Skilled nursing facility

What it means

A skilled nursing facility provides care requiring a nurse or therapist: wound care, intravenous medication, physical therapy after a hospital stay.

Medicare may cover a limited period of skilled nursing care following a qualifying hospital stay. It is short-term coverage tied to a clinical need, not coverage of long-term residence.

The same building often provides both skilled care and long-term custodial care, which is why families believe Medicare is paying for a stay that it is not.

Why it matters

The distinction between skilled and custodial care is what decides who pays, and getting it wrong is what leaves a family paying privately for care they assumed was covered.

Coverage can end when the clinical need ends, even though the person still cannot go home. Families are frequently told this at short notice.

When you are likely to meet it

• When a parent is discharged from hospital to a facility.
• When Medicare coverage of a stay is coming to an end.
• When comparing what a facility actually provides.

Levels of care, and who pays

The distinction that decides who pays, and the one families discover at the point of crisis.

Whether a state's Medicaid program covers care outside a nursing facility, and on what terms, is set by that state.

Related terms

• Activities of daily livingThe everyday self-care tasks — bathing, dressing, eating, using the toilet, moving from a bed to a chair, continence — that care assessments and insurance policies measure.
• Assisted livingHousing with help for daily tasks and staff on site, but without the licensed clinical care a nursing facility provides.
• Benefit periodThe unit Medicare counts hospital and rehabilitation days in — and it is not a calendar year.
• Community spouse resource allowanceWhat the husband or wife still at home may keep when the other qualifies for Medicaid care.
• Continuing care retirement communityA campus offering independent living through to nursing care, usually entered by paying a large fee up front.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Discharge plannerThe hospital staff member responsible for what happens after a stay ends.
• Home and community-based services waiverA Medicaid program paying for care at home instead of in a nursing facility.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• Lifetime reserve daysSixty extra hospital days a person may draw on once in their life, and never get back.
• Long-term care insuranceA policy that pays toward help with daily living — at home, in assisted living, or in a nursing facility — which health insurance and Medicare do not cover.
• Long-term care ombudsmanAn independent advocate for residents of nursing homes and other care facilities, who investigates complaints and works to resolve them.
• Maintenance coverageMedicare cover for skilled care that will not improve the patient, but prevents deterioration or preserves what they have.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• MedicareThe federal health insurance program for people aged sixty-five and over, and for some younger people with disabilities. It does not pay for long-term care.
• Medicare AdvantageMedicare delivered by a private insurance plan instead of directly by the government. It is also called Part C.
• MedigapA private policy that pays some of what Original Medicare leaves the patient to pay. It cannot be combined with a Medicare Advantage plan.
• Memory careResidential care designed for dementia — secured, higher-staffed, and more expensive than ordinary assisted living.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Qualifying hospital stayThe three consecutive inpatient days Medicare requires before it will pay for rehabilitation in a nursing facility.
• Quality Improvement OrganizationThe independent body that reviews a Medicare discharge or a termination of cover, free and fast, at the patient's request.
• Skilled careCare so complex that only professional or technical staff can safely provide or supervise it — the test Medicare coverage turns on.
• Spend-downUsing up income or assets on care until they fall below the limit at which Medicaid will start paying.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — skilled nursing facility care and what qualifies for it (opens in a new tab)

Sahvelo guidance that uses this

• Housing transitions