Are you a skilled nursing or rehabilitation nurse? Even you may be unsure about the difference between these two designations.
In post-acute settings, skilled nursing and rehabilitation are often interchangeable, but this is not always true. Read on to fully understand the complexities behind skilled nursing vs. rehabilitation.
Post-Acute: Understanding the What, Where, and Why
Patients are usually eager to go home after hospital stays. However, they often need periods of post-acute care before going home.
Post-acute care helps patients recover enough to return home or to a long-term care setting. So, what are typical post-acute care settings?
According to the American Hospital Association (AHA), post-acute care options include the following settings:
- Inpatient rehabilitation facilities (IRFs)
- Long-term care hospitals (LTCHs)
- Skilled nursing facilities (SNFs)
- Home health
Post-Acute vs. Skilled Nursing
Inpatient rehabilitation facilities are acute care settings. Patients receive subacute rehabilitative care in skilled nursing facilities. Subacute care patients have more stable conditions. Therefore, they require a lower level of care.
Like IRFs, long-term care hospitals offer acute care to patients who continue to need this level of care after short-term hospital stays.
Home health is available for some patients requiring post-acute care. However, patients who need 24/7 subacute nursing care should go to a skilled nursing facility.
Skilled Nursing and Rehabilitation Center Patients
After a hospital stay, the healthcare team must work together to plan for the patient's care after discharge. For a patient to return home, they must be able to do the following:
- Safely use a cane, a walker, crutches, or a wheelchair
- Sit and stand without requiring much assistance (or with the level of aid the patient can receive at home)
- Move from bed to bathroom to kitchen safely
- Go up and down stairs if necessary (based on the patient's home)
If patients cannot do these tasks alone or do not have enough help in their homes, they may need extra care at skilled nursing facilities.
Medical conditions that often lead to SNF/rehab stays include the following:
- Extended hospital stays (regardless of condition)
- Stroke or other brain injury
- Joint replacement surgery for knees, hips, shoulders, etc.
Other conditions that may qualify patients for skilled nursing or rehab include the following:
- Medical problems that are not well controlled, including diabetes, lung problems, and heart problems
- Medicines that cannot be administered at home safely
- Surgical wounds requiring frequent care
What Is a Skilled Nursing Facility?
Before digging deep into the meaning and scope of skilled nursing, it would be helpful to understand the difference between SNFs and nursing homes.
Traditionally, nursing homes were places where older adults could receive long-term care.
However, nursing homes have evolved significantly since the early 1900s. In 1950, amendments to the Social Security Act allowed payment for care in licensed public institutions. This led to the rapid growth of the current nursing home system.
According to the Centers for Medicare & Medicaid Services (CMS), nursing homes encompass skilled nursing facilities and nursing facilities. In other words, all skilled nursing facilities are nursing homes. However, not all nursing homes are skilled nursing facilities.
A publication from the National Academies of Sciences, Engineering, and Medicine shared the following data insights:
- Post-acute patients recovering after a hospital stay: 43% of the nursing home population
- Long-term residents: 57% of the patient population
- Average length of stay for a post-acute patient: 28 days
- Average length of stay for a long-term care resident: 2.3 years
- Residents under 65: 18.6% of the short-term and 14.9% of the long-term nursing home population
What Care Do Patients Receive in Skilled Nursing Facilities?
Nursing homes provide various services. These services include skilled nursing and medical care, 24-hour supervision, hospice, treatments related to incontinence, and assistance with activities of daily living (ADLs).
Approximately 15 percent of nursing home residents require assistance with five activities of daily living or more. The following percentages indicate the ADLs that residents most often need assistance with:
- Bathing: 96.7%
- Dressing: 92.7%
- Walking or locomotion: 92.0%
- Toileting: 89.3%
- Transferring in and out of bed: 86.8%
- Eating: 59.9%
Most nursing homes provide both short-term rehabilitation and subacute care.
Registered nurses (RNs) and licensed practical nurses (LPNs) provide nursing care.
Certified nursing assistants (CNAs) help residents with activities of daily living.
Occupational, physical, and speech-language therapists provide rehabilitation services for long-term and short-term residents.
Not all residents need rehabilitation. For reference, approximately 32 percent of nursing home residents received rehabilitation in 2016.
Where Can Individuals Receive Rehabilitation Services?
First, what is rehabilitation? Rehabilitation helps individuals recover after illness or injury. It helps people return to their normal lives and carry out daily activities.
Numerous healthcare settings offer rehabilitation services. The CMS recognizes inpatient rehabilitation facilities, outpatient rehabilitation providers, comprehensive outpatient rehabilitation facilities (CORFS), and skilled nursing facilities.
Inpatient Rehabilitation Facilities
IRFs are rehabilitation units in acute care hospitals or free-standing rehabilitation hospitals. They provide intensive rehabilitation programs.
Patients move to inpatient rehabilitation facilities directly from acute care hospitals or within 60 days of hospital discharge.
