How Nursing Homes & Skilled Nursing Facilities are Similar and How they Differ
According to reliable sources, Colorado has about 230 “nursing homes” and more than 200 “skilled nursing facilities” (SNFs). Due to their similar sounding names, these two entities are often confused with one another. It’s true that nursing homes and SNFs do have some things in common. Both offer a place to stay while providing custodial and medical care. They have 24-hour nursing staffs, can access emergency care when that’s needed, and may offer certain amenities that are similar as well. But the fact is the overall services they offer are different and are intended for persons with different conditions and circumstances. Here we will offer some of the key distinctions between the two.
Duration of stay is different
One key difference is that nursing homes are typically a long-term place to live for seniors who do not need a hospital but require a higher-than-normal level of care or medical attention. Their stay is usually indefinite. By contrast, SNFs are geared more toward providing care for residents who require short-term medically necessary services. SNF patients are commonly persons who have just left the hospital and require follow-up rehabilitation. SNF services can include physical therapy, IV therapy, occupational therapy, speech therapy, and more. The typical goal in SNFs is to get well enough to go home.
Reasons for admission are different in Nursing Home and Skilled Nursing
The differing durations of stay and types of care offered coincide with the differing reasons for admission to a nursing home or SNF. Nursing homes benefit those who cannot care for themselves and their homes in a secure manner, often due to cognitive decline and worsening health. The patient/resident may require memory care or mobility assistance. They may also need help with everyday tasks and grooming, and with managing medications. Many people in nursing homes are bedridden and immobile, thereby requiring help in every aspect of personal care. A nursing home is often a good fit for those with cognitive decline (such as due to dementia or Alzheimer’s) or who have other impairments in mobility, communication, hygiene, and memory.
A patient normally enters a SNF for different reasons, such as monitoring physical and/or other therapy or receiving wound care or selected rehabilitation that’s needed following a hospitalization. Again, the goal of SNF care is to have a time-limited stay and recover well enough to return to home, perhaps with an arrangement for additional services and support there if needed.
Slightly different caregivers
Nursing home care is largely provided by licensed practical nurses (LPNs) and other care professionals under the supervision of a registered nurse (RN). SNF care is typically provided by a team of physicians, nurse practitioners and physician assistants. In both cases, all necessary treatments are normally available within the facility. Most primary care physicians do not do rounds in SNFs, but once discharged from a SNF, patients may resume seeing their primary care docs as usual. In nursing homes many patients switch to being seen by the provider team that regularly visits the facility. But patients and families do generally have the option to maintain their relationship with their outside personal physicians. They can go see those physicians in their office unless circumstances such as severely limited mobility or compromised health make that unmanageable. It’s unusual for a primary care doc to see a patient in the nursing home.
Different amenities in Nursing Home and Skilled Nursing
Nursing homes offer an array of services to their residents, some fairly comparable to a hospital, but in a more home-like setting. They typically offer amenities like appropriate wellness activities, recreational opportunities, and other enrichment for residents and families. Other amenities nursing homes may offer include housekeepers, salon care, laundry service, accessibility ramps, transportation, counseling, security, and social outings for those who are able.
For those constantly worried about the health and well-being of a family member, a nursing home may offer great peace of mind in knowing their loved one is being looked after professionally and securely. Patients unable to care for themselves any longer due to serious illness, disease or debilitation may also feel their own relief at unburdening their family of their continuous care needs.
Service offerings in SNFs are not as varied and robust as in nursing homes, which is to be expected since SNFs are designed for short-term stays accompanied by very specific skilled nursing care. The SNF setting is not intended to be as home-like as a nursing home. But SNF residents can nonetheless expect to have housekeeping and laundry services, nutritious meals, medication management, minor and major medical supervision, and assistance with daily activities and mobility.
Medicare coverage differs in Nursing Home and Skilled Nursing
Nursing homes are considered long-term care (LTC), and Medicare as a general rule does not cover LTC. There may be some partial coverage for a limited period while the patient is receiving temporary doctor-recommended care. Covered expenses are largely limited to medically necessary services.Costs for what is normally termed room and board are the resident’s/patient’s responsibility. Veterans’ benefits as well as Medicaid may provide funds for the cost of a nursing home when ordered by a doctor. Provided there is documentation of the illness or injury, the costs could be at least covered in part.
Medicare will pay for SNF care if it is preceded by a qualifying hospital stay. Medicaid may also cover costs in some cases. With either program, the care must be recommended by a doctor and be provided in a facility that is Medicare-certified. It is advisable to consult with an advisor who specializes in Medicare/Medicaid coverage to understand the details in any person’s given set of circumstances.
Colorado’s nursing home and SNF costs
Our research indicates that nursing home costs in Colorado are among the highest in the nation, ranging as high as $85,000 to $100,000 or more per year. These costs are associated with the fact that skilled nursing services are required at nursing homes. The facilities have to spend a lot of money to staff all of the needed personnel. Another determining factor in cost is the type of room one has. There are rooms of all sizes and occupancies available, similar to that of a hotel. The larger and more private the room, the higher the cost will be.
