acute care vs nursing home

What's the difference between a skilled nursing facility and a nursing home?

Published by Medicare Made Clear®

On the surface, a skilled nursing facility and a nursing home may look very similar. Some care facilities actually operate as both, with a separate floor or section of a building devoted to each.

The difference between a skilled nursing facility and a nursing home comes down to the care provided – skilled nursing care vs a nursing home level of care.

What is skilled nursing care?

Skilled nursing care is provided by trained registered nurses in a medical setting under a doctor’s supervision. It’s basically the same level of nursing care you get in the hospital.

Patients may go from the hospital to a skilled nursing facility to continue recovering after an illness, injury or surgery. In addition to skilled nursing, care may include rehabilitative services from licensed physical, occupational or speech therapists.

A skilled nursing facility provides transitional care. The goal is to get well enough to go home.

What is a nursing home level of care?

Nursing home care is provided mostly by licensed practical nurses and nurse aides under the supervision of a registered nurse. Care is focused on activities of daily living, like dressing, bathing and eating. This is often called “custodial care.”

People sometimes move to nursing home when they unable to take care of themselves due to medical, cognitive, behavioral or functional issues. In addition to custodial care, nursing home residents may get help taking medications or managing chronic conditions.

A nursing home provides long-term residential care. The goal is to provide a safe, comfortable and caring environment for people who are unable to live independently.

Does Medicare cover care in a skilled nursing facility or nursing home?

Medicare Part A covers up to 100 days in a skilled nursing facility after a qualifying hospital stay. The Part A deductible covers the first 20 days per benefit period. After that, you pay a share of the cost for each additional day of your stay. You would start paying the full cost after 100 days.

Medicare does not cover long-term custodial care in a nursing home, though Medicaid or private long-term health insurance may. However, Medicare does continue to cover medical care for nursing home residents.

About Medicare Made Clear

Medicare Made Clear brought to you by UnitedHealthcare provides Medicare education so you can make informed decisions about your health and Medicare coverage.

• Introduction to Medicare
• Types of plans

Get the latest

Boost your Medicare know-how with the reliable, up-to-date news and information delivered to your inbox every month.

*All fields required

More articles

Find a plan.

Enter your ZIP code for plans in your area

Call UnitedHealthcare toll-free at

1-833-301-2052, TTY 711

Hours: 8 a.m. - 8 p.m. 7 days a week

Meet with us

Make an appointment with a licensed insurance agent/producer in your area

What Is a Skilled Nursing Facility vs. a Nursing Home?

Discover the nuances between skilled nursing facilities and nursing homes to help you make informed care decisions.

This article is based on reporting that features expert sources.

Getty Images

It's overwhelming enough helping your mom get discharged from the hospital after a fall . Then, what if her doctor doesn't think it's safe for her to return home? As you scramble to find somewhere for her to go, you’re inundated with unfamiliar senior living terminology: What is a skilled nursing facility? What is a nursing home? Are they the same?

The answer isn’t so straightforward. In some situations, medical professionals use the terms "nursing homes" and "skilled nursing facilities" interchangeably. In others, they can mean two distinct levels of care. Read on to learn about the subtle differences between the two types of senior care .

Key Takeaways:

• "Nursing home" and "skilled nursing facility" are often used interchangeably, but usually skilled nursing facilities refer to short-term stays that require a higher intensity of care.
• Many facilities now blend custodial and skilled nursing care, leading to confusion between the terms "nursing home" and "skilled nursing facility."
• Medicare covers qualifying skilled nursing facility admissions but does not cover nursing home care.

Nursing Home vs. Skilled Nursing Facility: Is There a Difference?

Nursing home care usually means long-term custodial care, or help with activities of daily living . Skilled nursing care usually refers to short-term care that requires more advanced training to provide, such as giving IV medications or physical therapy after surgery.

The confusion begins because not everyone's care needs are one-size-fits-all. While some long-term nursing home residents only need custodial care, others need nursing care for the remainder of their lives.

Nursing home vs. skilled nursing facility: Are the two terms related?

“Nursing homes were once referred to as ‘homes for the aged,’” explains Mark Sanchez, administrator for United Hebrew, a campus of elder care facilities in New Rochelle, New York.

Now, though, the terms nursing home and skilled nursing facility are often used interchangeably because most modern facilities must integrate skilled nursing care as the needs and acuity of the aging population have risen.

“Fewer facilities offer nursing home or custodial-only care,” Sanchez adds.

Because of this overlap, nursing home care and skilled nursing care are usually offered in the same building. However, there might be specific wings or locations for each type of care and various assortments of medical professionals that oversee them.

What Is a Nursing Home?

Let's say your mom fell because of worsening Alzheimer’s disease and has experienced continued difficulty keeping her balance. The fall caused minor scrapes and bruises, but her doctor thinks now she requires around-the-clock medical supervision.

In this situation, your mom would mainly benefit from custodial care, or help with activities of daily living.

What is nursing home care?

The main function of a nursing home is to provide custodial care, or nonmedical help with daily functioning.

Custodial care includes services such as:

• Aid with activities of daily living, or basic tasks needed for independent living , such as toileting or grooming
• Basic health care that unlicensed professionals can provide, like putting on a knee brace or administering eye drops. The type of care unlicensed professionals can provide varies by state.
• Support for instrumental activities of daily living, or complex skills needed to live independently, like preparing meals
• Supervising the resident self-administering over-the-counter medication, such as Tylenol

What Is a Skilled Nursing Facility?

