As you explore care for older adults, you may encounter many new terms and care options. Sometimes, knowing which resources are best for your circumstances is challenging. This issue is especially apparent when you’re looking for residential support for your loved one and exploring skilled nursing facilities and nursing homes.
Both nursing homes and skilled nursing facilities offer around-the-clock residential care, but they differ in a number of ways. Kelley Lewis, a certified senior transition specialist at Seniority Senior Housing Services, says terms like “nursing home” and “facility” are even becoming less frequent. “They are now called communities, which gives a better connotation than the nursing homes of old,” she says, noting many communities are all-inclusive, offer activities and provide support with activities of daily living (ADLs).
Here, experts provide insights on what amenities each option includes and what you need to know to decide which type of care is best for you or your loved one.
What is a skilled nursing facility?
A skilled nursing facility (SNF) is a short-term, in-patient service where patients receive rehabilitation services and medical treatment. SNFs are a transitory support that helps you as you adjust to and heal from the following:
- Intravenous (IV) delivery of fluids, nutrients, blood or medication.
- Feeding tube and catheter management.
- Wound care and cleaning.
- Pain management and post-surgical care.
Skilled nursing care is usually initiated through a referral from their medical provider. SNF employees have specialized training — as physical therapists, occupational therapists or in related roles — to help you adapt to life after an event, like surgery, and regain functions. Before starting care, patients communicate with their provider and develop an individualized care plan with the facility staff. Services typically last two to three weeks, though their stay can be shorter or longer.
“An individual usually finds their way to a skilled nursing facility from a hospital,” says Patrick Mish, CEO and Co-founder of SilverStay, a transition support company that aids individuals with complex health needs as they transition to higher levels of care. “So usually, after some sort of acute event, they are discharged to the skilled facility to get physical and occupational therapy as they rebuild strength on returning home.”
Lewis adds that “skilled nursing communities” is a broader term that can include both Assisted Living Facilities (ALFs) and Residential Assisted Living (RAL), which is operated by skilled nurses. RALs are “usually smaller in size, closer to a residential home where 3-16 residents live and get more intimate and individualized care from the caretakers and staff,” says Lewis. “They can offer the same options as the traditional nursing home, such as memory care, but this varies.”
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Nursing home vs. skilled nursing: are they the same?
A nursing home is a long-term care option for those who cannot care for themselves independently. Whereas skilled nursing facilities require a referral, patients can transfer to nursing homes from assisted living facilities or directly from home. Nursing homes are federally regulated and provide care led by a mix of professional nurses, physicians, administrators and a director. Some also provide rehabilitation services like physical, speech and occupational therapy.
“A nursing home provides long-term care for individuals needing assistance with activities of daily living (ADLs), memory care for conditions like Alzheimer’s disease or end-of-life care,” says Mish. “In this setting, an individual with care needs will live indefinitely while receiving the care they require.”
Some essential services provided by a nursing home may include:
- Room and board.
- Meals, including nutrition care.
- Medical and diagnostic services.
- 24-hour skilled nursing care.
- Access to a pharmacy.
- Medication support.
- Assistance with dressing, bathing, going to the bathroom and eating.
- 24-hour emergency medical care.
- Social activities.
- Social services, including counseling.
- Therapies include physical, speech and occupational therapy.
What is the cost difference between nursing homes and skilled nursing facilities?
Typically, health insurance covers skilled nursing services — otherwise, it would cost hundreds daily, experts say. However, most insurance companies don’t pay for nursing homes. The average cost of a private one-bedroom in a nursing home is $116,800 per year ($104,025 for semi-private), according to a 2023 cost of care report by Genworth.
“Nursing homes are paid one of two ways: private pay at between $8,000 to $15,000 per month, or if the individual meets financial and medical eligibility criteria for Medicaid Long Term Care, then Medicaid will cover the cost of the nursing home,” Mish says. He notes that assisted living tends to be a good option for individuals who don’t qualify for Medicaid but cannot pay tens of thousands of dollars per month for their care needs. In many markets, assisted living can be accessed for as little as $2,000 monthly.
Lewis says the cost of care depends on your needs, but smaller ALFs or RALs also tend to be more affordable. “Many find that the best option is to sell the home the loved one has occupied to help pay for the care that is needed,” she says.
Nursing home vs. skilled nursing: which is right for your loved one?
So, how do you decide if a nursing home or a skilled nursing facility is the best care option for yourself or your loved one? Start by asking a few questions:
- Are you seeking short-term or long-term support?
- Have you or they tried a skilled nursing facility but not met recovery goals?
- Can you afford to bring in care experts for support at home?
Other factors to consider include:
Availability
Mish says skilled nursing facilities are rated, and those with good ratings tend to have limited availability, but the short-term beds do turn over. Nursing homes are more widely available, but those with high ratings and a quality reputation fill up quickly, and it can be harder to find placements.
Ratings and reviews
Find a nursing home
You can use Care.com to search for skilled nursing facilities and nursing homes in your area, check reviews, schedule tours and more. You can also providers on your local state health department website or at Medicare.gov to see penalties in the last three years, health inspection results, ratings and more. The National Institute on Aging also recommends contacting your local Area Agency On Aging or the Joint Commission’s Quality Check.
Alternative or combined care options
Some nursing homes offer rehabilitation support, like physical and occupational therapy. Occasionally, patients can receive short-term skilled nursing services in nursing homes, senior rehab facilities or at home. Alternatively, “a skilled nursing facility can be a nursing home for these [rehabilitation] purposes,” Lewis says, especially if care involves more regular invasive treatments.
Support for families seeking skilled nursing or community care
Mish says families navigating between skilled nursing facilities and nursing homes often require support due to the complexity of healthcare decisions. A transition specialist or senior placement agent can help with this process. “Having support can help families understand the differences between SNFs and nursing homes, assess their loved one’s care needs accurately, navigate insurance coverage and payment options and make informed decisions that align with their loved one’s preferences and values,” he says.
Lewis affirms this, noting that senior placement agents are a free service where skilled professionals help identify one’s best care options. “Working with an expert can mean the difference between lots of wasted time, frustration and unsafe situations, and getting your loved one into the right environment quickly and safely with minimal stress,” Mish adds.
The bottom line
Skilled nursing facilities and nursing homes overlap in many ways, but they have a few distinct differences as well. Both offer around-the-clock residential care, but the right option for you or a loved one will depend on the complexity of care needed, how long you need care and other factors.
There’s much to consider while seeking the “right fit” for care and managing a loved one’s needs. Thankfully, there are resources, like medical care providers, social workers and senior care placement agents, who can help you make the best care decisions, no matter your circumstances.
