No one plans a medical emergency. Or a fall. Or an illness. But when the unthinkable happens you may find yourself trying to evaluate skilled nursing facilities vs. nursing homes, without a clear understanding of the difference. The Pine Run Health Center is available for short and long-term stays to provide the nursing care, rehabilitation, therapies, and support needed to get back on your feet or to help manage chronic conditions and illnesses and improve quality of life.
“Moving to the Pine Run Health Center either for a short stay or permanently is not a choice any of us wants to make,” said Sandy Stiles, Nursing Home Administrator at the Pine Run Health Center. “But for those who require round-the-clock medical care and assistance with activities of daily living, or who have recently had a hospital stay or surgery, a skilled nursing facility provides the medical care that is needed as well as the social, emotional, and nutritional supports for those who need to be here,” continued Stiles.
If you or your loved one has experienced a medical emergency and has worked with hospital discharge planners or are experiencing challenges managing illnesses in your home, the next steps are often confusing. What are skilled nursing facilities? What is short-term care? Rehabilitation? Long-term care? Is this different than a nursing home? And who pays for these services?
The essential differences between skilled nursing facilities vs. nursing homes can be summarized this way: a skilled nursing facility (short-term care and rehabilitation) is a temporary residence for patients undergoing medically necessary rehabilitation treatment. A nursing home (long-term care) is a permanent residence for people in need of 24/7 care. The Pine Run Health Center offers both of these options.
While Medicare and many health insurance plans cover the costs of a short-term rehabilitation in a facility, many families are surprised to learn that they do not cover the costs of long-term care.
Skilled Nursing Facility/Short-Term Care & Rehabilitation
Individuals with certain medical diagnoses or who have had a recent hospitalization or surgery often benefit from a short-term rehabilitation stay in a skilled-nursing facility like the Pine Run Health Center. Rehabilitation services can include:
- Physical Therapy: therapeutic exercise, strength and mobility training, gait and balance training, and muscle re-education to regain strength and function. Physical therapists help injured or ill people improve movement and manage pain.
- Occupational Therapy: education and training in activities of daily living, strength and range-of-motion training, selection and use of adaptive equipment. Occupational Therapists help people develop, recover, improve, as well as maintain the skills needed for daily living and working.
- Speech-Language Therapy: increase functional communication, cognitive skills and teach safe swallowing by introducing diet modifications and special feeding techniques. Speech therapy may include muscle retraining, compensatory strategies and use of communication devices to treat language disorders, speech disorders and swallowing problems.
The goal of a short-term care stay is to prepare someone to return to their prior level of function. Medicare and many health insurance plans may cover care after a hospital admission in a skilled nursing facility for short-term rehabilitation. A typical stay may range from seven to 14 days, as determined by your insurance.
Nursing Home/Long-term Care
Different from a short-term stay, long-term care is for residents who can no longer live safely on their own who require 24/7 care. Long-term care is also known as nursing home care. These residents move permanently to a facility for medical care as well as assistance with their activities of daily living (e.g., bathing, dressing, eating, grooming, and using the bathroom). Long-term care provides the support and life enrichment they need to live the highest quality of life possible.
Medicare and most health insurance plans do not cover the fees for a long-term stay in a facility. Most facilities charge a daily rate which covers a resident’s room and board. However, the daily rate may not cover other services a resident may need, such as:
- Medical supplies and equipment (e.g., Oxygen, feeding pumps, CPAP and BiPAP machines, wound supplies)
- Over-the-counter medications and prescription drugs that are not covered by a prescription plan
- Laundry and linen services
- Physical, Occupational, or Speech Therapy that are not covered by Medicare or a health insurance plan
- Companion services
- Salon services
Services that are included and excluded from a facility’s rates should be clearly outlined by a facility’s admissions representative, along with a review of insurances, including Medicare A, B, and prescription plans so that all are aware of the costs.
At the Pine Run Health Center, the daily rate covers a resident’s room (either private or semi-private), three chef-prepared meals per day, all life-enrichment activities, and local transportation to the Doylestown Hospital campus and medical appointments within 10 miles.
How Do I Pay for a Long-Term Care Stay?
Some residents have a long-term care Insurance policy, which is a specialized type of insurance which helps to cover the costs associated with a long-term stay in a facility. These plans often have a 90-day elimination period, which means that they do not take effect until after a resident has been at the facility for 90 days. If you have a long-term care policy, it is important to know what it covers and what the maximum benefit is.
For those without a long-term care policy, the daily rate is paid out-of-pocket. Before moving to a facility, an admissions representative will often meet with a family in-person or over the phone to review all the costs of care beyond the daily rate and provide them with a financial application. The facility’s financial team will then review a prospective resident’s assets to ensure he or she can adequately afford any services needed.
Medicaid is available in select facilities for individuals who otherwise could not afford the daily rate. The Pennsylvania Department of Health provides more information on the eligibility requirements, locations, and application process.
Pine Run Health Center
Skilled Nursing Facilities and Long-term Care are highly regulated by the Commonwealth of Pennsylvania and the Centers for Medicare & Medicaid Services (CMS). To be certified by CMS, skilled nursing communities must meet strict criteria and are subject to periodic inspections to ensure quality standards are being met. Pine Run Health Center consistently receives five-star ratings from CMS. The Pine Run Health Center has also been named among the “Best Nursing Homes” in the country for 2021-2022 by U.S. News & World Report for both short and long-term care. This is a designation achieved by an elite 13% of short and long-term care residences across the country.
“The Pine Run Health Center is proud to offer an interdisciplinary team of doctors, licensed nurses, certified nursing assistants, social workers, rehabilitation therapy staff, therapeutic recreation staff and dietitians who consistently deliver compassionate and informed care for our residents,” said Stiles.
Peace of Mind
Understanding the difference between skilled nursing facilities vs. nursing homes can feel overwhelming, especially if the need for services comes on suddenly. But families can have peace of mind knowing that Pine Run provides for both short and long-term care and provides the comfort and support residents need to have the highest quality of life possible. While it may not be anyone’s first choice, short and long-term care facilities often provides both residents and their families peace of mind with the knowledge that their loved ones are safe, supported, and living their best lives.