Understanding Skilled Nursing Services
Definition of Skilled Nursing Care
Skilled nursing care refers to a patient’s need for medical care or treatment that can only be performed by licensed nurses or other licensed healthcare professionals. This type of care is typically provided in various settings such as hospitals, assisted living communities, Life Plan Communities, nursing homes, and other certified locations [1].
Licensed nurses deliver skilled nursing care under the supervision of a doctor, ensuring that patients receive the same level of nursing care as they would in a hospital. This care is essential for individuals recovering from an illness, injury, or surgery, providing them with continued recovery services including rehabilitative care from licensed therapists.
Importance of Skilled Nursing Facilities
Skilled nursing facilities (SNFs) play a crucial role in providing the highest level of care outside of a hospital. These facilities cater to individuals with complex medical conditions that require 24/7 care from a registered nurse. This is particularly important for those recovering from severe health incidents such as strokes or heart attacks, as they need intensive rehabilitative care [3].
SNFs offer around-the-clock nursing or medical care for residents who are chronically ill, recovering from an illness or surgery, and require frequent nursing care and related healthcare services. They also serve as transitional care between a hospital stay and a patient's home, which is increasingly important as hospital stays become shorter.
Understanding the role and importance of skilled nursing services and facilities can help individuals make informed decisions about their care options.
Services Offered in Skilled Nursing
Skilled nursing services encompass a wide range of medical and therapeutic care designed to meet the complex needs of patients who require a higher level of care. These services are essential for individuals recovering from illness or surgery, managing chronic conditions, or needing long-term care.
Medical Care and Therapies
Skilled nursing facilities (SNFs) provide comprehensive medical care that includes various therapies to help patients achieve the best possible outcomes. The medical care offered in skilled nursing includes:
- Physical Therapy: Helps patients recover mobility, strength, and function [1].
- Occupational Therapy: Assists patients in regaining the skills needed for daily living and working [5].
- Speech-Language Pathology: Provides therapy for speech, language, and swallowing disorders.
- Wound Care: Specialized care for complex wounds to promote healing and prevent infection.
- Intravenous (IV) Therapy: Administration of medications and fluids directly into the bloodstream.
- Injections: Administration of medications through injections, including insulin and other necessary treatments.
Monitoring and Vital Signs
Monitoring and managing vital signs are critical components of skilled nursing services. Skilled nursing staff are trained to continuously observe and assess patients' health status, ensuring timely intervention when needed. Key aspects of monitoring include:
- Vital Signs Monitoring: Regular checks of blood pressure, heart rate, respiration rate, and temperature.
- Medical Equipment Monitoring: Supervision of medical devices such as ventilators, feeding tubes, and catheters.
Rehabilitation Services
Rehabilitation is a key focus in skilled nursing facilities, aimed at helping patients regain their independence and quality of life. Rehabilitation services include:
- Physical Rehabilitation: Tailored exercise and mobility programs to improve physical function and strength.
- Occupational Rehabilitation: Activities designed to help patients perform daily tasks and improve their ability to live independently.
- Speech Therapy: Interventions to address speech and swallowing difficulties, enhancing communication and eating abilities.
Skilled nursing facilities provide a higher level of care than traditional nursing homes, offering both custodial and skilled care. The staff includes registered nurses (RNs), licensed practical nurses (LPNs), certified nurse assistants (CNAs), physical therapists (PTs), occupational therapists (OTs), speech therapists (STs), doctors, social workers, and dietitians. They collaborate to create individualized care plans for each patient, ensuring comprehensive and personalized care [5].
Qualifications and Training for Skilled Nursing
Providing high-quality skilled nursing services requires specialized training and qualifications. This section focuses on the essential certificate programs and the skills and competencies needed for skilled nursing care.
Certificate Program for Skilled Nursing Facility Essentials
A comprehensive certificate program equips nurses and healthcare personnel with the necessary skills to excel in skilled nursing facilities. One such program, offered by MedBridge, includes 16 courses covering various aspects of skilled nursing care. This program aims to improve the quality of life for older adults by providing healthcare professionals with a strong foundation in essential skills.
Program Components:
- Online Video Lectures: 15 hours of educational content including patient demonstrations.
- HEP and Patient Education Resources: Tools to enhance patient understanding and adherence.
- Case-Based Quizzes: Assessments to improve clinical reasoning and decision-making.
Key Topics Covered:
- Regulatory processes
- Roles of the nurse in healthcare teams
- Supervision skills for directing nursing assistants
- Risk factor determination
- Physical assessment of older adults
- Nursing delegation
- Safe patient care
- Communication and teaching skills in long-term care
Skills and Competencies for Skilled Nursing Care
Nurses and healthcare personnel must possess a range of skills and competencies to deliver effective skilled nursing services. The certificate program outlined above helps develop these crucial abilities, ensuring that care providers can meet the needs of frail older adults in long-term care settings.
Core Skills and Competencies:
- Health Promotion and Disease Prevention: Understanding preventive measures and promoting overall health.
- Safety Concerns: Identifying and mitigating potential safety risks for older adults.
- Medication Administration: Accurate and safe administration of medications.
- Treatment Performance: Proficiency in executing various treatments and procedures.
- Communication Strategies: Effective communication with patients, families, and healthcare teams.
By completing such a certificate program, nurses and healthcare personnel are better prepared to provide quality, competent, and safe care in skilled nursing facilities, adhering to regulatory guidelines and improving patient outcomes.
