical care and recovery
- Pain management
- Respiratory therapy
Rehabilitation services:
- Physical therapy to improve mobility, strength, and balance
- Occupational therapy to improve the ability to perform daily activities
- Speech therapy to address swallowing difficulties and communication problems
Personal care and daily living services:
- Assistance with bathing, dressing, grooming, and toileting
- Meals and nutrition management
- Laundry and housekeeping
- Social activities and recreational programming
- Spiritual care and chaplain services
- Social work services
Short term vs long term care in skilled nursing facilities
Skilled nursing facilities serve two distinct populations with different needs and different funding sources:
- Short term rehabilitation — people who have been hospitalized for surgery, a stroke, a hip fracture, or another acute medical event often need a period of intensive rehabilitation before they can return home. Short term rehabilitation stays in a skilled nursing facility typically last days to weeks and focus on restoring function and independence. Medicare covers short term skilled nursing facility care following a qualifying hospital stay.
- Long term custodial care — people with advanced dementia, chronic illness, or significant physical disability may need ongoing personal care and supervision that cannot be provided at home. Long term care in a skilled nursing facility may last months or years. Medicaid is the primary payer for long term custodial care for people who meet financial eligibility requirements.
How skilled nursing facilities are regulated
Skilled nursing facilities that participate in Medicare and Medicaid are regulated by both federal and state governments. Federal regulations establish minimum standards for staffing, care quality, resident rights, and physical environment. State health departments conduct regular surveys — typically annually — to assess compliance with these standards.
Survey results including any deficiencies cited are publicly available through Medicare’s Care Compare tool at medicare.gov. This tool allows families to review a facility’s survey history and compare facilities on a range of quality measures.
Medicare coverage of skilled nursing facility care
Medicare Part A covers short term skilled nursing facility care following a qualifying hospital stay under the following conditions:
- The patient must have had a qualifying inpatient hospital stay of at least three days not counting the day of discharge
- The patient must be admitted to the skilled nursing facility within 30 days of the hospital discharge
- The patient must require skilled care — skilled nursing or therapy services — on a daily basis
- The skilled nursing facility must be Medicare certified
Medicare covers skilled nursing facility care for up to 100 days per benefit period. Coverage is structured as follows:
- Days 1 through 20 — Medicare covers the full cost with no copay
- Days 21 through 100 — Medicare covers most of the cost but the patient pays a daily coinsurance amount — $194.50 per day in 2024
- Day 101 and beyond — Medicare does not cover the cost
Medicaid coverage of skilled nursing facility care
Medicaid is the primary payer for long term skilled nursing facility care for people who meet financial eligibility requirements. Unlike Medicare which covers only short term skilled care Medicaid covers ongoing custodial care for as long as the person needs it and qualifies financially.
To qualify for Medicaid nursing home coverage a person must meet both medical necessity criteria — needing nursing home level care — and financial eligibility criteria including income and asset limits that vary by state.
How to choose a skilled nursing facility
Choosing the right skilled nursing facility requires research and careful evaluation. Key steps include:
- Use Medicare’s Care Compare tool — research facilities at medicare.gov to compare star ratings, staffing levels, quality measures, and inspection results
- Visit in person — tour any facility you are seriously considering at different times of day. Observe staff interactions with residents, cleanliness, odors, and overall atmosphere.
- Ask about staffing — ask about nurse to resident ratios on all shifts including nights and weekends. Adequate staffing is one of the most important indicators of care quality.
- Ask about specialized services — if the patient has specific needs such as dementia care, wound care, or ventilator management make sure the facility has the expertise to meet those needs
- Talk to residents and families — their candid impressions can provide valuable insights beyond what inspections and star ratings reveal
- Understand costs and payment — clarify what is included in the base rate and what is charged separately
Residents’ rights in skilled nursing facilities
Federal law guarantees nursing home residents a comprehensive set of rights including the right to be treated with dignity and respect, the right to participate in their own care planning, the right to be free from abuse and unnecessary restraints, the right to communicate freely with family and others, and the right to file complaints without fear of retaliation.
The Long Term Care Ombudsman Program — available in every state — provides free advocacy services to nursing home residents and their families and investigates complaints about care and conditions.
Key terms to know
- Skilled nursing facility — SNF — a licensed facility providing around the clock medical care and personal care assistance
- Medicare benefit period — the way Medicare measures use of hospital and skilled nursing facility services beginning with a hospitalization and ending after 60 consecutive days without inpatient care
- Qualifying hospital stay — a Medicare requirement of at least three inpatient hospital days before skilled nursing facility coverage begins
- Custodial care — non-medical assistance with daily activities not covered by Medicare for long term care
- Care Compare — Medicare’s online tool for researching and comparing nursing homes at medicare.gov
- Long Term Care Ombudsman — an advocate for the rights and wellbeing of nursing home residents
- Medicaid spend down — the process of reducing assets to qualify for Medicaid nursing home coverage
Sources
- Medicare.gov — Skilled Nursing Facility Care
- Centers for Medicare and Medicaid Services
- Medicaid.gov
- National Consumer Voice for Quality Long-Term Care
This article is for general informational purposes only and does not constitute legal or medical advice. Medicare and Medicaid coverage rules vary and are subject to change. Consult a licensed professional or contact Medicare directly for guidance specific to your situation.