Let's say your mom’s fall was severe enough to require a hip replacement. After surgery at a hospital, her doctor recommends short-term skilled nursing care, such as physical therapy and IV pain medication. The term is particularly used when referring to short-term rehab care after a surgery or injury.

What is skilled nursing care?

Skilled nursing facilities are a higher level of care than nursing homes, so while they still provide custodial care, they also provide skilled nursing services. "SNFs are designed to deliver short-term, medically intensive care for patients who require rehabilitation after a hospital stay, surgery or acute medical event," says Vince Baiera, a San Diego-based nurse and post-acute care partner at Relias.

Care provided in a skilled nursing facility includes:

• Care that is performed by a licensed nurse. This may include all types of nursing care, from someone who needs catheter care after a recent prostatectomy to tracheostomy care after prolonged intubation in the hospital.
• Specialized therapy, such as physical, occupational or speech therapy
• Additional health monitoring, like vital signs, labs or cardiac monitoring, which may be necessary while recovering from a hospital stay, or for monitoring certain conditions, like newly diagnosed abnormal heart rhythms

"A cornerstone of SNF care is rehabilitation services tailored to help patients regain mobility, independence and functionality," Baiera says.

Often, a short-term skilled nursing stay leads to longer-term nursing and custodial care.

Find senior living near you

Search by state, city or ZIP code to find the best community for you.

Qualifying for a Skilled Nursing Facility

To medically qualify for a skilled nursing facility, your family member will need a recommendation from a medical provider or documentation that they need nursing tasks to manage their lifestyle or health condition .

"Skilled nursing care is crucial for those who need daily skilled nursing services tailored to their specific situations. Whether it's meticulous wound care, careful medication administration or intensive therapy sessions, these services become even more vital following significant medical events like major surgeries, strokes or severe injuries," says LeShaun Williams, a family nurse practitioner at the Center for Better Aging in Chicago.

Does Medicare pay for skilled nursing care?

As Medicare is a health care plan, coverage focuses on care that stems from a health problem that started in the hospital. It also includes rehabilitation that requires a need for skilled nursing as part of a recovery process. This is the scenario where the term "skilled nursing facility" is most often used.

Medicare covers up to 100 days of skilled nursing services. In each benefit period, you'll pay $0 for the first 20 days, then a coinsurance amount for days 21 to 100. You're responsible for all expenses after 100 days.

The requirements for Medicare coverage include:

• A three-day inpatient hospital stay within the past 30 days
• Remaining days in the benefit period that are available to be used
• A medical provider determining that you have skilled nursing needs

Medicare does not cover ongoing care needs, indefinite skilled nursing needs or custodial care alone.

Does Medicaid pay for skilled nursing care?

Medicaid , unlike Medicare, is a joint federal and state program for low-income individuals. If your loved one qualifies for Medicaid, they may use these funds as a means to help pay for some of their long-term care needs.

Is a Skilled Nursing Facility or a Nursing Home a Better Fit?

Start off with a thorough assessment of what type of senior care your family member needs. This should be a shared decision process with your loved one, their medical provider and their family. Decide whether a family member would benefit more from custodial care alone or if they would also benefit from skilled nursing care.

Williams recommends considering:

• The complexity of the medical conditions, such as how many conditions they have, and how these interact with each other. For example, having heart failure and chronic kidney disease at the same time requires intense care management.
• The need for skilled services, such as intricate medication management or specialized wound care
• Their ability to participate in rehabilitation
• Their recovery time, or if recovery is expected at all
• A medical provider's recommendations

When it comes to the spectrum of care available, people often start at a lower level of care, such as assisted living communities or an adult family home, or group home , in order to save money. A nursing home , on the other hand, tends to be one of the most expensive care options. For example, a private room in a nursing home can run more than $9,000 per month, according to Genworth Financial's 2023 Cost of Care survey.

Explore Top-Rated Senior Living Facilities With U.S. News & World Report

The next most important thing is to prepare early. Most people don’t face the cluttered world of senior care until they have a life-altering event. When decisions are made in stress and haste, it can make getting the right level of care for the right price much more difficult. So, do your research and outline your budget so you can make an informed decision without pressure.

Check out the B est Nursing Homes with U.S. News & World Report. To help find the best match for a loved one, in 2024 U.S. News evaluated more than 15,000 facilities throughout the country and rated most of them in two different areas, short-term rehabilitation and long-term care.

Talking About Assisted Living

Payton Sy April 14, 2023

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our  editorial guidelines .

Baiera is a San Diego-based nurse and post-acute care partner at Relias.

Sanchez is the administrator for United Hebrew, a campus of elder care facilities in New Rochelle, New York.

Williams is a family nurse practitioner at the Center for Better Aging in Chicago.

Tags: senior health , nursing homes , Medicare , Medicaid , insurance , hospitals , surgery

Most Popular

Senior Care

Best Assisted Living Communities

Senior Living

health disclaimer »

Disclaimer and a note about your health ».

Sign Up for Our 3-Day Guide to Medicare

Confused about Medicare? We can help you understand the different Medicare coverage options available to help you choose the best Medicare coverage for you or a loved one.

