Skilled Nursing After a Hospital Stay: What to Expect

If a parent is in hospital after a fall, surgery or a serious illness, there is a good chance a discharge planner will suggest a short stay in a skilled nursing facility before going home. The conversation often happens quickly and on the day before discharge. Here is what it means and what to ask.

What skilled nursing is

A skilled nursing facility provides care that must be delivered or supervised by licensed professionals: physical, occupational and speech therapy, wound care, intravenous medication, monitoring after surgery. A short-term stay is about rehabilitation. It is a different thing from long-term nursing home residence, even when both happen in the same building.

What Medicare pays

Medicare Part A covers up to 100 days of skilled nursing per benefit period after a qualifying inpatient hospital stay of at least three consecutive nights. The first 20 days are covered in full. From day 21 to day 100 there is a daily co-payment, which a supplemental policy may cover. Coverage continues only while the person is making progress and needs daily skilled care, so the stay often ends sooner than 100 days.

One trap: time spent in hospital under observation status does not count towards the three nights. Ask the hospital whether your parent was admitted or observed.

Choosing a facility

• You may choose. The hospital will give you a list; you are not required to take the first available bed.
• Check the federal star ratings and the most recent inspection report.
• Ask how many therapy minutes a day your parent will receive, and on how many days a week.
• Ask about the ratio of nursing staff to residents at night and at weekends.
• Visit if you can, even briefly. The rehabilitation gym and the dining room are the two rooms to see.

Plan the discharge from day one

Ask for a care conference in the first week and a target discharge date. Find out what help will be needed at home and whether home health is being arranged. If going home no longer looks realistic, this is the moment to begin looking at assisted living, with the facility’s social worker helping.

If you are asked to pay privately

When Medicare coverage ends and your parent still needs care, the facility will offer a private-pay rate for a long-term bed. Before agreeing, ask whether the facility accepts Medicaid, and get advice on eligibility. The answer shapes everything that follows.