What’s the difference between a Skilled Nursing Facility (SNF) and a Nursing Facility?
Technically they serve different government programs and their beneficiaries. In practice, the same facility is often both. Lawyers, regulators, and administrators are more likely to use the terms of art technically.
Terms of Art
Most of us in everyday life use these terms interchangeably, along with Nursing Home or Long-term Care Facility. But there are some regulatory differences. Consider the speaker or context to see if the usage is intended generically or as a term of art. In particular, your CCRC contract is likely to use words technically including non-self-obvious limitations. The specific language of a contract always controls over general usage.
- SNF (pronounced “Sniff”). A Skilled Nursing Facility (SNF) is certified to deliver care for, and be paid by, Medicare for rehabilitative services. Rehabilitative services are common upon discharge from a hospital during the recovery phase. Rehabilitation requires improvement in the patient’s health and does not include long-term care for long-term stable or deteriorating patients. Medicare does not pay for long-term care. Medicare places a lifetime limit of 100 days on rehabilitative care for any one patient.
This same 100 day period is mirrored in the provisions of many CCRC contracts. This is a demark point between levels of care within the community’s continuum. For instance, in many contracts, a resident is allowed to use up to 100 days of skilled nursing care (rehabilitative) in the community’s SNF or health center and still stay in independent living.
- Nursing Facility. In that same technical context, a registered Nursing Facility is certified to deliver for and be paid by Medicaid for long-term care services. Medicaid does pay for long-term care, but only for the poor. Residents of a high-end CCRC or Life Care Community are not going to be on Medicaid due to the spend-down of assets required to qualify for Medicaid.
Medicare and Medicaid
The middle-class and upper-middle-class are on their own to pay for long-term care, either out-of-pocket, through long-term care insurance or through a CCRC. This comes as a shock to many approaching retirement or in early retirement. Medicare and Medicaid are easily confused. As you age the differences really matter.
A nursing home or long-term care facility is normally dual certified with designated SNF (Skilled Nursing Facility) or rehabilitation beds and NF (Nursing Facility) or long-term care beds. In other words, the same health center can be both a SNF and an NF.
The health center in a CCRC should at minimum be certified as a SNF to provided the continuum of care expected by CCRC residents. It will normally also provide NF long-term care and be certified as a NF for Medicaid.
Why Terms of Art Matter
Why might the terms of art matter? Remember most CCRCs receive revenue from other sources beyond the residents’ buy-in or monthly fees. Many CCRC nursing facilities do not limit the residents of the health facility to members entering from early stages of the community’s continuum of offerings. These CCRCs get paid by nonresidents. Or they’re paid by the insurers for these non-residents. So these regulatory levels address both CCRC residents and nonresident members of the broader community, including private pay (with or without long-term care insurance), and even Medicare recipients. This also becomes an issue when you (a CCRC resident) need care in the nursing facility. Will there be an empty bed? If so, do you have first preference over a nonresident private pay patient?
Your CCRC contract will most likely use the terms of art. Most contracts include a definitions section. This section details what exactly is meant for that contract by a specific term of art. When you read your contract (or proposed contract) be sure to refer to the definitions section and don’t read technical terms with their common usage or generic meaning.
Even Medicare uses Nursing Facilities to refer broadly to both categories, such as in the Medicare Nursing Facilities Rating System. (For more information on Medicare’s 5-star Rating System see our explanation at this link.)