In most cases, patients are referred to a skilled nursing or long term
care facility during hospitalization. The continuum of care process
within the healthcare community can be overwhelming for those of us
that are not familiar with it. We are here to help you with the
When a patient no longer meets the medical requirements for
hospitalization and connot safely return home, their discharge
planner and physician refer the patient and/or legal representative
to a skilled nursing or long term care facility for continued
Although there may be pressure to choose a skilled nursing or long term care
facility quickly, you are strongly urged to tour the facilities under
consideration before making a decision. During your visits try to
speak to staff and family members of residents. Ask to meet the
Administrator. He/She should be accessible and willing to speak with
Our admissions coordinator and business office manager can assist you in
determining your eligibility to receive benefits under most health
plans. There are several different types of insurance. Below are
examples of how each plan is administered in skilled nursing/long
term care facilities.
Medicare Part A -
Medicare is the national health insurance program for people age 65 or older,
some people under age 65 with disabilities and for people with
End-Stage Renal Disease (ESRD).
Medicare pays only for medically necessary skilled nursing facility (SNF)
care. Generally, skilled care is available only for a short time
after a hospitalization. Skilled care is health care given when you
need skilled nursing or rehabilitation staff to manage, observe, and
evaluate your care. Examples of skilled care are changing sterile
dressings and physical therapy.
To qualify for Medicare Part A Skilled Nursing Coverage, the beneficiary
must spend at least 3 full days in a hospital, must have a skilled
nursing need and have a physician’s order. The beneficiary is
entitled to 20 days at 100% coverage and 80 days at 80% coverage per
spell of illness. After day 20 the beneficiary will be responsible
for the 20% co-pay, unless he or she has supplemental coverage.
There is a misconception that Medicare Part A covers up to 100 days
regardless of need. The beneficiary must actively participate, must
show consistent progress and be in need of a skilled service with a
physician’s certification order. In most cases, the length of stay
in a skilled nursing facility is likely to me much less than 100
Institutional Care Program (ICP) Medicaid -
Medicaid is a welfare program that pays for medical assistance for certain
individuals with low incomes and resources. This program became law
in 1965 and is jointly funded by the Federal and State governments to
assist States in providing medical long-term care assistance to
people who meet certain eligibility criteria. Medicaid is the largest
source of funding for medical and health-related services for people
with limited income.
Long-term care is considered to be “custodial care” and is covered under
the ICP Medicaid program for qualifying individuals. Most of these
beneficiaries come from home, and assisted living facilities or
another nursing home transistion.
VA Benefits (Service connected of 70% or more Veteran’s Administration Benefits)
Some veterans may be eligible for health insurance benefits that cover
skilled and long term care services. Contact our admissions
coordinator for more information.
There are many insurance plans that cover skilled and long term care
services. Contact our admissions coordinator for more information.
Long term, skilled and respite services are also available to private pay
clients. Contact our admissions coordinator for more information.
Making an Informed Decision
Skilled nursing and long term care facilities vary in the level of overall
health and functional impairment of individuals and in admission and
discharge practices. These differences can affect scores on the
quality measures but do not reflect the quality of care provided by
the nursing homes. Unless scores are adjusted for such factors, a
quality measure may not give a true and fair picture of clinical care
being provided. Therefore it is important to visit prospective
facilities and inquire about their services. Click on the links below
to learn more about questions to ask and facility comparisons.
Nursing Home Compare Web Site
Florida Health Care Association (FHCA)
Part D Prescription Drug Plan
Note: The following are brief summaries of complex subjects. They should be
used only as overviews and general guides to the Medicare, Medicaid,
and other insurance programs. The views expressed herein do not
necessarily reflect the policies or legal positions of the Centers
for Medicare & Medicaid Services (CMS) or the Department of
Health and Human Services (DHHS). These summaries do not render any
legal, accounting, or other professional advice, nor are they
intended to explain fully all of the provisions or exclusions of the
relevant laws, regulations, and rulings of the Medicare and Medicaid
program. Original sources of authority should be researched and