So far, I have talked about levels of care, assisted living and Independent care.  The next level I’d like to address is skilled nursing. I first heard of this term when my mom was in a rehabilitation facility and the doctor kept referring to “SNFs” (she pronounced it “sniffs!”  I finally told her I had no idea what a “sniff” was and she explained.

My mom was ready to leave rehab but had developed pneumonia and could not return to her assisted living community.  She required more help than was available at her present living situation.

Skilled nursing refers to medical care provided by licensed nurses (RN’s or LPN’S) under the supervision of a doctor’s care.  This is often, but not always, in a Skilled Nursing Facility or SNF.  Skilled nursing is short-term, medically necessary care for people recovering from an illness, surgery or injury, (like a fall ) or patients who have complex medical conditions.  It offers more care than assisted living communities can provide. However, it often times is used as a long term residence for people with complicated needs, as well as those who can’t afford assisted living but have high level care needs.

Skilled nursing can involve wound care, IV care and injections, Catheter or ostomy care and feeding tube care.  They also provide medication/pain management.  Post stroke and post surgery rehabilitation, therapies such as physical, occupational therapy and speech therapy are also considered skilled nursing.

Skilled nursing facilities and nursing homes are often synonymous.  They are short stay facilities that provide 24/7 licensed nursing care and on-site rehabilitation therapy.  Typical stays are a few days to several weeks.  They basically get the patient stabilized and then discharge them.

Skilled nursing can be done at home through Home Health, depending on your needs.  If you qualify, a nurse can visit your home to provide monitoring, wound and IV care, medication management and help coordinating therapies.  Some Home Health agencies will cover some skilled nursing but draw a hard line caring for feeding tubes, catheter care and wound care that is at or below a level 2 wound.  Medicare usually covers skilled nursing care if you have had a 3-day hospital stay, a doctor certifies that it is necessary and you enter a medicare certified SNF within a short time or immediately after discharge. Private insurance rules vary.

What situations usually require skilled nursing?  In my mother’s case she was recovering from a fall that resulted in a broken hip.  Sometimes it is after joint replacement, after a stroke, a serious infection, complex wound care or focused medical monitoring.

Skilled nursing is very complicated because there are so many rules and nuances that seem to to change weekly.  If you think skilled nursing is needed, consider these things:  is this short-term rehab or is long term placement needed?  What therapies are are needed? Are they provided?  What is the staff to patient ratio?  How often does the doctor visit? What are out of pocket costs? What are the facilities quality ratings?

Another variable one should consider when looking for skilled nursing facilities for your loved ones is whether or not they have dementia. There are some skilled nursing facilities that are dementia certified and secured to prevent patients from wandering off the premises. You should also consider whether or not your loved one has any personality disorders as you will want them to be in a facility that can properly handle their needs.

If your loved one has been referred to a skilled nursing facility and you have questions or concerns, please do not hesitate to reach out to one of our specialists at SLS of California.  It is a free resource and we are happy to answer any questions or concerns you may have.  We are here for you.