By Robert Sorrenti, M.D., UniCare State Indemnity Plan

From the  Summer 2012 Issue of Newsletter

The Skilled Nursing Facility (SNF) benefit covers an important type of care, often referred to as transitional care. Transitional care occurs when a person has been in the hospital but no longer needs the acute care that hospitals provide. At the same time, the person may not be able to go home because he or she still needs the special services of a nurse or other health care professionals. The person may need extensive care for a wound, frequent suctioning of the lungs or continuing physical therapies. Instead of staying in the hospital, the person goes to a skilled nursing facility for those special services. Here are a couple of examples of the use of the SNF benefit.

  • A 58 year old member, who lives alone, has a hip replacement. After four days in the hospital, he is not ready to go home. However, he does not need the full level of services that an acute rehabilitation hospital provides. So, he is transferred to a skilled nursing facility for six days where he receives physical therapy twice a day to get him ready to move around his home. He can then go home, and a physical therapist comes to his home three times a week to help continue his progress.
  • A 67 year old member, with heart disease, is admitted to the hospital with severe pneumonia. After she recovers, she is ready to leave the hospital. She needs continuing intravenous antibiotics as well as some adjustments to her medications as she recovers her strength. She is transferred for this transitional care to a skilled nursing facility for three weeks. The medical staff there continues her care and trains her husband in helping to care for her at home. She is discharged home with periodic visits from a visiting nurse.

A skilled nursing facility is not a nursing or rest home. It can manage the more complex health services of someone needing transitional care. The usual stay is about 12 days.  The GIC’s Skilled Nursing Facility benefit aims to provide the coverage for that length of stay.  After that stay, the person is generally able to go home, sometimes with continuing visits from a nurse who comes to the home. 

Sometimes people confuse the SNF benefit with coverage for long term care or a rehab hospital (an inpatient facility with comprehensive services for patients still in the acute phase of their conditions.)  The SNF benefit serves to give members support for short term transitional care, and is part of an insurance benefit that focuses on acute care, and more and more, on preventive care as well.  Long term care, in contrast, is for people who need to be in a facility for months or even years.  Coverage for long term care almost always requires an insurance plan, separate from your medical insurance. The two types of insurance work side by side. If you go to an acute hospital, your medical plan takes over. If you need to be hospitalized, remember that you do have a Skilled Nursing Facility benefit. It may prove very helpful in helping you make the transition from the hospital to home.

Robert W. Sorrenti, MD, MHA, is the Regional Vice President for UniCare, a subsidiary of WellPoint, Inc., one of the largest health benefits companies in the U.S. His responsibilities include oversight for UniCare’s medical management program and its various components. Dr. Sorrenti has an MD from Harvard Medical School and an MHA from Clark University.

This information provided by the Group Insurance Commission.