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Skilled nursing facilities, often referred to as “nursing homes” provide both short term rehabilitation, and long-term care.
A skilled nursing facility will have medically trained staff, such as nurses, physical therapists, occupational therapists, and a physician who monitors patients. There are social workers on site to ensure residents needs are met, care plans are coordinated, and residents have the medical equipment and services needed to discharge from the facility. There are activity directors at skilled nursing facilities who engage residents, encourage socialization, and plan activities for residents to enjoy.
Short term rehabilitation stays in a skilled nursing facility typically happen after a surgery, illness, or accident. People who have a hospital stay often discharge from the hospital to a skilled nursing facility for rehabilitation. A person in a skilled nursing facility will have access to physical therapy, occupational therapy, speech therapy, and nursing professionals. Those team members will work with the resident to increase strength, ensure medications are administered correctly, and assist with activities of daily life while the resident is there.
The focus in short term rehabilitation is on ensuring the resident regains as much strength and mobility as possible. Medical insurance, such as Medicare, covers the cost of short term rehabilitation. A person must need acute medical care or have a need for inpatient therapy. Insurance coverage for these services is dependent on the need for inpatient care, along with the person’s ability to show improvement in therapy. Many people are under the impression that Medicare will cover 100 days of skilled nursing care, which is incorrect. Medicare will cover up to 100 days of skilled nursing care. It is rare for someone to qualify for a stay longer than a few weeks. Medicare will cover 100 percent of the cost for only 20 days with a co-pay cost starting on the 21st day.
Long term care is available for residents who cannot live safely at home and need care. Medical insurance, such as Medicare, does not pay for long term care. Medicare pays for rehabilitation in a skilled nursing facility to help someone get well after a surgery, injury, or illness. Medicare does not cover the cost of care when a person is not improving and is unlikely to improve. For instance, Medicare would not cover the cost of care for a person with dementia who is not safe to live at home because there is no medical treatment available that would improve the dementia and allow the person to live safely at home. In that case, long term care in a nursing facility or assisted living memory care is often the best option. Long term care is considered custodial care. Custodial care is assistance with dressing, bathing, grooming, meals, transferring and ambulating. These are needs that do not require the attention of a medical professional such as a nurse
In long term care, most individuals have a shared room. A person can pay out of pocket for a private room. Once the individual has exhausted their resources, they can apply for Medicaid. Medicaid will cover the cost of living in a long term care facility, but it will not cover the cost of a private room at this time. Meals, activities, and utilities are included. In long term care, there are always nurses available to meet any medical needs a person may have.
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