What’s the Difference Between Skilled Nursing Care and a Nursing Home?


Understanding the terminology used in the long-term care industry is an important first step in determining viable care options for an aging loved one. When it comes to senior care, there are a lot of terms that sound similar and some are used interchangeably.

Confusion often arises surrounding use of the term “skilled nursing.” It is helpful to consider that skilled nursing is a description of the type of service that is offered. The need for skilled nursing services does not automatically necessitate placement in a facility, though, because it is available in a variety of settings, including a senior’s private home.

What Is Skilled Nursing Care?

Skilled nursing care is a high level of medical care that must be provided by or under the direct supervision of licensed health professionals, such as registered nurses (RNs) and physical, speech, and occupational therapists. These services can be necessary over the short term for rehabilitation from an illness or injury, or they may be required over the long term for patients who need a high level of care on a frequent or constant basis due to a chronic medical condition.

Examples of skilled nursing services include wound care, intravenous (IV) therapy, injections, catheter care, physical therapy, and monitoring of vital signs and medical equipment. Skilled nursing care provided in any setting for any duration must be ordered by a doctor to be covered by Medicare, Medicaid, the U.S. Department of Veterans Affairs (VA) or private health insurance.

Skilled Nursing Care at Home

As more seniors choose to age in place, home health agencies have responded by offering skilled services provided by licensed nurses or therapists in clients’ homes. When prescribed by a doctor, these skilled care services can be covered by Medicare, some private health insurance policies, the VA and long-term care insurance policies. Utilizing a home health care provider enables a senior to receive highly effective medical treatment while remaining as independent as possible in the comfort of their own home.

Read: How to Pay for In-Home Care

Skilled Nursing Care in Assisted Living Facilities

Seniors who require more assistance than can be provided in the home may need to consider a move to an assisted living facility (ALF). Assisted living facilities provide a wide range of services to individuals who want to maintain some level of independence but require support with activities of daily living (ADLs).

Assisted living facilities vary widely in the levels of care available, and state licensing often determines the tiers of medical care that can be provided in these settings. Residents’ care plans are created, overseen and regularly reviewed by RNs and licensed practical nurses (LPNs). Some level of security, personal care and nursing staff is available around the clock, but the purpose of assisted living is to provide nonmedical supervision and support, not 24/7 skilled care.

If a resident’s care needs exceed what the ALF can provide, they must either hire a home health agency to come in and provide additional services in their apartment or consider moving to the next level of residential care: a nursing home.

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Skilled Nursing Facility vs. Nursing Home

Nursing homes are licensed healthcare residences for individuals who require a higher level of medical care than can be provided in an assisted living facility. Skilled nursing staff consisting of RNs, LPNs and certified nursing assistants (CNAs) are available to provide 24-hour medical attention and assist with ADLs.

Many people also refer to nursing homes as skilled nursing facilities (SNFs). While this isn’t necessarily incorrect, it’s important to understand the difference between a nursing home and a skilled nursing facility. Both provide around-the-clock medical care on site. However, SNFs are commonly used for short-term rehabilitative stays, which are at least partially covered by Medicare for up to 100 days in many instances. Medicare does not pay for long-term or permanent stays in nursing homes.

Medicaid, on the other hand, covers both short-term stays and extended stays in nursing facilities for seniors with limited assets and low income who have a medical need for this high level of care. Keep in mind that the details of this coverage and eligibility requirements vary by state.

Please note that some facilities may provide only long-term care, only short-term care for rehabilitation purposes or both. In order to be certified by the Centers for Medicare & Medicaid Services (CMS), skilled nursing facilities and nursing homes must meet strict criteria and are subject to periodic inspections to ensure that quality standards are being met.

Evaluating Senior Care Options

When researching elder care, whether you are looking for home health care or a nursing home, be sure to ask about necessary state and federal certifications and regulations as well as who enforces them. You can find an overview of all care types and explore local providers in your area using the AgingCare.com Senior Living Guide.

Sources: Home Health Services Coverage (https://www.medicare.gov/coverage/home-health-services); VA nursing homes, assisted living, and home health care (https://www.va.gov/health-care/about-va-health-benefits/long-term-care/); SNF Care Coverage (https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care); Nursing Facilities (https://www.medicaid.gov/medicaid/ltss/institutional/nursing/index.html)

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