Skilled care is health care given when you no longer need hospital care but are not yet ready to go home.
You may need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care.
Qualifying for skilled care
- You have a medical need that can only be provided for in a skilled nursing facility.
- If you are a Medicare patient, you must have a 3-day qualifying hospital stay within 30 days of going to an skilled nursing facility. Your care manager (clinical resource coordinator or social worker) will discuss this with you.
Paying for skilled care
- Medicare: Medicare covers 100% of the first 20 days and you pay a co-payment for days 21-100. If you have supplemental insurance, it may cover the co-payment for days 21 through 100.
- Medicaid: Medicaid will pay for skilled care as long as the facility is a state-contracted Medicaid provider. There may be some restrictions.
- Commercial insurance: Coverage varies by policy. Your care manager (clinical resource coordinator or social worker) can help you find out what coverage you might have. You may be responsible for a co-payment.
- No insurance: You pay or you may be able to get assistance (such as Medicaid). A social worker can help you apply for assistance.
Arranging for skilled care
Your care manager will discuss with you the facilities near your home; however, some patients may need to stay near the hospital for follow-up treatments. Referrals will be made to facilities that will meet your needs. Every effort will be made to get you into the facility of your choice, but options and bed availability may be limited.
You will be informed when the skilled nursing facility has an available bed. Your clinical resource coordinator will assist in setting up travel to the facility; you may need an ambulance or wheelchair van, or you may be able to go by car.
Length of skilled care
Your stay at a skilled nursing facility could be a few days or several weeks. Your length of stay depends on your personal needs and how well your recovery is coming along.
Sometimes patients will choose to stay in a skilled nursing facility, because they simply cannot return home after their Medicare skilled days are complete. They would then change to a different type of care: "custodial" or long term. This is another level of care and is not covered by Medicare. Payment for custodial care is made privately or Medicaid may cover the cost.
- Medicare may deny your stay at the hospital if you do not accept a bed offer that meets your needs.
- You will not be seen by a doctor daily; however, you will have 24-hour nursing care in the skilled nursing facility.
- Most skilled nursing facilities do not have televisions or telephones in the room. These services are usually available in common rooms, or you can provide your own.