Skilled nursing helps patients transition safely to home after a hospitalization. The patient may not be quite ready to be at home, whether it’s a safety issue or an ongoing nursing need. Here are some commonly asked questions I hear in my role as a clinical liaison for Via Christi Villages.
Who should seek skilled nursing care?
Most of the time when someone has spent time in the hospital, they’re going to be weakened physically. Muscles atrophy quickly, especially with age, so if the patient has had any length of a hospital stay, they’re probably going to need some strengthening. Skilled nursing is a nice transition to be sure that when they get home they’re at the highest level of function they can be and the safest they can be, with the goal being to prevent a readmission back into the hospital.
What is the difference between a rehabilitation hospital and skilled nursing?
Some people may wonder what the difference is between a rehabilitation hospital and skilled nursing. They both provide physical and occupational therapy. At a rehab hospital, the patient has to be able to participate in therapy for a certain amount of time, which is often less than is required in a skilled nursing facility.
Who helps in the decision-making process?
Typically the decision about whether or not a patient would be a good candidate for skilled nursing is made at the hospital level or by health care providers who determine that someone is not quite ready to transition home.
Based on the criteria of the hospital, the patient may be well enough to be discharged but just aren’t quite safe enough to go home. Usually safety is an issue or whether or not there are resources or assistance available to the patient once they return home.
If someone’s not able to get around safely, or if they require standby assist or stairs in the home, they may be referred to skilled nursing. Physical and occupational therapy staff do assessments to determine if the patient would benefit from skilled nursing before being discharged from the hospital.
In my role as a clinical liaison, if a patient has received a referral for skilled nursing, I do a clinical review of the patient’s medical records and work with the hospital case manager to see if they would benefit from skilled nursing.
What factors should be considered when deciding if a patient is appropriate for a Via Christi Village skilled nursing unit?
Some of the factors taken into consideration when we place a patient in skilled nursing:
- Does the patient have a need for skilled nursing?
- Can we meet their needs at our care facilities at Via Christi Village?
- What are the patient’s long-term goals? Would they like to go home? To long-term care?
While we’re assessing a patient for skilled nursing placement, it’s important to look past the patient’s medical issues as there are often times other issues to take into account.
Some patients want to go to a facility that offers Mass; others want to be able to have their pets visit them. We try to look at the whole person and not just the physical needs. If you meet these other needs, you can often help improve the patient’s physical needs.
How long do patients stay in skilled nursing?
Many times patients will ask how long they will need to remain in skilled nursing. I explain that it often depends on the patient: How well they participate in therapy, how driven they are and if they really want to go home.
Once the patient has decided on a skilled nursing facility, I work to seamlessly to transition them from the hospital, including arranging for transportation and making sure all medical records and referrals are transferred.
Does insurance cover skilled nursing?
One common question I get is what will insurance cover when it comes to skilled nursing.
A patient has to be hospitalized for three “midnights” in order to qualify for skilled nursing.
If the patient has been healthy and hasn’t had a recent hospitalization, Medicare will cover 100 days in the skilled nursing facility. Medicare will pay for the first 20 days, then on day 21, if you have no secondary insurance, there is a co-pay of $161 per day. Most people have secondary or supplemental insurance and most of those will cover all or most of the co-pay.
If the patient has 60 days of wellness, they will get 100 days of skilled nursing covered by Medicare. If they are readmitted after a skilled nursing stay, the new hospitalization will also have to be subtracted from the covered 100 days.
If the patient returns home after a skilled nursing stay and finds that they need to continue with skilled nursing because things aren’t working out at home, they can come to skilled nursing from home if they’ve had a hospitalization within 30 days.
It’s important to note that long-term care is not covered by Medicare. Some people have long-term care insurance to help in the event that care is needed.