Oftentimes, when discussing elderly living, many different terms are used interchangeably. Two examples of these terms are skilled nursing care and assisted living. The confusion surrounding these terms often leaves the families of the patient wondering if there is a difference between the two, and if so, what is it?
Skilled Nursing Facilities
Well, for starters, skilled nursing facilities (SNF) are covered by Medicare for some period of time and assisted living facilities are not. In order for a facility to be covered by Medicare, it is evaluated and must meet strict criteria. These criteria are listed on www.medicare.gov:
Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Medicare-covered services include, but aren’t limited to:
- Semi-private room (a room you share with other patients)
- Skilled nursing care
- Physical and occupational therapy*
- Speech-language pathology services*
- Medical social services
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
*Medicare covers these services if they’re needed to meet your health goal.
Now, let’s find out who is eligible for SNF Medicare coverage. People with Medicare are covered if they meet all of these conditions:
- You have Part A and have days left in your benefit period.
- You have a qualifying hospital stay.
- Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff. If you’re in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they’re offered.
- You get these skilled services in a SNF that’s certified by Medicare.
- You need these skilled services for a medical condition that was either:
- A hospital-related medical condition.
- A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition.
Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient—you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay.
Assisted Living Facility
The distinguishing factor between a skilled nursing facility and an assisted living facility is that residents in the assisted living facility require daily care when it comes to completing everyday activities. These activities can include getting in and out of bed, eating three meals a day, dressing and undressing themselves, and using the restroom. Assisted living facilities are often managed by charitable, non-profit organizations and don’t provide the level of care that skilled nursing facilities do.
Assisted living facilities serve as homes for people who are incapable of living on their own due to physical, mental, or emotional issues. Below is a definition of assisted living facilities as defined by Medicare:
“Medicare doesn’t cover custodial care if it is the only kind of care you need—in other words, care that doesn’t require skilled health care professionals. Custodial care is care that helps you with usual daily activities like getting in and out of bed, eating, bathing, dressing, and using the bathroom.
It may also include care that most people do themselves, like using eye drops, oxygen, and taking care of colostomy or bladder catheters.”
In conclusion, when researching the best option for your loved one, be sure to inquire about the facility’s certifications, regulations, and management to determine whether you are making the right choice in regards to assisted living care or skilled nursing facility care.