Skilled Nursing Facility (SNF)

A skilled nursing facility is a place where people stay who are medically stable but need a higher level of nursing care than is provided in a long-term care facility like a nursing home or an assisted living facility. A SNF is not a long-term nursing home. People typically enter a skilled nursing facility right after discharge from the hospital after surgery or an illness or injury. Here they can regain strength and rehabilitate so they can return to their homes or an assisted living facility. The length of stay in a SNF is usually 1 to 2 weeks. Skilled nursing care may also be called sub-acute or transitional care.

Upon the person’s discharge from the hospital, the doctor overseeing their hospital care will provide written instructions for their continued care at the SNF.

Some examples of conditions that may be helped from care at a SNF include:

• Stroke rehabilitation

• Wound care

• Care after an injury, illness, or infection

• Recovery from surgery

What services are provided at an SNF?

Services generally provided in a SNF include:

• 24-hour supervision and skilled nursing care such as IV therapy, tube feedings, and intensive wound care

• Private or semi-private rooms

• Meals and snacks

• Management of medicine

• Help with hygiene and toileting

• Help with eating

• Socialization

• Physical, occupational, and speech therapies

• Laundry and cleaning services

• Transportation to medical appointments, emergency medical care, and other activities

Who works in an SNF?

A variety of health professionals and other staff members provide care at the SNF. They include:

• Nurses

• Doctors and advanced practice providers such as nurse practitioners (NP) and physician assistants (PA)

• Certified nursing assistants (CNA)

• Med techs

• Physical and occupational therapists, and speech therapists

• Hospice workers

• Social services

• Nutritional counselors and registered dietitians

• Maintenance and housekeeping staff

• Dietary and kitchen staff

An onsite administrator oversees the facility and the staff. A doctor (MD or DO), or an advanced practice provider (nurse practitioner or physician assistant) oversee the medical care. They may be onsite on certain days or be on call.

Questions to ask

In some cases, you may not have time to visit many SNFs. Ask your hospital care team for any recommendations. If you or a loved one can preview a SNF, ask these questions:

• How many residents live in the facility?

• Does each room have its own thermostat and bathroom?

• Are all of the rooms private or semi-private?

• What services are offered?

• What happens if the person gets ill or their condition gets worse?

• What levels of care are available?

• Are there laundry services?

• What is the staff-to-resident ratio?

• What is the experience and training of the staff?

• Is smoking allowed?

• Is there a TV in the room?

During a visit, assess these things:

• Cleanliness and unusual odors or noises

• Appearance of the residents

• Safety

• Friendliness of staff, and how staff interacts with residents

• Number of registered nurses on staff during a shift

• Availability of food and snacks

• Can guests eat meals with the patient? Where do patients eat their meals? Can patients choose what they eat?

• Security. Are the doors locked? Are there fire sprinklers? Are there handrails?

Paying for your care

Medicare Part A may pay for short stays in a SNF to get care for a hospital-related health condition or post-hospital discharge rehab (rehabilitation). Your healthcare provider or hospital care manager (discharge planner) can help advise you. Medicare does not cover ongoing skilled nursing care. After a certain period of time, you will pay out of pocket for these expenses. Other options include:

• Long-term care insurance

• Federal aid for former service members

For more information

• Eldercare Locator, 800-677-1116, www.eldercare.acl.gov. Eldercare Locator is a service of the U.S. Administration on Aging to help connect people to services for older adults.

• Medicare.gov, www.medicare.gov/care-compare to find and compare facilities in your area.