Skilled Nursing or Inpatient Rehabilitation Center?


Ruby Care Senior Living Advisors

For more information about the author, click to view their website: Ruby Care Senior Living Advisors

Posted on

Mar 28, 2023


Texas - Dallas, Collin, SE Denton & Rockwall Counties

I recently found myself having to decide between a skilled nursing facility or inpatient rehabilitation center when it was time for my 104-year-old grandmother to be discharged from the hospital.  Here she was doing well, and ready to transfer out of the hospital setting, but not strong enough to go back to her apartment in independent living. 

How does one make the decision to go to one over the other? What are the pros/cons? Where will your loved one be the safest and get the care needed to regain strength and make it back home? These are questions that run through one’s mind and need to be answered when making this type of decision.  While it is best to work on prevention to avoid a hospital stay in the first place, it’s good to know that there are options available that can help one transition between the hospital and home.

Remember that the number one cause of injury for seniors is due to falls. ( See our blog for information on How to Prevent Falling How to Prevent Fallin... (

Skilled Nursing Facilities and Rehabilitation Centers are great transition options.  Medicare often required a min 3 day hospital stay before qualifying to stay at a Skilled Nursing Facilities and Independent Rehabilitation Centers. (

Skilled Nursing Facility (SNF)

Definition: Skilled nursing is a term that refers to a patient's need for care or treatment that can only be done by licensed nurses.  Skilled nursing is mostly regulated by the U.S. Department of Health and 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. Often referred to as a nursing home although that actually refers to the actual building that skilled nursing is provided. ( and

The focus of care in SNF’s is on 24/7 medical care, assistance with activities of daily living (ADLs), and rehabilitation for those who require ongoing medical care.

Types of patients that go to SNFs typically require ongoing medical care, such as those needing wound care, healing from surgery, or chronic medical conditions.

One will typically have a longer stay, often a few weeks to months, when in a skilled nursing facility. Rehabilitation therapy is required 5 days a week, but not as intense. 

Services covered by Medicare

· Meals

· 24/7 Nursing available

· Activities of Daily Living (ADL) assistance

· physical, occupational therapy, speech therapy

· medication management

· social services

· medical equipment (DME)

· ambulance transportation to a medical facility for additional services needed when not available at the skilled nursing facility

Services NOT covered by Medicare:

· palliative or hospice care services or long-term care needs. 

 (Hospice care services are covered once rehabilitation is no longer an option and end of life is needed).

Inpatient Rehabilitation Center (IRF)

DefinitionInpatient Rehabilitation Facilities (IRFs) are freestanding rehabilitation hospitals and rehabilitation units in acute care hospitalsThey provide an intensive rehabilitation program and patients who are admitted must be able to tolerate three hours of intense rehabilitation services per day. (

The focus of care in an inpatient rehabilitation facility is on rehabilitation and helping patients regain independence and mobility.

Types of patients that typically go to an IRF are those who have had a recent injury, illness, or surgery that requires intense rehabilitation to regain their ability to function independently.

One typically has a shorter stay of days up to several weeks and is required by Medicare to participate in a min of 3 hours a day or min of 15 hours per week of therapy (Physical/Occupational/Speech).

Who helps me decide where to go?

The Hospitalist – This is the internal Medicine doctor that oversees patient care while staying in the hospital. They will often make a recommendation.

Case Manager (Hospital) – Assigned to the patient to aid in navigation the transition from the hospital to SNF, Rehab Center, or home. If going directly home, they would also assist with Home Care options and DME.


· Rehabilitation – Short or Long-term inpatient rehabilitation is often covered under insurance after a serious surgery or injury. This can help not only provide daily therapy, but also provide a family caregiver some respite or allow for the injured party to gain some strength and mobility back before returning home.

· Physical Therapy - Often covered by insurance. One can receive physical therapy to help build overall strength and mobility of the area that was impacted. Services can be given in the hospital, skilled nursing, rehab, outpatient setting, or through Home Health.

· Occupational Therapy – This type of therapy is great for helping to discover new ways to do everyday activities that have become more challenging since an injury or fall. Typically covered by Insurance. Services can be given in the hospital, skilled nursing, rehab, outpatient setting, or through Home Health.

· Speech Therapy – This type of therapy is great for making sure swallowing, eating, drinking, and talking are all in good working order after surgery, injury, or serious illness. Is often covered by insurance, and services can be given in in the hospital, skilled nursing, rehab, outpatient setting, or through Home Health.

Care Assistance

· Home Care – Bringing in some assistance temporarily while recovering can help take the load off the day-to-day chores and assist with Activities of Daily Living (ADLs), allowing you to focus on healing and getting stronger. This is often private pay unless you have long-term care insurance or qualify for VA benefits.

While both SNFs and IRFs provide 24/7 medical care and rehabilitation services, they differ in what they focus on regarding the patients that they admit and the intensity of the rehabilitation services they offer.

What happened to grandma? Based on her level of energy and weakness due to her illness and the fact that it would take another week for her to start getting some energy back, it was decided the best choice would be a Skilled Nursing Facility. The 3 hours a day therapy requirement would have been too much at the time for her to endure.  Happy to report she is truly remarkable and making good strides toward a full recovery. Go grandma go!

Britt Hemsell – Ruby Care Senior Living Advisor & Blog Contributor

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