Understanding Skilled Nursing Care

Evaluating a Community

Skilled nursing facilities and nursing homes are often misunderstood, leading to misconceptions about what they’re like and how they can benefit seniors with long-term care needs. Learn more about what services are offered and how you can make a smarter decision if you need to find skilled care.

Skilled Nursing Care vs. Nursing Homes
How to Evaluate Your Options
What to Look For

Skilled Nursing Care vs. Nursing Homes

Skilled nursing care is a service that provides high-level care for seniors who are unable to care for themselves, and need 24/7 monitoring and medical assistance for chronic conditions or short-term rehabilitation from an illness or injury. This service can be provided in a variety of senior care settings.

A nursing home – more commonly known as a skilled nursing facility – is a licensed residential facility that offers on-site skilled care for those who need a higher level of care than an assisted living facility can provide. These can be stand-alone facilities or part of a continuum of care at a senior living community.

Skilled nursing staff typically include RNs, LPNs and certified nurse aides who are available 24/7 to provide injections, monitoring of medical equipment and medications, wound care and physical therapy.

Common services include:

  • Private or semiprivate rooms
  • Three meals per day
  • Housekeeping and laundry service
  • Social programs and activities
  • Exercise and physical therapy programs

Costs for skilled nursing vary depending on the length of stay, size of the room, and what region of the country you’re in. The latest Genworth Cost of Care Survey shows that the national average monthly cost for a semiprivate room is $7,148. A private room averages $8,121 per month.


How to Evaluate Your Options

When a loved one needs constant professional care, how do you choose a provider? There are a number of resources that can help you get started.

Health Center Ratings – The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services that evaluates nursing facilities to help older adults and their families identify which delivers the highest quality of care. They award ratings from one to five stars based on the following criteria:

  • Health inspections, which are conducted by experts to ensure that a community meets Medicare and Medicaid’s minimum care standards
  • Staffing data used to measure the average hours of care provided to each resident
  • Quality measures used to track 16 different health variables

Facilities and health centers with a 5-Star rating often promote that score in their marketing materials. You can also use Nursing Home Compare, an online tool run by CMS to see 5-star ratings and how facilities in your area stack up.

U.S. News & World Report Nursing Home Rankings – Since 2009, U.S. News & World Report has issued a list of the top nursing homes and other continuing care communities. Though rankings were originally based entirely on federal CMS ratings, recent lists have made use of much stricter criteria.

While they continue to rate communities on a five-tiered scale that ranges from “Top Performing” to “Poor,” communities found to deliver only the bare minimum of rehabilitation or medical care quality are barred from receiving a full recommendation.

Long-term Care Accreditation – To earn and maintain accreditation by the Joint Commission, long-term care organizations must undergo regular on-site surveys about every three years. Surveyors evaluate care processes and operational systems that affect the quality of patient safety or care. You can ask about the most recent surveys, and also get more information at QualityCheck.org.

Nursing Home Inspect – A joint effort by Yelp and ProPublica, Nursing Home Inspect shows you a facility’s size, how many deficiencies were found in recent inspections, fines levied, and whether there have been sufficient problems that Medicare/Medicaid payments have been suspended.

State Ombudsmen – Federal law requires each state to have a long-term care ombudsman to be an advocate for nursing home residents and their families. They review complaints and concerns so they can help fix problems. They put a wide variety of information on their websites that’s readily available to the public. To find your region’s ombudsman, visit National Consumer Voice.

Personal Recommendations – Talk to friends and relatives who may have had experience with a facility you’re considering. Ask your health care provider which one they would go to.


What to Look For

Part of your evaluation needs to include a visit. Schedule a tour and be ready to ask a lot of questions. Here are a few to start with:

  • Are you for-profit or nonprofit?
  • What care services do you offer?
  • Is this facility certified by Medicaid and Medicare?
  • What’s the average length of stay?
  • Are family members included in creating resident care plans?
  • What are the qualifications for therapy staff?
  • Are there background checks for staff?
  • Can residents bring personal belongings and furniture?

Make notes about the facility itself.

  • Is it well lit?
  • Is it free from unpleasant odors?
  • Is it clean and well-kept?
  • Are residents clean, well-groomed, and appropriately dressed?
  • How does the staff treat residents?
  • Does staff knock on the door before entering a room?
  • Are there spaces for family and friends to visit?
  • Are there working smoke detectors and sprinklers?

You can find a more comprehensive and downloadable visit checklist here.

Keep visiting and asking questions until you’re satisfied you’ve found the best skilled nursing care possible for your loved one. You can use our community locator tool to find a community near you.

Where You Live Matters is powered by the American Seniors Housing Association (ASHA), a respected voice in the senior housing industry. ASHA primarily focuses on legislative and regulatory advocacy, research, and educational opportunities and networking for senior living executives, so they can better understand the needs of older adults across the country.