Sign in to manage your newsletters »

Sign up to receive the latest updates from U.S News & World Report and our trusted partners and sponsors. By clicking submit, you are agreeing to our Terms and Conditions & Privacy Policy .

You May Also Like

Does medicare pay for nursing homes.

Medicare only pays for nursing home care in certain short-term situations. Find out what Medicare does and does not cover and explore other ways to pay.

Paul Wynn Nov. 26, 2024

Antipsychotic Drugs in Nursing Homes

The use and ethics of antipsychotic drugs in nursing homes is an ongoing discussion. Learn why these medications are sometimes misused and how can you advocate for your loved one.

Elaine K. Howley Nov. 15, 2024

Memory Care vs. Nursing Home

Both memory care and nursing homes are care options for people with advanced cognitive impairment, but there are some key differences. Here’s what you need to know about memory care, nursing homes and how to choose the best option for your loved one.

Elaine K. Howley Nov. 13, 2024

FAQ: How We Rate Nursing Homes

In 2025, ratings were determined by nurse staffing, patient outcomes and whether steps known to be effective in avoiding harm and improving health were built into nursing home routines.

Zach Adams Nov. 12, 2024

Nursing Home Red Flags

When comparing nursing homes for a loved one, diligence is key. Be on the lookout for the telltale signs of a poor nursing home facility.

Payton Sy Nov. 6, 2024

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

13 Things to Know About Subacute Rehab (SAR)

Subacute rehab (also called subacute rehabilitation or SAR) is complete inpatient care for someone experiencing an illness or injury. SAR is time-limited with the express purpose of improving functioning and discharging home.

SAR is typically provided in a licensed skilled nursing facility (SNF) . Sometimes, SNFs are part of a hospital system and even physically located on the same campus, while other times, they're independent organizations.

Regardless, an SNF must be licensed by the Centers for Medicare and Medicaid (CMS) in order to provide SAR. This licensing process includes regular onsite surveys to verify compliance with health regulations and life safety codes (such as fire protection and exit strategies).

You may benefit from SAR if you don't require hospital care, but still need a higher level of medical care. This article explains what SAR offers, who benefits from SAR, what SAR therapy is like, and how long it lasts. You'll also get tips on finding, choosing, and paying for an SAR and on dealing with insurance and other issues that may come up.

SAR Services

Isaac Lane Koval / Corbis / VCG / Getty Images

SAR provides help in two different areas:

Licensed physical, occupational, and speech therapists provide therapy to increase your strength and functioning. For example, depending on what your need is, they might work to:

• Increase your balance
• Improve your safety when walking
• Help you move your legs again after a stroke
• Improve your independence with activities of daily living (ADLs)
• Improve your cardio (heart) fitness after a heart attack

Licensed nursing staff provides medical care such as:

• Wound management
• Pain management
• Respiratory care
• Other nursing services that must be provided or supervised by a registered nurse (RN) or licensed practical nurse (LPN)

Who Benefits From SAR?

People who have experienced a fall , injury, or medical condition may benefit from a brief stay at a SAR facility.

The goal of SAR is to provide time-limited assistance designed to improve functioning and safety at home or the previous place of living (such as an assisted living or independent living facility).

People receive SAR for a wide variety of conditions, including:

• Joint (hip, knee, shoulder) fractures or replacements
• Cardiac conditions
• Deconditioning related to a fall
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure (CHF)
• Spinal cord injuries

Therapy at a SAR

Your healthcare provider will typically order therapy for you based on the recommendation of the physical therapist, occupational therapist, and/or speech therapist.

Some people can tolerate only about 30 minutes a day at first, depending on their condition. Others may be able to tolerate multiple hours a day of therapy. SAR usually will provide up to about three hours of therapy per day.

If you're at a SAR facility and feel as if you should be getting more therapy per day, ask your healthcare provider if your therapy minutes can be increased.

Length of Stays

SAR stays vary greatly. Some people are only there for a few days, while others may be there for weeks or even up to 100 days.

A variety of factors determine how long you might stay at a SAR facility, including:

• The extent of your injuries or medical condition
• Your overall health
• The length of time your insurance approves
• Your ability to live safely after you leave the SAR

SAR vs. Acute Rehab vs. Hospital

The terms used to talk about medical care and rehabilitation can be confusing at times. SAR is different from a hospital or an acute inpatient rehabilitation center.

A hospital, which is sometimes called "acute care," is appropriate only for significant medical issues with the goal of a very short stay.

An acute rehab center is designed for high-level rehab needs, typically requiring three hours a day of physical, occupation, or speech therapy per day five days per week.

Subacute rehab (SAR) centers are usually most appropriate for people who need less than three hours of therapy a day, thus the label of "subacute," which technically means  under or less than acute rehab.

Finding a High-Quality SAR

One of the challenges in rehabbing after a stroke, for example, is choosing an excellent program in which to rehab. Doing research ahead of time before you or your loved one ever needs rehabilitation can be very helpful.

Centers for Medicare and Medicaid (CMS) provide a 5-star rating system on nursing homes , and many of those facilities provide SAR. Comparing the ratings of different facilities can be very helpful. 

Typically, your most valuable resource will be recommendations from loved ones or friends who have already been through this process. Their personal experience is invaluable.

