Medicare Nursing Homes

2014 Medicare and Medigap Updates

A Nursing Home in the United States which participates in the Medicare program is usually referred to as a ‘Skilled Nursing Facility’ or ‘SNF’. Each Skilled Nursing Facility is subject to the laws and regulations of the State in which it is situated and is required to hold both a license and an inspection certificate.

A Medicare participating nursing home is required to have licensed practical nurses (LPNs) or Vocational Nurses (LVNs) on duty 24 hours per day and for at least 8 hours per day, 7 days per week, there must be a registered nurse on duty.

Services provided in Skilled Nursing Facilities are as follows:

Nurses

Nursing aides and assistants

Physical, occupational and speech therapists

Social workers

Recreational assistants

Room and board

It should be noted that most nursing staff members in Medicare Nursing Homes are provided by certified nursing assistants rather than by skilled personnel, although each Home is subject to federal requirements with regard to staffing and quality of care for residents. Management of the Home is provided by a Licensed Nursing Home Administrator.

Medicare can help you to recover from an illness in a Skilled Nursing Facility for up to 100 days providing you have the appropriate Hospital Insurance and meet the following criteria:

1 - You have been in hospital for at least 3 consecutive days not counting the day you are discharged.

2 - You are admitted to the Skilled Facility within 30 days of being discharged from the hospital.

3 - The services to be received within the Medicare Nursing Home are related to the condition you were treated for in hospital.

You require skilled nursing care or rehabilitation services on a daily basis which can only be provided on an inpatient basis, for example if you have suffered a stroke and in need of physical therapy or require multiple daily injections. The Medicare program does not cover nursing care if only supervisory care is needed such as help with bathing or walking. The facility’s staff will be able to help you in determining whether your illness or disability qualifies for recovery in one the many Medicare Nursing Homes.

In recent years, Medicare has begun hosting an online comparison site to encourage competition between Nursing Homes with the intention of improving the quality of care within each facility. Gradually, a few of the Homes are beginning to create more resident centered environments with the aim of making people feel like they are at home rather than in an institution. Residents are able to choose when they wake, eat and what they wish to do during the day. They are also given access to more companionship such as pets. You might see this kind of Skilled Facility referred to as a ‘greenhouse’.

Staff working within Medicare Nursing Homes utilizing this ‘greenhouse’ model are generally assigned to particular patients rather than being allocated specific tasks for several residents on a particular ward. This gives them the opportunity to develop relationships with individual patients, creating a family atmosphere and reducing the feelings of loneliness and displacement very often felt by residents being treated in a more institutional environment.

If you are eligible for medicare you may want to also read our article on medicare fraud to stay informed on this important subject.