Skilled nursing care: what it is, and how to pay for it

The term “skilled nursing” is often confused with “nursing homes.” To clear this up, skilled nursing is high-level medical care that can only be provided by a licensed clinician or therapist at a patient’s home or in a facility, while Skilled Nursing Facilities (SNFs), also known as nursing homes, are residential facilities that provide 24-hour medical care.

We want to dive deeper into skilled nursing care, covering what types of skilled nursing care exist, how to find them, and how to pay for them. 

Types of skilled nursing care

Skilled nursing care must be ordered by a physician and administered by licensed clinicians or therapists. The duration of these services varies depending on the type of care needed. For example, rehabilitation services after a surgery or injury would be relatively short term. However, if you or your loved one have multiple chronic conditions and require intermittent skilled nursing care, then the services would be provided over a longer term. 

Examples of skilled nursing care include, but are not limited to: intravenous therapy (IV); medication management and administration; catheter care; physical, speech, and occupational therapy; monitoring of vital signs, and more. Note: these services are provided by a licensed clinician and are not considered custodial care. Learn more about custodial care by clicking here.

Tips for finding skilled nursing care 

• First, identify you or your loved one’s care needs. Have this conversation with your physician, as they can evaluate your health and the level of care needed, and because ultimately, they have to order skilled nursing care. As a family, you can talk about what care setting would be best. Should these services be provided in the home? Or at a facility? 

• If you decide to receive care at home, you can search for home health agencies using the CMS Home Health Compare tool. 

• If you decide to receive care at a facility, you can search for nursing homes using the CMS Nursing Home Compare tool. If you are a Veteran and enrolled in the VA health care, you can learn more about the services the VA covers and how to access them by clicking here.

Paying for skilled nursing care

Skilled nursing care must be ordered by a physician to be covered by Medicare, Medicaid, the Veteran Administration, or private health insurance. There are complex eligibility rules that should be considered and reviewed before care is provided. 

• Medicare Part A  and Part B will cover certain eligible services for home health care. It is important to note that these services must be part-time or "intermittent" skilled nursing care. This means less than 7 days a week or less than 8 hours a day over a period of 21 days or less. There are exceptions for special circumstances.

• Medicare Part A will cover certain eligible services provided in a Skilled Nursing Facility as long as eligibility requirements have been met. It is important to note that Medicare will only cover short-term stays at a skilled nursing facility. Your physician may recommend that you or your loved one receive services more often than Medicare may cover. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs out-of-pocket. Be sure to ask your care team about the services being recommended and whether Medicare will cover them or not. 

If you are looking for additional assistance understanding skilled nursing care and how to access care, talk to our concierge service here at Peacefully. The concierge service can help with referrals to trusted professionals, offering case-specific advice, recommendations, and coordination for you. For more about our concierge service or to schedule a free consultation, click here.

— Lesley Hellow