Going to a skilled nursing facility for rehab is a stressful but necessary step for many older adults. Following a hospital stay related to a serious illness or fall, older adults often transfer to a skilled nursing facility to further recover before returning home.
It’s important to understand what to expect while staying in a skilled nursing facility so you can make the most of the experience. And, so you can adequately plan for a safe return to home after your rehab is complete.
Who Pays for Skilled Nursing Facility Rehab?
Older adults covered by traditional or supplemental Medicare plans quality for short-term rehab after they have a “3-day stay” in a hospital. Depending on what injury or illness you are recovering from, the social workers at the hospital will help you identify an acute or post-acute (skilled nursing) rehab facility that accepts your insurance and has availability.
Over the course of your short-term rehab stay, your Medicare and/or supplemental Medicare Advantage policy will cover most of the cost of your services. As an example, original Medicare covers the following:
- For days 1–20, Medicare pays the full cost for covered services. You pay nothing.
- For days 21–100, Medicare pays all but a daily coinsurance for covered services. You pay a daily coinsurance. As of 2021, this amount is $185.50/day.
- For days beyond 100, Medicare pays nothing. You pay the full cost for covered services.
The coinsurance changes (increases) each year. If you have a Medicare Supplement Insurance (Medigap) policy with Original Medicare or are in a Medicare Advantage Plan (like an HMO or PPO), your costs may be different. Or, you may have additional coverage. If you’re in a Medicare Advantage Plan, you might not need to be in the hospital for 3 consecutive days. Check with your plan about coverage requirements for a skilled nursing stay.
Keep in mind that skilled nursing rehab is intended to be short-term which is defined as 100 days or less. If you require additional treatment and care beyond the allowable 100-day period, you will need to transition to long-term care at home or in a skilled nursing facility.
What Can I Expect from Therapy?
When you are admitted to a skilled nursing facility for rehab, you will have initial meetings with the community’s physical therapy team. As soon as you are able (and typically within 48 hours of admission), you will begin any therapy as ordered for you by your treating physician.
This could include any or all of the following therapy types:
- Speech Therapy: The assessment and treatment of communication problems and speech disorders.
- Occupational Therapy: Care that focuses on helping you perform daily tasks more easily.
- Physical Therapy: Rehabilitative care that focuses on improving movement, mobility, and function.
In a skilled nursing rehab setting, you’ll receive one or more therapies for an average of one or two hours per day. And, you can expect the attending physician to provide a comprehensive initial assessment within 30 days of your admission. Therapy usually takes place during the week. The national average length of stay for a skilled nursing facility rehab is 28 days.
If you are sent to an acute-rehab hospital instead of a skilled nursing facility, you can expect to receive typically three hours or more of therapy per day. Therapy sessions usually take place during the weeks and weekends. The national average length of stay for an acute rehab hospital is 16 days. Although it varies per facility, typically you will see a rehabilitation physician multiple times a week to assess your goals and progress.
Regardless of which rehab facility you choose, you will receive assistance with bathing, grooming, dressing, eating and taking your medication from certified nursing assistants.
What Happens After I Complete Rehab at the Skilled Nursing Facility?
Before treatment begins, your therapists will set goals based on your current condition. The basic idea is to help you return to or even improve your prior levels of function. Over time, and as you progress through treatments, they will note your progress and communicate often with your care team to ensure you are on the right path.
Since rehab stays are traditionally very short, the team will also start planning for your expected level of recovery at discharge. This just means they’ll anticipate your recovery level based on your current progress and work with you or your loved one to put a plan together for future care.
Typically, once older adults are discharged from their rehab at a skilled nursing facility, they are eligible to receive additional therapy at home from a Medicare certified home health provider. This therapy is a continuation of what you received in the skilled nursing facility and is also covered on a short-term basis by Medicare.
So long as you continue to progress in your rehab at home or in the skilled nursing facility, you will continue to receive services within your allowable Medicare reimbursed period. At the point you are no longer able to achieve progress in rehab, you will be discharged from therapy. (This simply means therapy will end because it is no longer classified as ‘medically necessary’ and thus not covered by Medicare.)
What if I Need More Care?
Many older adults find themselves needing or wanting extended care following a skilled nursing rehab stay. If that’s the case, and you’d like to stay at home, you’ll need to explore private-duty home care agencies for help with activities of daily living. The social worker at your skilled nursing rehab facility can recommend an agency and you can request a meeting in the facility before discharge.
We always recommend interviewing agencies before you discharge home so that you can ensure you are returning to a safe and supportive environment. And, so you have some support in the event you need someone to help you pick up any medicine or food during your first couple of days at home.
If you decide that home isn’t the best option for you, you can also ask your social worker to connect you with a local assisted living community. Their community sales team will also visit you in the skilled nursing facility and help you explore your options and next steps.
And finally, if your health conditions aren’t resolving and you still need ongoing skilled nursing care, you may need to transition to a long-term, private pay skilled nursing facility. Again, this is where the rehab facility’s social workers can assist you or your loved ones with finding a facility that is appropriate for your long-term needs. They’ll also start walking you through the process of getting your finances in order and possibly applying for Medicaid if appropriate.
If you do decide to return home, our team at CarePods can help you sustain and improve your health over the long-term. We also put a safety net in place with 24/7 remote monitoring so you’re never alone in the event of an emergency. We often partner with home care agencies to provide you with excellent, personalized care so you can avoid another trip to the hospital and make good decisions about where and how you want to age in future.
If you or someone you know is looking for high-quality, affordable senior care in Charlotte, Fort Mill, or Rock Hill, contact us today for a free consultation!