A nursing home , convalescent home , Skilled Nursing Unit ( SNU ), care home or rest home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical or mental disabilities. Eligible adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness.
United States
In the United States, a "Skilled Nursing Facility" or "SNF" is a nursing home certified to participate in, and be reimbursed by Medicare. Medicare is the federal program primarily for the aged who contributed to Social Security and Medicare while they were employed. A "Nursing Facility" or "NF" is a nursing home certified to participate in, and be reimbursed by Medicaid. Medicaid is the federal program implemented with each State to provide health care and related services to those who are "poor." Each State defines poverty and; therefore, Medicaid eligibility. Those eligible for Medicaid may be aged, disabled or children (e.g. Children's Health Insurance Programs - CHIPs and Maternal-Child wellness and food programs).
In the United States, each State "licenses" its nursing homes, making them subject to the State's laws and regulations. Nursing homes may choose to participate in Medicare and/or Medicaid. If they pass a survey (inspection), they are "certified" and are also subject to federal laws and regulations. All or part of a nursing home may participate in Medicare and/or Medicaid.
In the United States, nursing homes which participate in Medicare and/or Medicaid are required to have licensed practical nurses (LPNs) (in some States designated "vocational nurses" or "LVNs") on duty 24 hours a day. For at least 8 hours per day, 7 days per week, there must be a registered nurse on duty. Nursing homes are managed by a Licensed Nursing Home Administrator. Unlike U.S. nursing there are no standardized training and licensing requirements for administrators, though most states require a Federal License, and many states such as California have their own licensure for administrators. In April 18, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December 12, 2002.
There are states that have other levels of care offered to elderly and other adults who need assistance and are able to live in the community. For instance, Connecticut has Residential Care Homes or RCH that are licensed by the State Department of Public Health. These homes provide 24-hour supervision and typically offer a more "home-like" environment. Many are actually large homes that have been converted to dwellings that offer a residential community that promotes an independent lifestyle and fosters fellowship with others who need some form of assistance to live in the community (see http://CARCH.NET).
Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 resident beds and 13 per 100 resident beds, respectively.
Nursing homes that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents. In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for 20 to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicare also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
The cost of staying in a Nursing home can cost several thousand per month or more. Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals for life. However, they require that the patient be "spent down" to a low asset level first by either depleting their life savings or asset-protecting them, often using an elder law attorney.
U.S. Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors. State surveyors may inspect for compliance with licensure (State regulations) and/or certification (Medicare and Medicaid regulations).
The "Mininimum Data Set" assessment (MDS) is part of the U.S. federally mandated process for comprehensive assessment of all residents in Medicare or Medicaid certified nursing homes. The MDS assessment is a screening assessment that forms the basis of a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify and help residents meet or cope with health and other needs. The MDS also yields "Resource Utilization Groups" (RUGS) which are used for all Medicare reimbursement to SNFs, and is used in many States to set reimbursement for NFs.
For United States SNFs and NFs, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below). CMS also publishes a list of Special Focus Facilities - nursing homes with "a history of serious quality issues." The US Government Accountability Office (GAO), however, has found that state nursing home inspections understate the number of serious nursing home problems that present a danger to residents. The GAO concluded that while CMS oversight has improved, there are still weaknesses in its oversight of nursing homes. A report issued in September 2008 found that over 90% of nursing homes were cited for federal health or safety violations in 2007, with about 17% of nursing homes having deficiencies causing "actual harm or immediate jeopardy" to patients.
SNFs and NFs are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).
Medicare and Medicaid surveys
Federal regulation and inspection (surveying) of SNFs and NFs applies a model of health care quality created for research by Avedis Donabedian in 1965. The model uses the concepts of structure, process and outcome.
Structure
For surveying, structure is the nursing home's resources. That includes staff, their knowledge and skills, policies, procedures, records, equipment, buildings, etc. Structure surveying looks at the instrumentalities of care and their organization.
Process
Process is the nursing home's resources in action. Process surveying looks at the appropriateness, timeliness and quality of care and services in relation to each resident's needs. Process can be organized into 5 kinds of intellectual and physical activities: assessing, planning, implementing (acting), evaluating, and communicating. These activities must be integrated and often occur together. Unfortunately these processes can be task or resident-centered. A task nurse implements a physician ordered-dressing change, perhaps assessing the wound while it is uncovered. A resident-centered nurse would already know if the treatment causes the resident pain and pre-medicated the resident. During the care, she (or he) will talk with the resident about topics they have both shared before, distracting the resident from discomfort and addressing social needs
Coronado, California Nursing Home Negligence Lawyer :: Skilled Nursing ...
Skilled nursing facilities (SNFs) and intermediate care ... Nursing Home / Elder Abuse Litigation. Elder Abuse; Skilled Nursing Facilities
San Diego Nursing Home Facility | Casa de las Campanas
San Diego Skilled Nursing Facility Our on-site Medicare-Certified skilled nursing facility allows our ... Home | Continuing Care | About Us | Active Lifestyle ...
Nursing Homes (Skilled Nursing Facilities)
Learn about Nursing Homes (Skilled Nursing Facilities) and choosing the best facility for your needs. Includes types of care and services offered, and links to checklists and ...
Skilled Nursing Facilities/Long-Term Care Open Door Forum Open Door ...
The Skilled Nursing Facilities / Long-Term Care Open Door Forum (ODF) addresses the ... CMS Skilled Nursing Facilities Center Nursing Home Quality Initiatives Medicare Contracting ...
Skilled Nursing Facility | Skilled Nursing Care | Skilled Nursing ...
Search comprehensive directory of Nursing Homes (Skilled Nursing Facilities) & choosing the best Skilled ... Greater Harlem Nursing Home Company Inc
South Roanoke Nursing Home-Roanoke Virginia Skilled Nursing Facility
South Roanoke Nursing Home is a 100 bed, Skilled Nursing Facility conveniently located in Roanoke Virginia. Since 1964 we have offered the best personalized nursing care in the ...
Nursing Home Checklist — Choose the right facility
Nursing Home Checklist Choosing a Nursing Home / Skilled Nursing Facility. Nursing homes can be large or small, rural or urban. They vary widely in the nursing care plans, activities ...
Nursing Home / Skilled Care Facilities, Lifestyle, Services, Housing ...
Nursing Home Skilled Care Facilities, Lifestyle, Services, Housing, Payment Methods
Skilled Nursing Facility | Skilled Nursing Care | Skilled Nursing ...
Search comprehensive directory of Nursing Homes (Skilled Nursing Facilities) & choosing the best Skilled ... Home Housing Home Care Groups Blogs Providers Services Help
Nursing Homes, Skilled Nursing Facility, Residential Care ...
Residential care facility, skilled nursing home, convalescent homes, assisted living care online guide.