Your Questions Answered
When you or a loved one requires more care than can be provided at home or in an assisted living facility, a skilled nursing facility (SNF) may be the right option. Skilled nursing facilities offer 24/7 medical care, rehabilitation services, and assistance with daily activities. But how do you get admitted to one in California? Here’s a step-by-step guide.
Determine the Need for Skilled Nursing Care
Before admission, a doctor or hospital discharge planner must determine that skilled nursing care is necessary. Common reasons include:
- Recovery from surgery or a hospital stay
- Rehabilitation after an injury or stroke
- Chronic medical conditions requiring ongoing nursing care
- Need for specialized wound care, IV therapy, or physical therapy
Get a Doctor’s Order
A physician must write an order for skilled nursing care, which is required for admission. If you’re being discharged from a hospital, the hospital’s case manager will help facilitate this process. Note: You will need to be discharged from a hospital to a SNF in order to be admitted into any skilled nursing facility.
Determine How You Will Pay for Care
The cost of skilled nursing care can be significant, so it’s important to know how it will be covered. Common payment sources include:
- Medicare and HMO: Covers short-term stays (up to 100 days) if the patient has had a qualifying hospital stay of at least three days. The first 20 days are fully covered; after that, a daily copay applies.
- Medi-Cal (California’s Medicaid program): Covers long-term care for eligible low-income individuals. A financial eligibility assessment is required.
- Private Insurance: Some health insurance plans cover SNF stays, but coverage varies.
- Out-of-Pocket: If other options don’t apply, private pay is required. Costs vary based on location and services provided.
Choose a Skilled Nursing Facility
Once you have a doctor’s order and a payment plan in place, it’s time to select a facility. Consider factors such as:
- Location and proximity to family
- Facility ratings and reviews (check Medicare’s Nursing Home Compare website)
- Services and specialties (e.g., rehabilitation, memory care)
- Availability of beds
A hospital discharge planner or social worker can provide recommendations based on your needs.
Apply for Admission
Each skilled nursing facility has its own admission process, but generally, the hospital case manager will need to:
- Submit medical records and the doctor’s order
- Provide insurance or payment information
- Complete an application and care assessment
If you are applying for Medi-Cal, the facility may help you with the application process.
Complete the Admission Process
Once a facility accepts you, the admission team will review care plans, facility rules, and financial arrangements. You or your representative will sign admission agreements and consent forms. The facility will then coordinate your arrival and initial care plan.
Getting admitted to a skilled nursing facility in California involves medical, financial, and logistical steps. Transitioning from a hospital and working with doctors, discharge planners, and SNF staff can help ensure a smooth process. If you or a loved one is considering skilled nursing care, start planning early to find the best facility that meets your needs.
Have questions about SNF admission? Contact us today for guidance!