What Is A Skilled Nursing Facility?

How does my father get into one?

Skilled nursing facilities (or SNFs) are often confused with nursing homes, both by patients and their families. SNFs provide a higher level of shorter-term care that aims at having patients return home or to a family member’s home. Nursing homes, on the other hand, provide primarily long-term, custodial care for patients who can no longer live elsewhere on their own.

Although many SNFs began as nursing homes, or have units in them that provide long-term care, they also house rehabilitation units where patients can stay temporarily to receive physical and occupational therapy until they have regained a level of functioning that allows them to go home. Unlike nursing homes, short-term rehabilitation in an SNF is a stepping stone, a structured setting of care to help patients go home.

Once you’ve begun the process of considering having your father go to an SNF for short-term rehabilitation, the hospital discharge planner should be able to pro-vide you and your father with a list of local facilities. The discharge planner at the hospital will probably have brochures or even videos on hand to provide you with some background about these places. If you or your father is interested about the type of care provided at an SNF, you can contact the admission office of any facility you are considering and arrange a tour.

Your father doesn’t necessarily have to go to an SNF in the town where he lives. If it’s more convenient, he can go to a facility closer to you in order to make it easier for you or other family members to visit him, provided there aren’t any restrictions based upon his insurance.

If you know of any facilities from previous experience or have friends who can make recommendations about places, so much the better. Try to identify about five facilities as potential placements for your father, as your first choice may be full or won’t accept your father because they can’t meet his medical needs. Consult with the hospital dis-charge planner so that he or she can put in the necessary paperwork for application to these facilities.

If your father participates in a managed care plan (see Part 7 for insurance information), remember that these care facilities may have to be in-network to be covered by insurance. Most SNFs accept Medicare, but Medicare will cover only the first 20 days of a stay at an SNF.

After that, there is a co-payment ($133.50 per day for the year 2009) for days 21 through 100, after which patients are financially responsible for the costs of their stay. For this reason, some facilities require some kind of financial review as part of the application, in case the patient stays at the SNF longer than anticipated.

Once your father is medically cleared and ready for transfer to an SNF, hopefully you will have already vis-ited your five choices and decided upon your preferences. Sometimes, though, your first choice for placement does not have a bed available, even though they’ve medically accepted the patient.

If you’re comfortable going with a second choice facility that does have a bed ready, fine; keep in mind also that it’s always possible to transfer later to another facility if the care provided is not adequate. If there are facilities willing and able to accept your father, but you or your father insists on one in particular, his health insurer may inform you that it will no longer pay for his current hospitalization while waiting for a bed at your first choice SNF.

Things don’t often reach this impasse as long as you’ve been working in conjunction with the medical team and discharge planner and have made a good faith effort to look at options and consider alternatives.

Another obstacle that can arise is when the SNFs refuse to accept a patient on medical grounds, either because the patient is too high-functioning to require rehabilitation in a facility or has other nursing care needs that the facility is unable to provide.

In the latter case, you need to go back to the discharge planner to find other facilities capable of providing the specialized care your father needs. If, on the other hand, your father is now getting out of bed independently, walking without assistance, and meeting other goals, SNF placement may, in fact, not be needed, and going home may be the appropriate plan.