Skilled Nursing or Nursing Homes

Skilled Nursing

The key difference between skilled nursingfacilities and nursing homes 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 willbe done to decide if the patient is able to return home.

Nursing Homes

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.

How Much Do Nursing Homes Cost?

There are important differences in medical coverage between these two care options. Outside of private pay and insurance program there are two main sources of government funding from Medicaid and Medicare. The biggest difference is that skilled nursing care is covered by Medicare under most circumstances, whereas long-term care services in nursing homes are not.

Under Medicare, the following services are covered at skilled nursing:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation to the nearest supplier of needed services
  • Dietary counseling

Up to 100 days in a skilled nursing facility is covered for the most part by Medicare. For 20 days or less, this is fully covered.Here is a breakdown of exactly what Medicare covers for a skilled nursing facility:

  • Days 1–20: $0 per day.
  • Days 21–100: $167.50 per day to be covered by patient or insurance. .
  • Days 101 and beyond: all costs covered by patient or insurance.

Long-term nursing homecare is not covered by Medicare. Most people pay for nursing home care through Medi-Cal.

Medi-Cal Income and Asset Limits

If you do not already qualify for Medi-Cal, you might be eligible if you have little income. The income limit for Medi-Cal now works out to 138% of the Federal Poverty Level (FPL)in California. In 2019, that was $17,236 for an individual ($1,436 per month)and $23,336 for a couple ($1,945 per month).

If you are elderly or disabled, you will still need to have few assets to qualify for Medi-Cal:$2,000 for an individual and $3,000 for a couple. Some assets are not counted,such as a home if your spouse is living there or if you intend to return there,one vehicle, personal belongings, and small burial or life insurance policies.

You are permitted to“spend down” your assets to qualify for Medi-Cal by paying for certain kinds of debts or expenses. Be very careful about transferring any of your assets.Medi-Cal will look back 60 months from the date that you apply for Medicaid-paid long-term care and examine any asset transfers to see if they were legitimate.

Share of Cost Medi-Cal

If you are"over-income" for Medi-Cal but have high health care expenses like nursing home fees, then you might qualify for a program called Share of Cost(SOC) Medi-Cal. SOC Medi-Cal allows recipients to pay a certain portion of their income every month towards their medical expenses, and Medi-Cal pays all of the expenses incurred afterward. The portion that the Medi-Cal recipient pays is called his or her share of cost.