If you have time, it can also be helpful to stop by a few different facilities and ask for a tour. Watching how the staff interact with the people in their care can be an important indicator of the quality of care provided.

Remember that even though some buildings can look brand new, it's the program and people caring for you that really will influence your experience there.

Choosing a SAR Facility

If you need SAR, be aware that many times, you do have a choice of where this SAR is provided.

Hospitals frequently will steer you toward their own SAR programs if they are affiliated with one. While this may be a good option, you do have a right to decide where you would like to rehab.

Your options may, however, be limited by whether your insurance classifies the facilities you choose as in or out of network , and whether those facilities choose to accept you into their program.

Paying for a SAR

If you need some rehab because of a decline in strength from a fall, hip fracture , or medical condition, SAR may be a benefit for you.

SAR is typically paid for by Medicare or a Medicare Advantage program. Medicare is a federal insurance program that you pay into over the years as you work.

Medicare Advantage programs are private groups that essentially manage people who are eligible for Medicare but have opted to choose to be part of these groups.

Financial coverage and requirements vary, depending on which plan you have chosen.

Leaving Early

If you think you're ready to go home before the medical staff thinks you should, you do have the right to leave the facility at any time.

If the healthcare provider feels strongly that you are not safe to leave yet and you choose to leave anyway, they will likely ask you to sign a form that says you are leaving against medical advice (AMA).

This means that although they can't make you stay, they don't believe you're safe to go home yet. It's protection for the facility because, without that documentation, they could be liable for harm that occurred because of your early discharge.

If you have dementia to the extent that your power of attorney for health care has been activated, this person is the only one who can sign you out of a facility. You can't do it yourself.

Insurance Coverage Ending

Most insurance companies monitor the use of SAR closely, with facilities having to perform detailed assessments frequently and receive both prior and ongoing authorization to provide SAR to its members.

Once it's been decided that your SAR coverage is ending, you must receive advance notice of this denial of coverage.

This is sometimes called a "cut letter" or "denial notice," and a copy must be provided to you and kept on file at the facility to prove that you were given notice of this change before it occurred.

Coverage might end for a variety of reasons, including:

• You no longer require skilled therapy or skilled nursing services.
• You're not able to participate in the therapy services (such as if your memory is impaired by dementia).
• You continuously choose not to participate in therapy services.
• You've used up your allotted number of days for SAR.

If You're Not Ready to Go

After being told that the insurance coverage is ending for your SAR stay, people often make plans to go back home or to their previous facility in the next couple of days.

While you may be eager to go home, it's also possible that you could be very concerned that you're not strong enough yet to go home.

If you feel that your insurance coverage should not be ending yet, you are allowed to appeal this denial of coverage. You can request an expedited appeal so that you will have an answer quickly.

Directions for appealing will be included in the denial of coverage notice that you receive.

If you choose to appeal, the facility will provide the insurance company with your relevant clinical information and they will approve or deny your appeal for additional SAR coverage.

If You're Not Safe to Go Home

Sometimes, despite your best efforts at rehabbing at a SAR facility, you might not gain enough strength or functioning to be safe at home right away. Not being able to meet your goal of going home can, of course, be discouraging.

The SAR social worker will help you look at other options which may include transitioning to a skilled nursing facility, like assisted living or an adult foster care home.

They may also be able to work with your family members and community agencies to provide additional assistance at home to increase the safety of this option.

Remember that some people do take longer to heal and regain functioning than others, so it's important that you continue to work to maintain and improve your strength, wherever you live.

For example, you might still be able to receive a lesser level of therapy services through Medicare Part B at a skilled nursing home which may make it possible to return home in the future as you slowly gain functioning.

Help at Home

It's common to continue to need help at home for a time after SAR. The goal of SAR is ideally to help you return to your previous level of functioning.

However, since many insurance companies try to limit the costs that they pay out for their clients, a more practical goal at SAR may be to help you be safe and strong enough to go back to your home and then continue rehab there.

Before you're discharged from SAR, the facility should provide referrals and make arrangements for you to receive ongoing care such as home health services, provided you agree to these support services. 

Home healthcare agencies can assist you at home with physical therapy, occupational therapy, speech therapy, professional nursing care, and medical social work services.

Using these community resources can help you successfully transition back home, which is the shared goal of both you and the SAR staff who have been working with you.

Subacute rehab (SAR) can help people trying to regain functional abilities after experiencing a fall, an injury, or other medical condition. SAR encompasses physical, occupational, and speech therapists as well as nursing medical care.

The treatment program and length of stay in a SAR facility will depend on the nature of your situation. Health insurance programs like Medicare help cover the costs. The goal of SAR is to make sure you're safe to return home and, ultimately, to regain your strength and functioning.

While you have the right to leave SAR early, completing the full stay will help you reach your goals faster. Talk to your provider about your level of ability to care for yourself before leaving the facility and ask about continuing physical therapy at home.

McPhail SM, Varghese PN, Kuys SS. Patients undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence .  ScientificWorldJournal . 2014;2014:810418. doi:10.1155/2014/810418

MedDiagnostics Rehab. Subacute inpatient rehabilitation .

Mean KM, Buschbacher R, Kortebein PM. Geriatrics . New York, NY: Springer Publishing; 2012.