As for skilled nursing facilities, sources that track these costs show some variability in Colorado. In the Denver and surrounding suburbs region, SNFs typically cost around $6,000 per month. In smaller cities, that monthly cost can be closer to $5,000. This is in keeping with national statistical information that finds smaller SNFs in less densely populated areas tend to be less expensive. One source lists Texas as the lowest-average-cost state for SNFs at just under $5,000 per month. This would suggest Colorado SNFs are not extraordinarily expensive. (Contrast this to Alaska, which is reported in one database to have the highest average cost at $37,000 per month.) Daily rates for SNFs typically range from $275 to $300 in national surveys.
Factors besides location that affect the cost of SNFs include the type of facility (size, scope of services available on site, amenities offered), the level of care needed, and the length of stay. Patients who need more intensive care or more frequent therapy services will be charged higher rates. Not surprisingly, private rooms have higher costs than semi-private.
Colorado help via Medicare/Medicaid or VA
Seniors living in Colorado may qualify for assistance with nursing home or SNF costs through either the HCBS Waiver for those who are Elderly, Blind or Disabled or the HCBS Waiver for Community Health Supports. These waivers require that you are eligible for Medicaid, which in turn requires that your income falls below certain limits. See (Health First Colorado) for more detailed information.
With nursing homes, if you have Medicaid, make sure to find a nursing home that accepts that coverage. If you have Medicare, find a Medicare-certified nursing home that will work with the federal insurance. In some cases costs may be paid for by the Veterans Administration. If you are a veteran, make sure you locate VA nursing homes, specifically tailored to those who have served in the armed forces.
The official Medicare.gov website states Medicare Part A (Hospital Insurance) covers care in a SNF for a limited time if all of these conditions apply:
- You have Medicare Part A and have days left to use in your benefit period
- You have a qualifying inpatient hospital stay prior to entering a SNF
- Your doctor affirms you need daily skilled care—from, or under the supervision of, skilled nursing or therapy staff
- You get these skilled services in a Medicare-certified SNF
- You need these skilled services for a qualifying medical condition
Full Medicare coverage is limited to 20 days. For days 21 through 100, the patient is responsible for a co-insurance payment. After 100 days the patient is fully responsible for payment.
Medicare.gov also states that Medicare covers very limited and medically necessary skilled care in a nursing home or in your own home if you need short-term skilled care for an illness or injury and you meet certain very specific conditions. In no case is custodial care or room and board costs paid for by Medicare.
The criteria that determine when Medicare or Medicaid covers SNF or nursing home care are quite precise. And coverage may vary depending on what Medicare plans a person has (Medicare Advantage vs. Original Medicare, Medicare Supplement, Part D drug plan, etc.) In all situations, it’s imperative to check your policy or policies and perhaps consult with an expert advisor who focuses on this area.
The role of private LTC insurance in Nursing Home and Skilled Nursing
Because many if not most seniors are aware of Medicare’s coverage limitations, they may choose to privately purchase long-term care insurance designed to pay for nursing home care, and for skilled nursing care as well. Policies vary as to how much will be paid for (usually a per-day figure), and for what services, and for how long. There is commonly a lifetime benefit stipulated, meaning no more benefits are paid when that is reached. Premium costs necessarily vary according to levels of coverage chosen.
LTC policies often include provisions to pay for skilled nursing care and for other services labeled as home care or informal care or adult day care, with these separate services having their own benefit limits. Private insurance may or may not pay for care that is custodial in nature—such as help with bathing, dressing, and eating—things commonly referred to as activities of daily living. Note that LTC policies come in a variety of “flavors,” and coverages will vary. There are also hybrid insurance products that combine LTC coverage and/or life insurance and/or annuities that can help pay for nursing home care if and when it is needed. So it is vital to clearly understand all of any policy’s provisions before purchasing it.
When it’s time to choose between a Nursing Home and Skilled Nursing
Older adults in need of any supportive care—especially long-term care—should consult with their caregivers, doctors, and family members before making any decisions. Professional evaluation of your health status and thorough research of your options are essential.
Note that it is increasingly common today for senior residential complexes to offer a continuum-of-care structure. Which means a person might be able to reside initially in an independent-living retirement community, then move to assisted living if necessary, and then as needed move to a more dependent-care situation such as memory/dementia care—all while still residing on the same campus. Be sure to consider factors like size, the offered levels of care, their amenities (socializing activities? nutritious meals? pet-friendly? and so on), location (convenient for visitors?) and of course their cost (including whether the care-providing component accepts Medicare/Medicaid).
Locating Nursing Home and Skilled Nursing
Facilities in Colorado
Multiple directories listing the different kinds of facilities in Colorado are available online. One source is the state Department of Public Health and Environment (https://cdphe.colorado.gov/find-and-compare-facilities). Colorado’s Area Agencies on Aging can be another good information/advisory source. All of the state’s AAAs are AgeWise Colorado Providers and can be linked to directly under the Provider Directory tab on our website by choosing the submenu item “Aging Advocacy and Resources.” More Colorado AAA information is available at (https://drcog.org/programs/area-agency-aging).