Skilled Nursing Versus Nursing Homes - What's The Difference?

Understanding the difference between a skilled nursing facility (SNF) and a nursing home can help you determine viable care options for your loved one.

When your aging loved one is discharged from the hospital, they may be referred to a skilled nursing facility instead of returning home. Understanding the difference between a skilled nursing facility and a nursing home is an important step in determining the best care option for your loved one.

The terms “skilled nursing facility” and “nursing home” are often used interchangeably to describe a residential facility that provides on-site, 24-hour medical care. Some people think the two are one in the same, when in fact they are very different.

A skilled nursing facility is a type of care while a nursing home is a senior living option. Let’s define both more clearly so you can make an informed decision about your options.

Skilled Nursing Facilities vs. Nursing Homes

The key difference between a skilled nursing facility and a nursing home is the required medical attention and the length of stay. A skilled nursing facility is usually used following a short hospital stay, when the patient requires specific medical services to fully recover. They have specialized staff such as speech-language pathologists, rehabilitation specialists, and audiologists who are not typically staffed in a nursing home. Following a short skilled nursing rehabilitation stay, a patient assessment will be done to decide if the patient is able to return home.

A nursing home, on the other hand, provides permanent custodial care—not medical care. These locations offer certified health professionals, meal preparation, and assistance with non-medical, everyday living tasks such as bathing, grooming, bathroom use, medication monitoring, and more. Nursing homes offer 24-hour care as well as room and board. Many nursing homes also have special wings for Alzheimer’s and dementia patients.

Nursing Home Costs – Medicare vs Medi-Cal (California Medicaid)

For the elderly population, skilled nursing facilities and nursing homes bills get paid in two different ways, creating what Michelle Cotte of the NY Times calls a “bifurcated population.” Skilled nursing patients are short-term residents, who usually arrive after a hospital stay. Nursing home residents are long-haulers needing custodial care, mostly seniors and the severely disabled. The majority of skilled nursing short stays are paid for by Medicare, which reimburses facilities at a much higher level than Medi-Cal, which covers permanent-stay residents.

How to Choose a Skilled Nursing or Nursing Home Facility

A hospital case manager or agency social worker may give you a list of possible skilled nursing facilities or nursing homes that have availability. Sarah Ordover, Owner of Assisted Living Locators Los Angeles, recommends doing your research before choosing a short or long term nursing facility. The Center for Medicare and Medicaid Services (CMS) has created a Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more.

The Nursing Home Compare web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. There is one overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

  • Health Inspections – The health inspection rating contains the 3 most recent health inspections and investigations due to complaints. This information is gathered by trained, objective inspectors who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicaid and Medicare’s minimum quality requirements. The most recent survey findings are weighted more than the prior year.
  • Staffing – The staffing rating has information about the number of hours of care provided on average to each resident each day by nursing staff. This rating considers differences in the levels of residents' care need in each nursing home. For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.
  • Quality Measures (QMs) – The quality measure rating has information on 15 different physical and clinical measures for nursing home residents. The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.

Non-profit public interest organization ProPublica has developed its own database called Nursing Home Inspect which compares nursing homes based on the deficiencies cited by regulators and the penalties imposed in the past three years. This database allows you to search nearly 80,000 nursing home inspection reports to look for trends or patterns; evaluate nursing homes near you; and find nursing homes that have been cited for deficiencies in infection control.

Ordover says “In the Los Angeles area, there is a wide variance in quality of service at skilled nursing and nursing homes. Remember, you have choice. Be sure to do your homework before deciding on a place for your family member to move. It is a vitally important decision and one that should be thoroughly investigated.”

Assisted Living Locators Los Angeles owner Sarah Ordover is one of LA’s top senior living advisors. Certified in dementia care, Sarah is a trained aging specialist who holds an RCFE assisted living administrators license. Sarah thoughtfully guides families through the senior living decision-making process, helping them find the best solution for their loved ones. Call Sarah at 310-853-8282 for a consultation. Assisted Living Locators is free to clients.

References:

https://www.nytimes.com/2021/08/01/opinion/aging-nursing-homes.html?referringSource=articleShare&fbclid=IwAR11E-Xu-Xygy5ULeN5aNXV-Yu9F0tPEZT-eSxbIFEQpNENA5gI8eoLj3tQ

https://projects.propublica.org/nursing-homes/

https://www.medicare.gov/care-compare/?providerType=NursingHome&redirect=true