Medicare Learning Network. Inpatient rehabilitation facility (IRF): Reference booklet .

U.S. Centers for Medicare and Medicaid Services. Home health services .

By Esther Heerema, MSW Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.

•   Contact Us

• Channels ►
• Executive Moves
• Transaction & Valuation
• Health Equity
• Patient Experience
• Care Coordination
• Legal & Regulatory
• Compensation
• Specialties ►
• Orthopedics
• Surgery Centers
• Dental / DSO
• Becker's Healthcare Websites ►
• Dental + DSO
• Behavioral Health
• Physician Leadership
• Newsletters ►
• Sign Up For Our Free E-Newsletters
• Hospital Review
• Health IT & CIO Report
• Clinical Leadership
• Revenue Cycle Management
• Digital Innovation Report
• Supply Chain Report
• Payer Issues
• Pharmacy Report
• Women's Leadership
• Laboratory Review
• Cardiology Report
• Oncology Report
• HR + Talent Review
• Post-Acute Report
• Life Sciences
• Marketing Report
• Anesthesia Report
• Radiology Report
• Events ►
• Upcoming Conferences and Events
• 15th Annual Meeting
• Spring Payer Issues Roundtable
• Spring Chief Pharmacy Officer Summit
• 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference
• Key Insights from Becker's 9th Annual Health IT + Digital Health + RCM Event
• Exhibiting & Sponsoring
• Call for Speakers
• Virtual Events ►
• Upcoming Virtual Events
• Transform Hospital Operations Virtual Summit
• Infusion Center Operations Virtual Summit
• The Driving Forces Transforming the Dental + DSO Industry Virtual Forum
• Behavioral Health Virtual Event
• Oncology Virtual Summit
• Digital Innovation + Patient Experience + Marketing Virtual Event
• Past Virtual Events
• Webinars ►
• Upcoming Webinars
• OnDemand Webinars
• Partner Content ►
• Current Partner Content
• Podcasts ►
• Our Podcasts
• Becker's Healthcare Podcast Episodes
• Becker’s Digital Health + Health IT Podcast
• Becker’s Payer Issues Podcast
• Podcast Summaries
• Becker's Behavioral Health Podcast
• Becker's Ambulatory Surgery Centers Podcast
• Becker's Spine and Orthopedics Podcast
• Becker's Dental + DSO Review Podcast
• Becker’s Clinical Leadership Podcast
• Becker’s Pediatric Leadership Podcast
• Becker's Cardiology + Heart Surgery Podcast
• Becker's Women's Leadership Podcast
• Lists ►
• 100 great community hospitals | 2024
• Great leaders in healthcare | 2024
• Nominations
• Sign up for list nomination updates
• Print ►
• Current Issue
• Past Issues
• Current Issue - Becker's Clinical Leadership
• Past Issues - Becker's Clinical Leadership
• Multimedia ►
• Intuitive + Becker's Content Hub
• NRC Health Content Hub
• LeanTaaS AI Solutions
• Healthcare Upside/Down Podcast Series
• Featured Content
• Featured Videos
• Career Center
• Insights ►
• The move to outpatient: Where’s your health system?
• Physician recruitment and engagement: Where’s your health system?
• Behavioral health: Where’s your health system?
• Pipeline programs: Where’s your health system?
• GLP-1s: Where’s your health system?
• About Us ►
• About Becker's Hospital Review
• Careers at Becker's
• Request Media Kit
• Content Specifications
• Most Read ►
• 25 largest health systems by hospital beds
• California system reduces workforce, streamlines leadership
• Judy Faulkner's net worth, by year
• VillageMD's CEO exits
• A boom in male nurses: 8 notes
• Biggest hospital cyberattacks of '24
• Hospitals brace for respiratory season peak
• UPMC cuts operating loss to $57.6M in Q3: 6 things to know
• Michael Dowling: We've revolutionized care for aging adults, but is America's health system ready for the senior population boom?
• Ascension posts $197M operating loss in FYQ1, improving $1.2B from last quarter
• Top 40 Articles ►
• 32 health systems dropping Medicare Advantage plans | 2024
• 17 large health systems growing bigger
• 19 recent hospital, health system executive moves
• Subscription
• RN pay for all 50 states adjusted by cost of living | 2024
• Trump wins election: 7 notes for healthcare leaders
• Top health system employers by state: Forbes
• 24 health system rating downgrades
• 703 hospitals at risk of closure, state by state
• Tim Walz on healthcare: 8 things to know
• HCA to acquire Catholic system
• Days cash on hand at 22 health systems
• 3 healthcare takeaways from the Trump-Harris debate
• 10 best, worst states for healthcare in 2024
• Healthcare buzzwords executives are tired of hearing
• 213+ CNOS to know | 2024
• Prime to acquire 9 Ascension hospitals: 6 things to know
• Rising stars: 42 healthcare leaders under 40 | 2024
• A quiet driver of the nurse shortage, explained
• President-elect Trump taps Dr. Oz for CMS administrator: 10 things to know
• 381 hospitals with 5 stars from CMS
• Tennessee hospital misses payroll
• Kamala Harris' healthcare policy positions: 6 notes
• Emory Georgia hospital to close by end of year
• Epic faces antitrust lawsuit: 7 things to know
• US News' top hospitals by state for 2024-25
• 13 women making moves in healthcare
• Top medical schools for 2024: US News
• President-elect Donald Trump picks RFK Jr. as HHS Secretary: 7 things to know
• President-elect Trump expands healthcare team: 44 notes
• Great hospitals in America | 2024
• Texas Children's to lay off 1,000
• US News' Best Hospitals 2024-25 Honor Roll
• From -7.9% to 14.9%: 41 systems ranked by operating margins
• 276 hospitals with 1 star from CMS
• 40 most common passwords of 2024
• 23 systems delaying surgeries amid the IV shortage
• Is Epic getting too big?
• 705 hospitals at risk of closure, state by state
• US hospitals face IV fluid shortage

