Frequently Asked Questions on Skilled Nursing Care
What is a skilled nursing facility?
A skilled nursing facility provides nursing care and rehabilitation services to people with illnesses, injuries or functional disabilities. Most facilities serve the elderly. However, some facilities provide services to younger individuals with special needs such as the developmentally disabled, mentally ill, and those requiring drug and alcohol rehabilitation. Skilled nursing facilities are generally stand-alone communities, but some are operated within a hospital or broader retirement community.
When is a skilled nursing facility needed?
Speak with your doctor or a member of your healthcare team to see if skilled nursing facility care is appropriate. Early discussion should allow time for everyone to participate in developing a plan of action.
How will my family or friends and I know which skilled nursing facility to choose?
If your loved one is in the hospital, your social worker will help in planning for skilled nursing facility placement. You may speak with the social worker and select the facility that best matches the individual’s needs. Placement often happens very quickly after applications are completed. You may contact, visit and tour our skilled nursing facilities.
Why can’t I stay in the hospital rather than going to a skilled nursing facility?
Hospitals are designed for patients who have serious medical problems that can be treated only in a hospital. Insurance companies can review and stop insurance benefits when you no longer need acute hospital care.
Who pays for care in a skilled nursing facility?
Depending on your situation, you will be "private pay" (you use your own funds) or covered by Medicaid. Some people have commercial insurance that covers skilled nursing facility costs. In limited cases, Medicare pays for skilled nursing facility care. If you need Medicaid to cover the cost of skilled nursing care, you may need to apply for Medicaid.
Will my long-term care insurance pay for the skilled nursing facility?
Long-term care policies vary; some will pay for custodial care while others pay only for skilled nursing care. You should check your policy or speak with your insurance company to know what is covered by your particular policy.
Can I leave the skilled nursing facility and return home?
Residents always have the right to leave a skilled nursing facility if they choose to do so.
What is Medicare and what does it cover?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) for people ages 65 and over and for certain disabled people under 65. Get more information about Medicare here, [link to Medicare.gov] or speak to a WILMAC representative about Medicare coverage at our facilities.
What is the difference between skilled and custodial care?
A skilled service is a service that has to be provided by a licensed professional (i.e., therapy services, wound care, dressing changes, tube feedings). A nonprofessional (i.e., family or friend) can provide custodial care. Custodial needs are generally chronic and occur when the individual requires ongoing supervision and assistance with activities of daily living (i.e., bathing, dressing, eating, and medication).
How will my loved one get to the skilled nursing facility?
The physician is consulted to determine the most appropriate mode of transportation. In order for a patient to be transferred by ambulance, certain medical criteria must be met. Some patients can be transferred to the facility by a wheelchair van or by family if they request to do so (and it is felt the patient can be safely transported). Depending upon the circumstances, the patient may be charged for transportation services.
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