THE DIFFERENCE BETWEEN

NURSING HOMES & SKILLED NURSING FACILITIES

The Difference Between

Nursing Homes And Skilled Nursing Facilities                                                 Is Whether Skilled Care Or Custodial Care Is Provided           


Skilled Nursing Facilities provide skilled care.

  Nursing Homes provide custodial care.


SKILLED NURSING FACILITIES (SNFs)

Skilled nursing services are offered in both hospital-based facilities and in free-standing facilities. 

  1.   A freestanding Skilled Nursing Facility (SNF) is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy.

  2.   Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
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NURSING HOMES or NURSING FACILITIES (NFs)

  1.   Medicare also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. 

  2.   Nursing home residents have physical or cognitive (short or long term) impairments and require 24-hour care during their stay.

  3.   The cost of staying in a Nursing home can cost several thousand per month or more. Some people deplete their resources on the often high cost of nursing home care. If eligible, Medicaid will cover continued stays in nursing home for these individuals for life. However, they require that the patient be "spent down" to a low asset level first by either depleting their life savings or asset-protecting them, often using an elder law attorney.

  4.   The primary care giver in a certified nursing home is a "Certified Nurses Aide" (CNA) - a non-professional aide, not a skilled professional.  in other words, most of the resident care care in nursing facilities is provided by certified nursing assistants, not by skilled, licensed personnel. 

  5.   In U.S. nursing homes, the training of the majority of direct caregivers is task oriented. Task oriented care is where nurses and nurses aides are assigned specific tasks to perform for numerous residents on a specific ward.
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Nursing Homes, Medicare and Medicaid

Medicare covers nursing home services for 20 to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days.

Medicare does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair.

To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.

SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
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Medicare Coverage of Nursing Homes (NFs)

Medicare also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.

The cost of staying in a Nursing home can cost several thousand dollars per month or more. Some patients deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals for life. However, they require that the patient be "spent down" to a low asset level first by either depleting their life savings or asset-protecting them, often using an elder law attorney.
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U.S. Government Licensing, Regulations and Oversight

SNFs and NFs are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).

All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors. State surveyors may inspect for compliance with licensing  (State regulations) and certification (federal Medicare and Medicaid regulations).

For United States SNFs and NFs, the Centers for Medicare and Medicaid Services website allows users to see how well facilities perform in certain metrics. CMS also publishes a list of Special Focus Facilities - nursing homes with "a history of serious quality issues."
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Problems In Nursing Homes and Skilled Nursing Facilities

According to the US Government Accountability Office (GAO), state nursing home inspections tend to understate the number of serious nursing home problems that present a danger to residents.

Although government oversight has improved, there are still weaknesses in the oversight of nursing homes.

For example, a September 2008 report noted that more than 90% of nursing homes were cited for federal health or safety violations in 2007; in addition, about 17% of nursing homes had deficiencies that caused "actual harm or immediate jeopardy" to patients.
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Get Organized Before Starting To Look For A Nursing Home


Once the decision is made that your loved one needs nursing home care, you may wonder how to get started. This is normal because so many factors must be taken into account to get the very best facility for your specific needs.


The key to choosing a nursing home is to approach the process with organization and clear thinking.  You need to stay calm and organized even if the decision to seek nursing home care was sudden due to hospitalization or worsening health status.


The non-profit organization Jewish Home Lifecare offers five things to consider once you’ve made the choice to seek nursing home care:


Time. How much time do you have to look for a nursing home? Your parent’s physician or other eldercare provider can share an educated estimate so you’ll know how much time you can spend looking at different facilities.

Finances. How much can your parent and/or your family afford in regard to nursing home care? Be sure that finances are organized, including records of assets and long-term care insurance, if applicable.

Location. Ideally the nursing home will be close to a variety of family and friends so that visits are more feasible and frequent.

Special Needs. Does your parent need specialized care due to Alzheimer’s disease or another complicated condition? This will narrow your choices as you look for facilities that have expertise in your parent’s unique health status.

Your Parent’s Wishes. What kind of nursing home would your parent prefer? Even if your parent can’t communicate his or her preferences right now, you might be able to recall earlier conversations when certain preferences about location, services, or other qualities were revealed.

Considering these five issues will help you stay focused as you develop a short list of nursing homes to explore.
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Web Links For More Information About Nursing Homes


  1. Medicare's Guide to Choosing a Nursing Home

  2. Nursing Home Checklist

  3. Your Rights as a Nursing Home Resident

  4. (Medicare) Helpful Contacts

  5. Five-Star Quality Rating Technical Users' Guide


You can also


  1. Download the Nursing Home Compare Database

  2. View the Note to Nursing Homes

  3. View Important Information about Nursing Home Compare

  4. View Information about Advancing Excellence in America's Nursing Homes Quality-Improvement Campaign


Learn More


  1. Five-Star Quality Rating- Learn how the ratings are determined.

  2. Health Inspections- Learn what inspectors look for during health inspections, and what happens if nursing homes do not meet inspection standards.

  3. Nursing Home Staffing- Learn about the different kinds of nurses working in nursing homes and how to use staffing information.

  4. Quality Measures- Learn what information nursing homes collect about their residents, and how and why it is used to create quality measures.

  5. Fire Safety Inspections- Learn what fire safety standards nursing homes are required to meet.

  6. Paying for Nursing Home Care- Learn about the various ways to pay for your nursing home care.

  7. Alternatives to Nursing Homes- A nursing home may not be your only long-term care choice. Learn more about state and community programs and get help deciding what is best for you.

Nursing homes provide skilled nursing care to seniors in need of intensive and/or extensive care and support during the final stages of their life. Below are some informational resources on nursing home care, financing options and selecting the right facility for your family member or loved one.

In his book, Alzheimer’s: A Caregiver’s Guide and Sourcebook (3rd ed.), Howard Gruetzner suggests that caregivers ask several questions to determine which nursing home is the best choice for a parent suffering from Alzheimer’s disease.


These same questions should be asked for anyone in need of nursing home care:

•Is the staff physician familiar with my parent’s health condition?

•Are staff members at all levels experienced in dealing with my parent’s unique health needs?

•How do staff members interact with the residents? Does the nursing home have a friendly atmosphere?

•What kinds of activities and social opportunities are available?

•Does the physical layout of the nursing home provide opportunities for socializing as well as privacy?

•Does the facility welcome family involvement and input?

•Is the nursing home clean and bright? Is it too noisy or chaotic? Does the facility smell pleasant?

•If your parent has Alzheimer’s disease or a related dementia, is the facility equipped to handle behavioral issues such as combativeness and wandering?

Although choosing nursing home care might be stressful, considering these issues and questions will help you choose the best facility for your parent or loved one.  The time you spend up front carefully checking out various facilities will go a long way toward ensuring the comfort and contentment of your loved one later on.
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The content on AsYouAge.com is provided as a courtesy for our site visitors. The information, resources, links, advertisements and other material on AsYouAge does not constitute a professional opinion or advice; nor does it constitute an endorsement of any organization or the information, products and/or services they may offer. AsYouAge reviews and updates its content regularly when new and relevant information is made available. This information is neither intended nor implied to be a substitute for professional advice in any area: health, medical, legal, insurance, financial or any other area. Always seek the advice of your physician or qualified health provider, or caregiver, attorney, financial, insurance expert or other specialist prior to starting, dropping or changing your current program or have questions or concerns  regarding current or anticipated issues.


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The Difference Between Nursing Homes and Skilled Nursing Facilities