Why Care Settings Matter: LTACHs vs. SNFs

Long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) have distinct clinical capabilities, patient populations and hospital outcomes.  LTACHs are uniquely equipped to efficiently and effectively meet the needs of medically complex patients, making partnership with LTACHs a key strategy in reducing costs and improving hospital throughput. 1

Setting Comparison

Choosing the appropriate level of care for medically complex and critically ill patients leaving the ICU is essential for achieving optimal outcomes for both patients and providers.

The below comparison shows 5 key differences in staff and services available at LTACHs and SNFs:  

• On-site physician visits at least once per day, sub-specialists available on location
• Approximately 1-6 patients per nurse, ratios lower in critical care units; High-acuity care provided by BLS- and ACLS-certified nurses with advanced critical care training
• 24/7 respiratory therapy in house in every location
• Onsite services such as telemetry, radiology, pharmacy, lab, and dialysis
• CMS-compliant infection control standards with hospital-level air ventilation systems and negative pressure isolation rooms
• On-site physician visits at least once every 30 days for the first 90 days, sub-specialists seen offsite
• Approximately 10-40 patients per nurse
• Limited respiratory therapy in select locations
• Radiology, pharmacy, lab, and dialysis services accessible, but not onsite
• Residential-level air ventilation systems

The differences in available staff and resources between LTACHs and SNFs means that they are designed to treat different types and severities of conditions.

Top Five Conditions by Setting  

• Pulmonary edema and respiratory failure
• Respiratory system diagnosis with ventilator for 96+ hours
• Septicema without ventilator support 96+ hours with major complication or comorbidity
• Respiratory system diagnosis with ventilator support ≤96 hours
• Respiratory infections and inflammations with major complication or comorbidity
• Urinary tract infection, site
• not specified
• Metabolic encephalopathy
• Sepsis, unspecified organism
• Encounter for other orthopedic aftercare  

Aside from the differences in principle admitting condition, many of the top conditions treated at LTACHs include a major complication or comorbidity . The Hierarchical Condition Category (HCC) score, which assigns complexity levels to patients, was almost 2X higher at LTACHs than SNFs in 2021. 4   Additionally, while only a small percentage of patients discharged to a SNF present an “extreme” Severity of Illness, these patients make up over half the population transitioning to an LTACH. 5  

With physician-led acute care, LTACHs are able to treat patients with complex and serious conditions, most of which include a pulmonary diagnosis. SNFs, on the other hand, care for a wide range of conditions that can be managed by nursing staff.  

Comparing Outcomes

When critically ill patients, especially those with complex pulmonary conditions, receive the specialized acute care available at LTACHs, they are well positioned to fully recover faster.

Even though patients at LTACHs tend to have more complex conditions, they experience both shorter lengths of stay (LOS) and fewer readmissions than those at SNFs. 4 This is particularly clear when looking at pulmonary diagnoses such as DRG 189, one of the most commonly treated at LTACHs.

How Partnership with Kindred Hospitals Can Help Your Hospital  

Each year, the Centers for Medicare & Medicaid Services, penalizes hospitals for excessive 30-day readmission rate. In 2018, over 2,500 hospitals were penalized, amounting to more than $564 million. 6 Strategic partnership with an LTACH is one initiatve that can help your hospital reduce readmissions and improve outcomes for medically complex patients, while also increasing throughput.

As an industry leader with a history of successful partnerships, Kindred Hospital offers hospital-in-hospital, contract management and joint-venture opportunities. Expand access to needed acute care services by integrating a Kindred Hospital into your health system’s care continuum today.

Discover how your hospital can benefit from an LTACH partnership by visiting  KindredLTACHPartner.com.

1. https://www.tandfonline.com/doi/full/10.3111/13696998.2010.551163

2. https://www.medpac.gov/wp-content/uploads/2022/03/Mar22_MedPAC_ReportToCongress_v3_SEC.pdf

3. https://www.definitivehc.com/resources/healthcare-insights/top-snf-diagnoses

4. https://dag.advisory.com/MarketExplorer/PAC/National/1X7SCS72

5. https://www.aha.org/system/files/media/file/2019/04/fact-sheet-ltch-0319.pdf

6. https://www.advisory.com/daily-briefing/2017/08/07/hospital-penalties

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy . Cookie Policy . Linking and Reprinting Policy .

Featured Whitepapers

Featured webinars.

Becker's Websites

Virtual Learning

• Whitepapers

Conferences

• 1.800.417.2035
• [email protected]

Acute Rehabilitation vs. Skilled Nursing

July 1, 2024

Discover the key differences between acute rehabilitation and skilled nursing. Make informed decisions for empowering recovery.