These qualifications and training programs play a significant role in ensuring that skilled nursing services are delivered with the highest standards of care and professionalism.
Medicare Coverage for Skilled Nursing
Understanding Medicare's role in covering skilled nursing services is crucial for those seeking advanced care for their loved ones. This section delves into the specifics of Medicare coverage, ensuring you are well-informed about the benefits and conditions.
Medicare's Role in Skilled Nursing Services
Medicare plays a significant role in covering skilled nursing services, provided certain conditions are met. Medicare Part A covers up to 100 days in a skilled nursing facility (SNF) after a qualifying hospital stay. The coverage includes:
- Specialized therapies (physical and occupational therapy)
- Medications
- Medical equipment and supplies
- Social services
To qualify, the skilled nursing community must be Medicare-certified.
Conditions for Medicare Coverage
To be eligible for Medicare coverage of skilled nursing services, several conditions must be met:
- Hospital Stay: The individual must have had a qualifying hospital stay of at least three days.
- Medicare Certification: The skilled nursing facility must be Medicare-certified.
- Physician's Order: A physician must prescribe the necessary skilled nursing services, such as specialized therapies, medications, and medical equipment.
It is important to note that Medicare does not cover long-term custodial care in a nursing home. Instead, Medicaid or private long-term health insurance may provide coverage for such care [2]. Medicare does, however, cover medical care for nursing home residents.
Being aware of these conditions will help you navigate the complexities of Medicare coverage and ensure that your loved one receives the appropriate skilled nursing care they need.
Comparison: Skilled Nursing vs. Nursing Home
When choosing the best care option for an elderly loved one, understanding the differences between skilled nursing facilities (SNFs) and nursing homes is essential. Both provide valuable services, but they cater to different needs and levels of care.
Care Levels and Services Provided
Skilled nursing facilities (SNFs) and nursing homes offer distinct types of care.
Skilled Nursing Facilities
Skilled nursing care is provided by trained registered nurses (RNs) in a medical setting under a doctor’s supervision, offering the same level of care as in a hospital. SNFs focus on patients transitioning from an illness, injury, or surgery, providing rehabilitative services from licensed therapists [2].
Nursing Homes
Nursing homes primarily provide custodial care, focusing on activities of daily living (ADLs) like dressing, bathing, and eating. This type of care is often referred to as "custodial care" and is provided mainly by licensed practical nurses (LPNs) and nurse aides under the supervision of an RN.
The goal of an SNF is to provide transitional care to help patients recover enough to return home. In contrast, nursing homes aim to offer a safe, comfortable, and caring environment for individuals who cannot live independently.
Medicare Coverage Differences
Medicare coverage for skilled nursing services and nursing home care varies significantly, which impacts the choice between the two.
Skilled Nursing Facilities
Medicare Part A covers skilled nursing care in a SNF for a limited time if certain conditions are met:
- A qualifying hospital stay of at least three days
- Admission to the SNF within 30 days after leaving the hospital
- Certification by a doctor that skilled nursing or rehabilitative services are needed (UnitedHealthcare)
Nursing Homes
Medicare generally does not cover long-term custodial care in nursing homes. It only covers medically necessary skilled nursing care or rehabilitative services for a short period under specific conditions.
Understanding these differences helps in making an informed decision about the best care option for your loved one, considering both the level of care required and the financial implications.
Advancements in Skilled Nursing Care
Value-Based Purchasing Program
The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program is a significant advancement in skilled nursing care. This program, mandated by the Protecting Access to Medicare Act of 2014 (PAMA), aims to improve the quality of care in skilled nursing facilities (SNFs) by offering incentive payments based on their performance.
The SNF VBP Program evaluates SNFs based on a single measure of all-cause hospital readmissions. Facilities that demonstrate lower readmission rates receive higher incentive payments, encouraging them to enhance their care practices to prevent hospital readmissions. This program started applying incentive payments to SNFs on October 1, 2018 [6].
Joint Commission Certifications
The Joint Commission offers various certifications to meet the distinct quality needs of nursing care centers. These certifications are available to organizations that have obtained or are receiving accreditation under the Nursing Care Center Accreditation program.
Post-Acute Care Certification
The Post-Acute Care Certification is designed to build an effective framework addressing the unique care needs of higher acuity or short-stay patients. This certification emphasizes effective care transitions to minimize the risk of unnecessary hospitalizations.
Memory Care Certification
The Memory Care Certification aims to enhance care for patients with various levels of cognitive impairment. This certification focuses on improving the safety of the environment, offering specialized care and service programming, advancing staff training, and providing support groups for families.
These advancements in skilled nursing care underscore the commitment to improving patient outcomes and the overall quality of care in skilled nursing facilities.
References
[1]: https://www.harrogatelifecare.org/news/skilled-nursing-care-what-is-it/
[2]: https://www.uhc.com/news-articles/medicare-articles/whats-the-difference-between-a-skilled-nursing-facility-and-a-nursing-home
[3]: https://www.aegisliving.com/where-to-begin/how-to-choose-a-community/what-is-skilled-nursing-care/
[4]: https://nursa.com/specialties/skilled-nursing
[5]: https://www.edenseniorhc.com/differences-between-skilled-nursing-facilities-and-hospitals/
[6]: https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing
[7]: https://www.jointcommission.org/what-we-offer/accreditation/health-care-settings/nursing-care-center/learn/accreditation-options-and-certifications/