The actual difference
A skilled nursing facility is a medical setting. Licensed nurses on duty around the clock, physician oversight, wound care, IV medication, feeding tubes, ventilators. People land there from a hospital, often for rehabilitation, sometimes for good. These facilities are licensed by the state health department, not by the social services department that licenses care homes, so they do not appear on our register at all.
A residential care home, an RCFE, is the other thing. Room, meals, supervision, help with bathing and dressing and medication, in a house or in a building. That is what our register covers: 336 of them across 12 Valley towns, 7 inside Encino, 31 of them licensed for 25 residents or more.
The short test: if the daily needs are medical and require a licensed nurse to perform them, it is skilled nursing. If the daily needs are personal, and someone needs to be there to help and to notice, it is a care home. Most families calling about a parent who has become frail and forgetful want the second and have been told to look for the first.
When it genuinely is skilled nursing
- Daily wound care, IV antibiotics, or injections that only a licensed nurse may give
- A feeding tube, a ventilator, or a tracheostomy
- A short rehabilitation stay ordered straight out of a hospital admission, with a goal of going home after
- Behaviour or medical instability that a home with a handful of caregivers cannot safely hold
The money question, answered honestly
Medicare can cover a limited rehabilitation stay in a skilled nursing facility after a qualifying hospital admission. The conditions attached to that are specific, they have changed over the years, and they depend on your parent's plan. Ask the hospital case manager to confirm it for your parent, in writing, before the discharge, and ask what happens on the day the covered period ends.
That last question is the one that ambushes people. The covered stay finishes, the family is told she is ready to leave, and there is no plan for where she goes. That is usually the day we get the call, and it is a week later than we would like.
Long term custodial care in a care home is paid for privately in most cases, sometimes with long term care insurance or veterans benefits contributing. Our costs page covers that in full, including the honest position on Medi-Cal, which is that the answer depends on the programme and the home and is not something we will guess at on a page.
What we can do for you
We do not maintain a skilled nursing register, because that is not our licence data and we will not pretend a list we have not verified is one. What we do is help you work out which category your parent belongs in, and we are honest when it is the one we do not place into.
When it is a care home, and it usually is, we go to work on the 336 homes we do know. When it is not, we will tell you to take that back to the hospital case manager, and we will tell you what to ask them, and we will still be here when the rehabilitation stay ends and the next decision arrives.
Written and reviewed by Senior Placement Encino, , against the California Department of Social Services licence register.