When it comes to senior living, many terms get thrown around: skilled nursing and nursing homes are two examples. Oftentimes, the terms are used interchangeably. The confusion leaves many caregivers asking, "is there a difference between skilled nursing and a nursing home, and if so, what's the difference?
"The words are used interchangeably in everyday conversations," explains says Jane Shukitis, Senior Vice President for Aging and Community Services at Unity Health System in , which offers many options for senior living (www.unityhealth.org). When a caregiver or elder refers to a nursing home, they may actually be speaking of skilled nursing. The same can be said for senior community staff and even government entities. For example, on the Medicare website, the terms are used interchangeably. The website offers a feature to compare skilled nursing facilities, but the tool is called "Nursing Home Compare tool." In reality, it evaluates skilled nursing facilities, because those are the only entities regulated by Medicare.
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"Technically there are differences between skilled nursing and nursing homes and it has to do with which entity is regulates and certifies the facility," says Shukitis.
Skilled nursing facilities are covered by Medicare (for a period of time) but nursing homes are not. Medicare certifies skilled nursing facilities by evaluating a number of criteria. Nursing homes are defined differently.
Definition of Skilled Nursing
To be certified by Medicare or Medicaid, skilled nursing facilities are regulated by the Department of Health and must meet strict criteria:
- Must have a transfer agreement in place with hospitals in case a resident/patient requires emergency care, restorative, or rehabilitation care.
- Skilled nursing and rehabilitation staff manage, observe and evaluate care. Examples of skilled care include intravenous injections and physical therapy. Care that can be given by non-professional staff isn't considered skilled care, according to the Medicare website (www.medicare.gov). Medicare covers skilled care services that are needed daily for up to 100 days.
- Medicare certifies these facilities to ensure they have the staff and equipment to give skilled nursing care, rehabilitation services and other related health services. Skilled nursing and rehabilitation staff includes:
- Registered nurses
- Medical director (to provide oversight for clinical quality and medical policies/practices)
- Licensed practical and vocational nurses
- Licenses physical and occupational therapists
- Speech-language pathologists
For more information about requirements for skilled nursing, see Medicare Coverage of Skilled Nursing Facility Care.
Nursing homes provide care for daily activities like getting in and out of bed, meals, bathing, dressing and using the bathroom. They may have certified professional health care works on staff like nurses and doctors. However, nursing homes are not covered by Medicare or Medicaid because they are not certified and not regulated by the national government. Nursing homes are more often run by charitable organizations, and don't provide the full spectrum of care that a skilled nursing facility does. Shukitis gives an example in : the sisters of nursing home, which is run by nuns.
Nursing Homes serve as permanent residences for people who are too frail or sick to live at home because of physical, emotional or mental problems. Nursing home residents usually require daily assistance.
How Medicare defines nursing homes
- 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.
Medicare doesn't certify these facilities, but oftentimes, they are licensed and inspected by state oversight agencies. It is usually the Department of Health that fulfills this function, but in some states it may be the Department of Social Services. Visit your state Department of Health website for more information.
When finding care for your parent – call it skilled nursing or a nursing home – be sure to ask about certifications and regulations and who governs them. You can find skilled nursing facilities in your area using the AgingCare.com Senior Living Guide.