There are many reasons a person is recommended for a short stay in a skilled nursing facility after a hospitalization. This type of care bridges the gap for those who are well enough to leave the hospital but not yet ready to safely return home.

Navigating the healthcare system can be difficult even under normal circumstances—let alone in the middle of a health crisis. When a rehab stay becomes necessary after a hospitalization, older adults and their caregivers often have a very short window to make decisions, which leads to rushed or less-informed choices.

Choosing the right skilled nursing facility involves considering cost, health outcomes, access to clinical staff, resident satisfaction, location, and overall condition of the care center. If you or a loved one need to decide on a short-term rehab provider, the following questions can help build confidence in your choice.

1. What type of rehab is right and how much therapy do they provide? 

A hospital care team typically recommends one of three types of short-term rehab. The recommendation is based on the patient’s medical condition, prior level of functioning, the criteria of each level of care, and what the insurance will cover. The most common type of short-term rehab is a skilled nursing facility (SNF).

SNFs provide physical and occupational therapy five to six times a week and speech therapy if needed. They can also perform some nursing interventions, such as IV medications, drain care, wound care, and labs. However, each provider varies in the conditions and medications they can accommodate.

2. Will insurance cover the rehab stay? 

Many insurance programs—including Medicare, Medicaid, and private insurance—cover the cost of a rehab stay, including at skilled nursing facilities.

For traditional Medicare, the stay is covered to the extent of the benefits without prior approval if the individual is admitted to the hospital for three midnights. The length of the covered rehab stay depends on the patient’s progress compared to Medicare guidelines, as determined by the facility’s care team. Traditional Medicare offers the most options since all certified Centers for Medicare & Medicaid Services (CMS) providers are in-network.

For Medicare Advantage plans, a hospital discharge planner assists in finding a list of in-network options, usually available on the insurance plan’s website. A pre-certification is often required from the insurance company before admission to a skilled nursing center, which the center or hospital handles. The covered length of stay is determined by the Medicare Advantage plan based on the diagnosis and progress.

A common misconception is that everyone automatically receives 21 days in a SNF. Coverage of any length of time is not guaranteed—it is always determined by an individual’s unique circumstances and conditions. Some people only need a couple of days before safely going home, while others may need a few weeks or much longer.

For individuals with insurance other than Medicare, it is recommended to visit the insurance’s website or contact the member services number on the back of the insurance card to ask these questions:

• Will my plan cover all or part of the stay?
• How is the length of the stay determined?
• What is my deductible or copay?
• Is pre-certification required?

3. What’s the best way to compare the quality of skilled nursing facilities? 

By visiting medicare.gov and clicking “find care providers,” you can view ratings of all levels of care regulated by CMS. Under “nursing homes,” three categories of ratings are available, and each one can be explored in more detail.

Another factor to consider is whether facilities are recognized as great places to work. If staff members enjoy their jobs and feel appreciated by their employer, turnover and reliance on temporary staff may be lower, improving quality and consistency.

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4. How is rehab at a skilled nursing center planned after hospitalization?

After discussing options, the hospital discharge planner sends clinical and insurance information to a few selected centers. Most hospitals ask patients to choose three to five centers to increase the likelihood of an available option at the time of discharge. Many factors affect a center’s ability to accept a patient, and acceptance is never guaranteed.

5. What happens after rehab begins at a SNF?

Once the therapy team completes an evaluation, they gain a better understanding of how long the stay will be. They make recommendations for discharge needs, and the discharge planner discusses these with the patient and family.

For most people, the goal is to return home. Many are recommended to receive home health care initially—a continuation of therapy that may be covered by Medicare. Depending on needs, physical therapists, occupational therapists, speech therapists, and nurses may also visit the home to provide care. If entering and exiting the home and vehicle is manageable, some individuals attend outpatient therapy in a therapy gym.

Others may require extra assistance or supervision for a few hours a day—or around the clock. Medicare generally does not cover this type of care. The discharge planner guides patients in determining the best plan for success based on physical and clinical needs, finances, personal values, and local resources.

Skilled Nursing Rehab Stay at Marjorie P. Lee

Our short-term rehab team works to make each recovery journey as smooth, supportive, and uplifting as possible.

With one of the highest staff-to-resident ratios in the Cincinnati area, the team of physical, occupational, and speech therapists works closely with nurses, aides, doctors, nurse practitioners, social services, facilities staff, dietary staff, and life enrichment professionals to create a peaceful, encouraging, and positive place for recovery.

To learn more about Marjorie P. Lee’s short-term rehab, contact Erica Proud, at eproud@erslife.org or 513.871.2019.