What Qualifies a Patient for Skilled Nursing Care?

Have you ever wondered what qualifies a patient for skilled nursing care in a nursing home?

You might think that skilled nursing care is only available to those who are elderly or have serious medical conditions, but that is not always the case. Skilled nursing care can be beneficial for patients of all ages and with different needs. Let’s break it down and explore what skilled nursing care looks like in a nursing home setting.

What Is Skilled Nursing Care?

Skilled nursing care is medical care provided by registered nurses and other licensed medical professionals who work with patients to manage their chronic illnesses or disabilities, prevent complications, and promote recovery. This type of care can include wound treatment, catheterization, intravenous therapy, rehabilitation services, medication management, and more. Skilled care is usually covered by Medicare or an insurance provider with a physician’s order and authorization.

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Who Qualifies for Skilled Nursing Care?

Patients of all ages may qualify for skilled nursing care in a nursing home if they have a need for comprehensive medical services on an ongoing basis. This includes those seeking short-term rehabilitation after an illness or injury as well as those requiring support with activities of daily living such as bathing, dressing, eating, and toileting.

Benefits of Skilled Nursing Care in a Nursing Home Setting  

The primary benefit of skilled nursing care is improved quality of life for the patient by helping them remain as independent as possible while managing their condition(s). A team of healthcare professionals can also help to ensure timely diagnosis and treatment to reduce the risk of further medical complications.

Additionally, physical therapy, occupational therapy, and speech therapy can all support the recovery time following an illness or injury while providing emotional support throughout the process.

All these benefits make skilled nursing care an excellent option for many individuals needing assistance in managing their health conditions over time.   Plus, you usually get more time than in a hospital to be able to recover at your pace. Most insurance carriers will cover up to 100 days of skilled nursing care.         

Medical Necessity

In order to qualify for skilled nursing care, you must have what is known as “medical necessity.” This means that your physician must certify that you need medical attention that can only be provided by trained caregivers in a supervised setting like a nursing home. This includes things like physical therapy and wound care services which cannot be provided safely or effectively outside of an inpatient facility.

Prior Authorization

In addition to having medical necessity, most insurance plans require prior authorization before they will cover skilled nursing care in a nursing home. This means that your physician must contact your insurance company to explain why they feel you need this type of care and why it is medically necessary. Insurance companies do not always approve requests, so it is important to make sure that all paperwork is filled out correctly and submitted in a timely manner.

Length of Stay Requirements

Most insurance plans also have length of stay requirements for skilled nursing care in a nursing home. This means that there is usually an upper limit on how long someone can stay at the facility before their coverage ends or they must switch to another type of service such as home health care or outpatient therapy services. It is important to find out what these requirements are before making any decisions about where you will receive your care.

Final Thoughts: What Qualifies a Patient for Skilled Nursing Care

Skilled nursing care can be an invaluable resource for patients looking to manage chronic illnesses or disabilities and improve their quality of life over time. The team approach makes it possible to provide comprehensive medical services while encouraging independence and improving recovery after an illness or injury. If you or someone you know is considering skilled nursing care in a nursing home setting, it’s essential to talk with your healthcare provider about your individual needs and the options available to you so that you can make an informed decision about your healthcare plan moving forward.