Furthermore, a physician must certify that the patient has a medical condition requiring the following:
- Continued medical supervision
- Coordinated care from doctors, other healthcare providers, and therapists
- Intensive rehabilitation
Patients in IRFs must be able to tolerate three hours of intense rehabilitation services daily.
Outpatient Rehabilitation Providers
Three types of organizations may qualify as Medicare/Medicaid-certified outpatient rehabilitation providers:
- Rehabilitation agencies: These agencies must provide integrated, multidisciplinary programs designed to develop the physical functions of disabled individuals. Teams of specialized rehabilitation personnel carry out these programs at offices throughout the country.
- Clinics: These facilities primarily provide outpatient physician services. The clinic must offer the medical services of three or more physicians practicing medicine together. A physician must be present at all times during the clinic's hours of operation to perform medical services.
- Public health agencies: State or local governments establish these agencies to maintain the health of the population. They provide environmental health services, preventive medical services, and, sometimes, therapeutic services.
Comprehensive Outpatient Rehabilitation Facility
Comprehensive outpatient rehabilitation facilities provide the following coordinated outpatient services:
- Diagnostic
- Restorative
- Therapeutic
These services are for the rehabilitation of injured, disabled, or sick individuals.
Most services are provided at outpatient rehabilitation facilities. However, physical, occupational, and speech-language therapy services may be provided off-site.
Skilled Nursing Facilities
Subacute rehabilitation in skilled nursing facilities is less intense than acute rehabilitation in IRFs. Patients in subacute facilities generally receive one or two hours of therapy per day. Patients in IRFs receive three.
Rehabilitation services usually include physical, occupational, and speech therapy.
Patients naturally receive nursing care and therapies based on their needs. The team of medical professionals determines these needs by conducting initial and ongoing assessments.
According to Medicare.gov, assessments in skilled nursing facilities consider the following information:
- A patient's physical and mental condition
- Their medical history
- Medications
- Ability to perform activities of daily living
- Speech
- Decision-making ability
- Physical limitations, such as problems with hearing or vision, paralysis after a stroke, or balance problems
Based on this assessment, the interprofessional healthcare team develops a care plan, including the following:
- A list of the services the patient needs and the type of healthcare professional who should give them
- The frequency with which the patient needs the services
- A list of equipment or supplies the patient needs, such as a wheelchair or feeding tube
- Special dietary needs
- The patient's health goals, including a description of how the care plan will help the patient reach said goals
According to a patient's assessment and care plan, physical, occupational, or speech therapy may be needed.
- Physical therapy: These services treat a patient's disease or injury through massage, exercise, and heat treatment.
- Occupational therapy: This therapy helps patients recover the ability to carry out activities of daily living, such as grooming and toileting. It also helps residents with instrumental activities of daily living, such as pushing a shopping cart or preparing a meal.
- Speech therapy: These services help individuals with swallowing issues and verbal communication.
How do doctors or patients decide between skilled nursing vs. rehab centers?
Deciding on the appropriate rehabilitation setting depends in part on the amount of rehabilitation patients need.
For example, some patients may require acute rehab services, such as those obtained in an inpatient rehabilitation facility. These patients receive three hours of rehabilitation per day.
Patients with subacute care needs (up to two hours of rehab daily) who still need around-the-clock supervision meet the requirements for stays in skilled nursing facilities. In this case, there is no difference between a skilled nursing facility and a rehab center.
Skilled Nursing Facilities vs. Rehab Centers
Is skilled nursing the same as rehab? In many cases, skilled nursing facilities and rehab centers are the same. This is because skilled nursing facilities offer rehabilitation services.
Patients in these facilities typically receive 24-hour skilled nursing care, including IV therapy, wound care, and injections. They also receive rehabilitation services, including physical, occupational, and speech therapy.
These facilities fall into the same category of post-acute/subacute nursing and rehabilitation services. However, some may specialize in certain conditions, such as:
- Stroke rehabilitation
- Brain injury rehabilitation
- Orthopedic rehabilitation
- Amputee rehabilitation.
Regardless of the facilities' focus or specialization, they all offer 24-hour skilled nursing care. Therefore, these facilities are categorized as skilled nursing facilities.
Now that skilled nursing vs. rehabilitation is clear, do you have the nursing skills to work in these specialties? Pick up high-paying PRN jobs in these facilities today.
Sources:
- National Academies of Sciences, Engineering, and Medicine: The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff
- National Library of Medicine: Acute and subacute rehabilitation for stroke: a comparison
- MedlinePlus: Skilled nursing or rehabilitation facilities
- U.S. Centers for Medicare and Medicaid Services: Assessments & Care Plans in Skilled Nursing Facilities
- Texas Speech-Language Hearing Association: Long-Term Care (LTC)/Skilled Nursing Facility (SNF)
- American Hospital Association: Post-Acute Care Advocacy Alliance
