Services Offered in Skilled Nursing Facilities
Types of Care Offered in Nursing Homes & SNFs
Services offered in skilled nursing facilities target higher levels of care needed by individuals; outside of a hospital setting for health conditions requiring 24/7 monitoring by a medical staff.
Their goal is to help people function at the highest level possible, by providing the inpatient care needed to manage chronic illness or condition, or to recover from an illness or surgery.
Skilled nursing facilities have doctors, nurses, and health care aides constantly on call and available. They care for people recovering from a surgery, a hospital stay or ones needing long-term custodial care.
Nursing Home Services Offered
Skilled nursing facilities give short-term skilled nursing and rehabilitation services to individuals after a stay in an acute care hospital.
In 2010, more than 15,000 skilled nursing facilities furnished covered care to almost 1.7 million fee-for-service (FFS) beneficiaries. In 2011, Medicare spent nearly $32 billion on skilled nursing care. (Source: Medicare Payment Advisory Commission)
Skilled nursing facilities offer:
- Post-hospital and post-surgical care
- Assistance with activities of daily living
- Incontinence, catheter & colostomy care
- Long-term custodial care
- Individualized care plans
- Medication administration and IV services
- Therapeutic and special diets
- Diabetic management
- Medicare-certified beds
- Blood transfusions
- Medical supplies and durable medical equipment during the stay
- Restorative Rehabilitation services
- Speech-language pathology services
- Ambulance transportation
A Breakdown of Skilled Nursing Services
Post-Hospital and Post-Surgical Care
Post-hospital care is more intensive than skilled nursing care but less intensive than hospital care.
- Intravenous therapy
- Ventilator or tracheostomy care
- Therapeutic Interventions for Swallowing
- Internal Feedings
- Treatment of extensive wounds
- Neurological Care
- Management of Infectious Diseases
- Rehabilitation but have complicating medical conditions
Assistance with Activities of Daily Living
- Requires daily assistance with eating, dressing, and self-care
- Forgets to take medication or over-medicate
- Behaves in ways that could be harmful (to self or others)
- Wanders away from home or experiences frequent signs of memory loss
- Have needs that are not being safely met by current caregiver
- All Types of Catheter and Colostomy Care
- Bowel and Bladder Incontinence Care
Rehab designed to help individuals improve and maintain their health while working toward their maximum potential. Led by trained professionals, they promote wellness through a combination safe, effective exercise and education.
- Monitors blood glucose
- Monitors blood pressure
- Monitors medications
- Monitors nutrition and diet
- Monitors meal planning
- Hyper/hypoglycemia prevention
- Measures coping ability
- Monitors the complex range of new medications
- Adverse reactions or a need for changes in the dosage or type of medication
- Documents individual's unstable condition
- Documents medication changes and continuing probability of complications
- Initiates tube feedings
- Nasogastric tube and percutaneous tubes (including gastronomy)
Medical equipment during stay at skilled nursing
- Home oxygen equipment
- Hospital beds
Skilled nursing assessment
Upon entering a skilled nursing facility and during the intake process, a team of staff from different medical fields plans your care. Your skilled nursing care team evaluates the physician's orders. Then using the information gathered at intake, the team assesses the individual's condition.
Your doctor, the skilled nursing staff, and the person should decide on the services needed and the health goals to accomplish. *A health goal is the expected result of your treatment, like being able to walk a certain distance or to climb stairs.
The daily assessments and skilled care starts the very first day of arrival. If paid by Medicare, they require recorded assessments periodically. The first recorded assessment is within the first eight days of the stay. Medicare also requires the facility to record assessments on days 14, 30, 60, and 90 of the covered stay, until all 100 days are complete.
Assessment gathers the following information:
- Physical and mental condition at intake
- The medical history
- List of current medications
- Evaluate how well you can do activities of daily living (like bathing, dressing, eating, getting in and out of bed or a chair, moving around, and using the bathroom)
- Evaluate speech ability
- Assess decision-making ability
- Measure the physical limitations: hearing or vision, paralysis after a stroke, or balance problems
When the staff measures and assesses your health condition at the skilled nursing facility, the staff prepares or updates your care plan. You (if you're able) and/or your family, or someone acting on your behalf, have the right to take part in planning your care together with the nursing staff. Let the staff know if you want to take part. This helps keep you aware of how the care you get will help you reach your health care goals.
The Care Plan includes:
- What kind of services you need
- What type of healthcare professional should give you the services
- The length of time needed
- What kind of equipment or supplies you need (like a wheelchair or feeding tube)
- If you need a special diet
Skilled Nursing Goals for Patients
The goal for a rehabilitation center and skilled nursing facility is to develop a care plan that helps patients reach their health goals and to return home, if possible.
The care plan plays the biggest role in getting you home. So when looking into the facilities that are near you or those suggested to you by your doctor, friends or the hospital, do your own due diligence and ask questions to find out more about them. A useful online resource is Nursing Home Compare. Here are a few questions to get you started:
- Do they take care of many people with your medical problem? For example, if you had a hip replacement or stroke, how many patients with your problem have they cared for? A good facility is able to provide you with data that shows they give good quality care.
- Do they have a pathway, or protocol, for taking care of patients with your medical condition?
- Do they have physical therapists who work at the facility?
- Are the therapists experienced in helping people with your health problem?
- Will you see the same one or two therapists most days?
- Do they provide therapy every day, including Saturday and Sunday?
- How long do the therapy sessions last?
- If your primary care doctor or surgeon does not visit the facility, will there be a doctor in charge of your care?
- Will staff take the time to train you and your family or caregivers about care you will need at the home?
When selecting a skilled nursing facility, have more than one option to choose. If there is no bed available in the skilled facility that is your first choice, the hospital will need to transfer you to another qualified facility.
Make sure the hospital staff knows about the places you've chosen.
After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.
- What are Skilled Nursing Facilities?
- Services Offered in Skilled Nursing Facilities
- Compare to Assisted Living
- Myths about Nursing Homes
- Nursing Home Staff
- Nursing Home Administrators
- Nursing Home Costs
- Paying for a Nursing Home
- Medicare and Nursing Homes
- Medicaid and Nursing Homes
- Will Social Security Cover Nursing Home Costs
- How to Find a Nursing Home
- What to Look For When Touring a Nursing Home
- Moving Into a Nursing Home
- Nursing Home Checklist
- Nursing Home Trends
- Nursing Home Technology
- Medicare Quality Data