Medicare Benefits: Skilled Nursing Facilities and Home Health Care
This is a big one. While we appreciate a good sense of humor and try to make light of Medicare, insurance companies and the Texans, we are going to take this one seriously. Our hope is that you can use this post as a reference for when you or a friend may need skilled nursing or home health. Every time that a person needs these services, it is a challenging and stressful situation. So, please read this article, save it to your favorites and remember to call us and use us as a resource when you have questions or concerns.
Skilled Nursing Facility/SNF
What is a Skilled Nursing Facility/ SNF?
A Skilled Nursing Facility or SNF is any inpatient facility that provides medical treatment and rehabilitation by medical professionals. A skilled nursing facility could be an inpatient program associated with a hospital, a nursing home, or an assisted living facility with a skilled nursing program. Outside of a hospital, a skilled nursing facility provides the highest level of care. A skilled nursing facility is the right fit for someone who is living with a complex medical condition and needs 24/7 care from a registered nurse.
In our area, Baptist and Christus hospital each have a skilled nursing/rehabilitation center within the hospital building. Other options are PAM Rehabilitation, Buckner Calder Woods, Jefferson Nursing and Rehab, and many others. This should be discussed with your healthcare team to choose the best fit for your need.
Here’s how it works:
Suzy has an accident or an injury (stroke, surgery, and/or a fall) resulting in admission to her local hospital for a stay of 3 days. She is not quite ready to go home and resume normal daily activities, therefore a skilled nursing admission is needed for further rehabilitation and recovery. Her physician advises her to continue her care at a SNF of her choosing. Care can include physical therapy, occupational therapy, and/or speech therapy, wound care, and a number of other services in an effort to resume activities of daily living. This is ultimately the goal of any admission to a skilled nursing facility, to help patients get back to the comfort of their home. Suzy can continue her recovery at this facility for up to 100 days, as long as progress is attained.
Admission
If you have had a hospitalization for an acute illness or injury (stroke, surgery, joint replacement, etc.) that has resulted in an inpatient stay of 3 or more days, when you are released, you may need an admission to a Skilled Nursing Facility or “SNF”. This will be determined by your doctor if they feel you need additional medical treatment/care or that physical therapy/rehabilitation is necessary before you go home.
Coverage of Cost
Medicare Part A will cover up to 100 days in a skilled nursing facility if needed. Your length of stay will be determined by your progress. The staff and doctor at the facility will do periodic assessments on your progress and once they have determined that you are ready to be released, then a release date is set. Medicare will not cover your stay after that release date.
You can have more than one stay with a skilled nursing facility within a year but only if it has been 60 days since your last hospitalization and stay at a skilled nursing facility.
Home Health Care
Home Health Care is skilled care delivered directly to your home. If you need part-time or intermittent services, your doctor can order Home Health Services for in-home visits.
The home health services must be ordered by your doctor to be covered by Medicare/Medicare Advantage.
Examples include a person needing assistance with physical therapy for balance and mobility, respiratory therapy, medication management, chronic condition education and evaluation, and post operative care/recovery. The essence of home health care is to provide necessary but limited medical care at home. Home health does not include housekeeping, bathing, cooking, shopping or toileting.
There are many local Home Health companies. Do your research for a reputable company and consult your doctor for a referral.
Coverage for Home Health Services
Home health services are covered by Medicare Part A so long as the home health service determines that it is needed.
The home health care staff will determine how often they need to visit your home and exactly what services they will need to provide.
Services for skilled nursing and home health are covered by both traditional Medicare and Medicare Advantage. Your out-of-pocket cost will depend on the type of plan that you choose.
Finally, please feel free to call us with any questions or concerns. We are here to help you.
