Skilled Nursing

Skilled nursing facilities (SNFs), commonly known as nursing homes, provide 24-hour medical care and rehabilitation services for individuals with serious medical conditions, complex care needs, or those recovering from hospitalization, surgery, or acute illness. As of January 2026, approximately 1.2 million Americans reside in skilled nursing facilities nationwide, receiving the highest level of medical care available in a residential setting with licensed nurses on staff around the clock.

Unlike assisted living or memory care (which focus on personal care and supervision), skilled nursing facilities employ registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) who provide continuous medical monitoring, wound care, IV therapy, medication administration, rehabilitation therapy, and complex care for conditions requiring nursing expertise. Federal regulations require at least one RN on duty 8 hours daily and licensed nurses available 24/7.

Skilled nursing serves two primary populations: short-term rehabilitation patients recovering from hospital stays (often covered by Medicare for up to 100 days) and long-term care residents with chronic conditions requiring ongoing medical supervision. Facilities must meet strict federal and state regulations covering staffing ratios, care standards, safety protocols, and resident rights, making SNFs the most highly regulated senior care setting.

Daily life in skilled nursing facilities revolves around medical care, rehabilitation therapy, and comprehensive assistance with all activities of daily living. Residents typically share semi-private rooms (though private rooms are available), with nursing staff visible in hallways and resident rooms throughout the day providing medication administration, wound care, vital sign monitoring, and assistance with bathing, dressing, toileting, and mobility.

For short-term rehabilitation residents, days are structured around intensive therapy sessions—physical therapy to regain mobility and strength, occupational therapy to relearn daily living skills, and speech therapy to address swallowing or communication issues. Medicare-covered rehabilitation requires at least 3 hours of therapy daily, five days weekly, with the goal of recovery and discharge home or to lower levels of care within weeks or months.

Long-term care residents follow more relaxed schedules with meals served at set times in dining rooms or rooms (depending on mobility and preferences), organized activities ranging from exercise classes to social events, and frequent medical assessments as conditions require. Family visitation is encouraged, with most facilities allowing visits during daytime and early evening hours, though policies vary.

The environment is more clinical than assisted living or memory care, with hospital beds, medical equipment, nurses' stations, therapy gyms, and safety features like handrails and emergency call systems throughout. While facilities strive to create homelike atmospheres with common areas, gardens, and activity spaces, the primary focus remains medical care and safety for individuals with significant health vulnerabilities.

Skilled nursing facilities employ comprehensive medical teams including registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), physical therapists, occupational therapists, speech-language pathologists, social workers, dietitians, and activity directors. Medical directors (physicians) oversee care plans, and attending physicians visit regularly to assess residents and adjust treatments.

Federal regulations mandate minimum staffing standards: at least one RN must be on duty 8 hours daily (typically during daytime shifts), and a licensed nurse (RN or LPN) must be available 24/7. CNA staffing ratios average 1:8 to 1:15 during day shifts, though ratios vary by state regulations and facility quality. Higher-quality facilities often exceed minimum requirements with better ratios ensuring more attentive care.

Nursing staff provide skilled medical services including administering medications and injections, managing IV therapy and feeding tubes, performing wound care and dressing changes, monitoring vital signs and medical conditions, coordinating with physicians, and responding to medical emergencies. CNAs assist with all activities of daily living—bathing, dressing, grooming, toileting, transfers, mobility, and eating—under nursing supervision.

Rehabilitation therapists create individualized therapy plans to help patients regain function after strokes, surgeries, injuries, or illnesses. Social workers coordinate discharge planning, connect families with resources, and address emotional and financial concerns. Dietitians develop meal plans for special dietary needs (diabetes, dysphagia, renal diets), and activity directors organize social, recreational, and cognitive stimulation programs to maintain quality of life and prevent isolation.

The fundamental difference is medical complexity and care intensity. Skilled nursing provides 24/7 licensed nursing care for individuals with serious medical conditions requiring constant monitoring, complex treatments, and rehabilitation services that assisted living cannot legally or practically provide. Assisted living offers personal care assistance (bathing, dressing, medications) for relatively stable seniors, while skilled nursing serves those with acute or chronic medical needs requiring nursing expertise.

Staffing reflects this difference: skilled nursing employs registered nurses, licensed practical nurses, and therapists providing medical care, while assisted living employs certified nursing assistants and medication aides providing non-medical personal care assistance. Skilled nursing facilities have physicians on staff or on call, whereas assisted living relies on residents' personal physicians for medical care.

Medicare coverage distinguishes the two: Medicare covers skilled nursing care for up to 100 days following a qualifying 3-day hospital stay when rehabilitation or skilled nursing services are medically necessary. Medicare does not cover assisted living costs at all. This makes skilled nursing financially accessible for short-term rehabilitation (often fully covered for first 20 days, then copay days 21-100), while assisted living is entirely private pay or Medicaid-funded in limited states.

The care environment differs significantly: skilled nursing facilities resemble medical settings with hospital beds, medical equipment, therapy gyms, and clinical atmospheres, while assisted living communities feel more like apartment buildings with homelike furnishings. Skilled nursing provides comprehensive assistance with all daily activities, while assisted living residents typically retain some independence and self-care abilities.

Transitions often occur when assisted living residents develop medical conditions exceeding the facility's care capabilities—requiring IV therapy, extensive wound care, feeding tubes, ventilators, frequent nursing assessments, or intensive rehabilitation. At that point, temporary or permanent skilled nursing placement becomes necessary to meet medical needs safely and legally.

Skilled nursing provides essential medical care and rehabilitation services for individuals whose complex health conditions cannot be managed safely at home or in less intensive care settings. For post-hospitalization patients, skilled nursing offers structured rehabilitation programs that help people recover function, regain independence, and return home after strokes, hip replacements, cardiac events, or major surgeries—outcomes research shows skilled rehabilitation significantly improves recovery rates compared to home recovery alone.

Medicare coverage makes skilled nursing accessible and affordable for short-term rehabilitation, with many patients paying little or nothing for the first 20 days of care and modest copays for days 21-100 when medically necessary. This coverage removes financial barriers to essential post-acute care that would be prohibitively expensive if paid privately, helping families access needed rehabilitation without depleting savings.

For long-term care residents, skilled nursing provides safety, medical monitoring, and comprehensive care for individuals with advanced dementia, terminal illnesses, complex chronic conditions, or severe disabilities who cannot be safely cared for elsewhere. Families gain peace of mind knowing their loved one receives professional nursing care, immediate response to medical changes, and dignity-preserving assistance with all personal care needs.

Medicaid coverage (after spending down assets) ensures access to skilled nursing for those who cannot afford long-term care costs, preventing situations where families must provide complex medical care beyond their capabilities or resources. Federal regulations protecting resident rights, care standards, and safety provide accountability and oversight that less-regulated care settings may not offer.

The interdisciplinary care team approach—nurses, therapists, social workers, dietitians, and physicians collaborating on comprehensive care plans—addresses medical, functional, nutritional, emotional, and social needs holistically. This coordinated care often achieves better health outcomes and quality of life than fragmented care across multiple providers and settings.