What is Skilled Nursing (SNF)?

What is skilled nursing?

Skilled Nursing Facilities (SNF) (how do you say SNF?…sounds like ‘sniff’) are for individuals that need short-term rehabilitation (physical, occupational or speech therapy and nursing services) after being discharged from a hospital. The individual is qualified for SNF if they have had a three (3) midnight stay in the hospital, and the attending physician observes the individual needs some rehabilitation to be able to go back to their prior setting safely, if appropriate. An average length of stay at a SNF is typically less than 30 days, though sometimes individuals need a longer stay. Medicare allots 100 days of coverage in SNF’s.  

For example: Let’s say an individual fell at home and broke their hip. They go to the hospital, have stayed in the hospital for at least 3 midnight’s, and the attending physician writes an order for SNF. The hospital’s discharge planner (sometimes called social worker) would meet with the patient and/or their durable power of attorney (DPOA-Healthcare) to discuss skilled nursing communities. Typically, a discharge planner does provide a list of SNF’s. However, most discharge planners have not visited these SNF’s, so they honestly do not know what the care is like and what is the recovery rate. Discharge planners are not entirely at fault because they are extremely busy and are being pushed to discharge patients quickly so the bed can be filled with another patient. In my experience many discharge planners do not make the time to go visit SNF’s, so please do not take their list and opinion as gospel. My advice, besides using my services, is tour the SNF’s yourself and see first-hand what you think. Moving onward…the patient or DPOA has the final decision of which skilled nursing to attend. Of course, there must be a room available at the SNF for the patient to be transferred from the hospital to the community. When a SNF is chosen by the patient or the DPOA, the discharge planner contacts the SNF and arranges services for the patient to be transported via the SNF’s bus/van to the community.

How does an individual pay for their short-term stay?

Typically, each patient is allotted 100 days of skilled nursing, but remember the average length of stay at a SNF is typically less than 30 days. If a patient does have standard Medicare, Medicare pays 100% of days 1-20. On day 21-100, Medicare only pays 80% of the stay, which means 20% will need to be either paid by a supplemental insurance or out-of-pocket (I believe the daily rate for SNF is $170.50). The SNF determines how long the patient needs to stay at the community. Fortunately, many SNF’s are getting patients rehabilitated within 20 days, so sometimes the day 21 concept is not an issue.

Now, if a patient has a Medicare Replacement Plan (Humana, Coventry, etc.), the SNF is at the mercy of the insurance company to determine how long they will pay for the patient’s stay. I am not an advocate for Medicare Replacement Plans; I am sure I’ll blog about my reasoning another day. Furthermore, there are SNF’s that are not in contract with some Medicare Replacement Plans, so the coverage is considered out-of-network, which means a patient needs to find a SNF that is in contract with their Medicare Replacement Plan, or else you will have to pay out-of-pocket at the SNF.

What is a 60-day wellness break?

I am going to try to explain this in layman’s term as much as I can.

For example: Let’s say an individual fell and broke their hip at home. They go to the hospital, have the 3 midnight stays, qualify for SNF, and rehabilitate at a SNF for 25 days (remember they are allotted 100 days). They go home and do well until they have another major fall or even a sickness within their 30 days from being discharged from the SNF. So, they go to the hospital, have the 3 midnight stays again, and qualify for SNF. Here is where the 60-day wellness break kicks in…since they spent 25 days at the first SNF and they now need SNF again, but there has not been a 60-day break from the day they left the first SNF to home, they are still using their prior 100 days. So, they are left with 75 days of Medicare coverage instead of having a new set of 100 days.

Now, let’s say during their first SNF visit they spent 25 days (out of 100 days) at the SNF. They go home, and after 60 days of being discharged from the SNF they have another fall that requires another 3 midnight stay in the hospital. So, they need SNF again. Since they had a 60-day wellness break (no qualifying hospital stays in 60 days) they receive a new set of 100 days of Medicare coverage.

There is so many other areas of the SNF world I could write about in this blog, but we’ll just leave it at this. Until my next post, please feel free to contact me with any questions or guidance to which SNF is top-rated in the area. It is best to have your ducks in a row before an injury or illness occurs. Being proactive will definitely save you and/or your DPOA from the stress and anxiety of where to go last minute.