Understanding Rehabilitation Options

When it comes to rehabilitation, there are different options available depending on the specific needs and goals of the individual . Two common options are acute rehabilitation and skilled nursing. Let's take a closer look at each of these rehabilitation options.

Overview of Acute Rehabilitation

Acute rehabilitation refers to a specialized form of care provided in an inpatient setting, typically within a hospital or rehabilitation center . It is designed for individuals who require intensive rehabilitation services due to a recent injury, illness, or surgery. The primary goal of acute rehabilitation is to help patients regain function, independence, and quality of life.

Acute rehabilitation services are multidisciplinary, involving a team of healthcare professionals who work collaboratively to develop and implement a personalized rehabilitation plan. This team may consist of physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, and other specialists. The focus is on providing intensive therapy and medical management to maximize the patient's recovery potential.

Overview of Skilled Nursing

Skilled nursing, also known as subacute rehabilitation or post-acute care, is another option for individuals needing rehabilitation services. Skilled nursing facilities (SNFs) provide comprehensive care for patients who require ongoing medical supervision and rehabilitation but do not require the same level of intensity as acute rehabilitation. Skilled nursing services are typically provided in a residential setting, either within a dedicated facility or as part of a nursing home.

Skilled nursing facilities have a team of healthcare professionals, including nurses, therapists, and support staff, who deliver personalized care to patients. The focus of skilled nursing is to provide rehabilitative services, such as physical therapy, occupational therapy, and speech therapy, along with medical management and assistance with activities of daily living. The goal is to help patients regain their functional abilities and transition back to their home or community setting.

To better understand the differences between acute rehabilitation and skilled nursing, it is important to explore the purpose, goals, and services provided in each setting. This knowledge can assist individuals and their families in making informed decisions about the most appropriate rehabilitation option for their specific needs.

Acute Rehabilitation

Acute rehabilitation plays a crucial role in helping individuals recover and regain independence after a debilitating illness, injury, or surgery. This specialized form of rehabilitation is designed to provide comprehensive care and intensive therapy to promote optimal recovery.

Purpose and Goals of Acute Rehabilitation

The primary purpose of acute rehabilitation is to help individuals regain functional abilities and improve their quality of life. The goals are tailored to each patient's specific needs and may include:

• Restoring physical mobility and strength
• Enhancing cognitive and communication skills
• Improving coordination and balance
• Facilitating activities of daily living (ADL) such as bathing, dressing, and eating
• Promoting independence and self-care
• Assisting with pain management
• Providing education and support to patients and their families

The overall aim of acute rehabilitation is to maximize the individual's potential for recovery and help them return to their previous level of functioning, or as close to it as possible.

Services Provided in Acute Rehabilitation

Acute rehabilitation programs offer a multidisciplinary approach to care, incorporating various healthcare professionals to address the diverse needs of patients. Some of the services provided in acute rehabilitation include:

• Physical therapy: Focuses on improving mobility, strength, and balance through exercises, manual therapy, and assistive devices.
• Occupational therapy: Aims to enhance independence in activities of daily living, including self-care, work, and leisure activities.
• Speech therapy: Helps individuals with speech, language, and swallowing difficulties regain or improve communication and eating abilities.
• Rehabilitation nursing: Provides specialized nursing care, including medication management, wound care, and patient education.
• Psychological counseling: Supports patients in coping with emotional and psychological challenges related to their condition and rehabilitation process.
• Case management: Coordinates care and ensures a seamless transition from the acute rehabilitation setting to other care settings or home.

The combination of these services, along with a supportive and structured environment, helps individuals in acute rehabilitation achieve their goals and regain independence.

In the next section, we will explore skilled nursing as another option for individuals requiring rehabilitation and long-term care.

Skilled Nursing

Skilled nursing is a specialized form of healthcare that provides around-the-clock medical care and rehabilitation services to individuals who require intensive support and supervision. This level of care is typically recommended for individuals who have complex medical conditions or who need assistance with activities of daily living. Skilled nursing aims to improve the overall health and functionality of patients while also promoting their independence and well-being.

Purpose and Goals of Skilled Nursing

The purpose of skilled nursing is to provide comprehensive medical care and rehabilitation services to patients who require ongoing monitoring and assistance. The primary goals of skilled nursing include:

• Medical Management : Skilled nursing facilities are equipped to handle a range of medical conditions and provide specialized care tailored to each patient's needs. This can include medication management, wound care, and monitoring of vital signs.
• Rehabilitation Services : Skilled nursing facilities offer various therapies, such as physical therapy, occupational therapy, and speech therapy, to help patients regain strength, mobility, and communication abilities.
• Assistance with Activities of Daily Living : Skilled nursing facilities provide support with activities of daily living (ADLs), including bathing, dressing, eating, and toileting. The goal is to enhance independence and improve the overall quality of life for patients.
• Social and Emotional Support : Skilled nursing facilities have a multidisciplinary team that includes nurses, therapists, social workers, and other healthcare professionals who provide emotional support and address the psychosocial needs of patients and their families.

