Can My Loved One Go to a SNF?

This article discusses the requirements for Skilled Nursing Facility admission, advocating for your loved one as a medical professional, and alternatives when SNF is not appropriate.

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Can My Loved One Go to a SNF?

When a loved one is admitted to the hospital, it can be a nerve-wracking experience, even for those in the medical field. Typically, the main concern for the patient and the family is the patient's current condition.

  • What is the diagnosis?
  • How is my loved one responding to treatment?
  • How serious is their condition?

These are all valid questions and important ones to ask.

Another vital question to ask is: What is the discharge plan? It is sometimes assumed that an elderly patient will automatically be discharged to a Skilled Nursing Facility (SNF). This is where the complications can start, especially if you or your loved one needs clarification about SNF admission rules. Understanding that a patient must be eligible for SNF admission is essential.

Before diving into eligibility for SNF admission, let's first look at the differences between a Skilled Nursing Facility (SNF) and a nursing home.  A SNF is not to be confused with a nursing home, although healthcare providers sometimes interchange these terms. They are not equal.

What is a Nursing Home?

A nursing home is a residential facility for seniors or those with physical or cognitive disabilities who can no longer live at home. A nursing home may or may not be covered by insurance. A nursing home will be the appropriate discharge location for your loved one if they:

  • Require a long-term residential stay
  • Are medically stable with no change in physical abilities
  • Can receive outpatient medical care

What is a SNF?

A SNF is a post-acute medical and rehabilitation facility providing skilled nursing care. A SNF stay is covered by insurance. A SNF will be the appropriate discharge location for your loved one if they:

  • Require a short-term medical stay
  • Need inpatient medical care and nursing care
    • IV therapies
    • Wound care
    • Close medical monitoring
  • Need one or more types of therapy
    • Physical therapy
    • Occupational therapy
    • Speech therapy

These services must be provided for a condition for which the patient was recently hospitalized. Sometimes, a patient's Primary Care Physician (PCP) can request direct admission to SNF, but the same requirements apply.

Who Can Go To a SNF?

The Centers for Medicare and Medicaid's (CMS) Medicare Benefit Policy Manual, Chapter 8, section 30, contains the roadmap determining if a patient is eligible for SNF admission. This section of the CMS guidelines is lengthy, so let's simplify it.

A patient is eligible for SNF admission if:

  • The patient is unable to do things they did before hospitalization – getting up from a chair, walking, going to the bathroom, bathing, or dressing, AND there is room for improvement
  • The patient requires one or more IV medications that cannot be managed at home
  • The patient has extensive wound care needs
  • The patient and/or their family require teaching for PEG tube feedings

You can find a copy of this section on the CMS website here.

How Can You Advocate for Your Loved One?

If you believe your loved one needs to go to a SNF based on the criteria above, it is essential that you advocate for your family member. This should be done early in the hospitalization. Remember, nursing educators drilled one thing into our heads during nursing school – discharge planning starts on admission. 

It is crucial that you discuss the following with the healthcare team:

  • Describe what your loved one was able to do before hospitalization – were they fully independent and driving, or did they require less help than they do now?
  • Request physical and occupational therapy evaluations – these are critical to approval based on rehabilitation needs
  • Explain the setup of your loved one's home – number of stairs to get inside, how many levels the home is, location of the bedroom and bathroom
  • Discuss caregiver availability – Does the patient live alone or with someone? Who is the primary caregiver, and is that person available 24/7?

What if SNF is Not the Right Place to Go?

If you find that SNF is not an appropriate discharge plan for your loved one, there are additional steps you can take to help ensure a safe discharge.

  • Talk with your other family members, friends, and neighbors to determine who can help your loved one at home – come up with a schedule to reduce the risk of burnout
  • Consider adult/senior day programs – these programs can bridge the gap while the caregiver is at work
  • Look into respite care programs – these programs give caregivers time to handle tasks such as grocery shopping, running errands, or even going to the gym

Key Takeaways

Hospitalization can be scary for the patient and the family and become more so when the discharge plan is unclear. As medical professionals, we must remind ourselves that discharge planning starts at admission. We must understand and help our loved ones understand what appropriate options may be available upon discharge from the hospital. In some cases, Skilled Nursing Facility admission will be the most appropriate discharge plan, while in others, it will not.

Stephanie Catalan, BSN, RN

References/Resources

Medicare Benefit Policy Manual: Centers for Medicare & Medicaid Services

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Stephanie Catalan RN

About Stephanie Catalan RN

Stephanie Catalan, RN, has 14 years of nursing experience and clinical background in Medical-Surgical, Stroke, Neurological, and Intermediate Care nursing. For the past 11 years, she has worked within Managed Care Organizations (MCOs) in various roles, including CM, UM, PA, and Clinical Quality.

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Specializes in Oceanfront Living.

Please elaborate on what insurance covers SNFs.

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