What is a Nursing Home?

Nursing Homes are more commonly referred to as skilled nursing and rehab centers. Nursing care is typically provided for people who need long-term care or rehabilitation after surgery or are recovering from a more severe medical condition like a stroke. These communities provide all of the personal care and services of an assisted living with the addition of 24-hour nursing care.

Long-term care is for older adults who need around the clock nursing care. These residents need help not only with basic ADLs (activities of daily living) but need the supervision of staff to maintain their safety.

Skilled nursing and rehabilitation services are also provided in most nursing centers. Complex medical care is typically for patients who have had an injury, acute illness or a surgery. This level of care requires the services of a licensed nurse and often times physical, occupational or speech therapy. These patients usually require more frequent, intensive treatment and/or therapy services.

Residents typically live in private or shared accommodations. Sometimes bathrooms are shared between patients or even between two rooms. Some rooms and suites have a private shower and most have a shower room or “spa” on each wing. Nursing home care is usually the most expensive type of care due to the personnel and equipment required to maintain patient care.

HOW ARE THEY PAID

Because of the high cost, many patients utilized Medicare or Medicaid to get reimbursed for stays in a Nursing Home. If the condition or financial situation does not permit the use of these programs, the patient will pay via private funds or private insurance (if available). Reimbursement for nursing care community patients and residents is a bit complex. If a patient is there just for a short-term rehabilitation stay, Medicare and/or private insurance typically covers the stay. (See Medicare overview) If the patient continues to meet what is known as the “skilled criteria” during their rehab stay, Medicare covers the first twenty days at 100% and then 80 additional days at 80%. If a patient has a secondary insurance, it often covers the 20% not covered by Medicare.

For long-term care residents, private funds, Medicaid, and long-term care insurance are the typical methods of payment.

HOW ARE THEY REGULATED

Nursing Homes are regulated at both the state and the federal level. They are licensed and regulated by the Department of Public Health for the state, and are certified by both Medicaid and Medicare. In addition, there are licensing standards for the administrators and the clinical staff.