Services Provided in Skilled Nursing

Skilled nursing facilities offer a wide range of services to meet the complex needs of patients. These services may include, but are not limited to:

‍ 24/7 Medical Care and Monitoring

Rehabilitation Therapies (Physical, Occupational, Speech)

Medication Management

Pain Management

Intravenous (IV) Therapy

Respiratory Therapy

Nutritional Support

Social Services and Counseling

Recreational Activities

Discharge Planning and Care Coordination

The services provided in skilled nursing facilities are designed to address the specific medical, rehabilitation, and personal care needs of each patient. The interdisciplinary team works collaboratively to develop individualized care plans that promote recovery and maximize functional independence.

Skilled nursing plays a vital role in the continuum of care, providing essential services to individuals who require more intensive medical and rehabilitation support than what can be provided in other settings. By offering a comprehensive approach to healthcare, skilled nursing facilities aim to optimize patient outcomes and help individuals achieve their highest level of functioning and independence.

Differentiating Between Acute Rehabilitation and Skilled Nursing

When it comes to choosing between acute rehabilitation and skilled nursing, there are several factors to consider. Two key differentiating factors are patient eligibility and admission criteria, as well as the duration of stay and intensity of therapy provided.

Patient Eligibility and Admission Criteria

The eligibility and admission criteria for acute rehabilitation and skilled nursing differ based on the individual's specific needs and condition. Let's take a closer look at each setting:

Acute Rehabilitation: Acute rehabilitation is typically recommended for individuals who require intensive therapy following a sudden injury, illness, or surgery. Admission to an acute rehabilitation facility usually requires meeting certain criteria, such as:

• The individual must have the potential to improve functionally through intensive therapy.
• They should be medically stable and able to participate in multiple therapy sessions per day.
• The individual must have the ability to actively participate in their rehabilitation program.

Skilled Nursing: Skilled nursing, on the other hand, caters to individuals who require more medically focused care and assistance with activities of daily living. Admission to a skilled nursing facility may be appropriate for individuals who:

• Need ongoing nursing care and supervision.
• Require assistance with activities such as bathing, dressing, and medication management.
• Have chronic conditions that require monitoring and management.

Understanding the specific needs and eligibility criteria of the individual is crucial in making the right choice between acute rehabilitation and skilled nursing.

Duration of Stay and Intensity of Therapy

The duration of stay and intensity of therapy provided in acute rehabilitation and skilled nursing settings also differ. Let's explore these factors further:

Acute Rehabilitation: Acute rehabilitation typically involves a more intensive and focused approach to therapy. The duration of stay in an acute rehabilitation facility can vary based on the individual's progress and goals. It may range from a few weeks to several months. The therapy sessions in acute rehabilitation are often more frequent and intense, with multiple sessions per day aimed at maximizing functional recovery.

Skilled Nursing: Skilled nursing facilities, on the other hand, usually provide a longer-term care solution. The duration of stay in skilled nursing can vary depending on the individual's needs and progress. It may range from a few weeks to an extended period of time. Therapy sessions in skilled nursing are generally less frequent and intense compared to acute rehabilitation, focusing more on maintaining and managing the individual's functional abilities.

It's important to note that the duration of stay and intensity of therapy may be influenced by factors such as the individual's progress, insurance coverage, and healthcare provider recommendations.

Understanding the differences in patient eligibility, admission criteria, duration of stay, and intensity of therapy can help individuals and their families make informed decisions when choosing between acute rehabilitation and skilled nursing. Consulting with healthcare providers and seeking their expertise can provide further guidance in determining the most appropriate care setting for the individual's specific needs.

Choosing the Right Care Setting

When it comes to choosing between acute rehabilitation and skilled nursing, there are several factors to consider. Each care setting has its own unique features and benefits, and the decision should be based on the individual's specific needs and goals. Here are some key factors to consider when making this important decision:

Factors to Consider When Choosing Between Acute Rehabilitation and Skilled Nursing

Collaborating with Healthcare Providers

When making the decision between acute rehabilitation and skilled nursing, it is crucial to collaborate with healthcare providers, including physicians, therapists, and case managers. These professionals can assess the individual's needs, evaluate their medical condition, and provide guidance on the most appropriate care setting.

By working together with healthcare providers, individuals and their families can make an informed decision that takes into account the individual's medical stability, therapy requirements, rehabilitation goals, and overall care needs. The healthcare team can provide valuable insights and recommendations based on their expertise and experience, ensuring that the individual receives the most suitable care and support for their recovery journey.

Remember, the choice between acute rehabilitation and skilled nursing should be based on a thorough assessment of the individual's unique circumstances and goals. By considering the factors outlined above and consulting with healthcare professionals, individuals can make an informed decision that promotes their recovery and enhances their quality of life.

https://www.trinityhealthma.org/find-a-service-or-specialty/acute-rehab/nazareth-aru/aru-vs-snf

https://bridgecaresuites.com/acute-inpatient-rehab/

https://www.aplaceformom.com/caregiver-resources/articles/choose-between-rehab-and-skilled-nursing

Similar articles

Best Pain Medication For Elderly Patients

What Is Senior Care Services?

Senior housing subsidies.

What Is Heart Failure In The Elderly?

Leisure Activities For Retirees

Hospice Care Statistics

Contact us today and experience ”the name in healthcare”.

Where compassion, well-being, and a welcoming community converge to redefine your healthcare journey. Welcome to Rosewood, where your family becomes our family.