It's not easy to qualify for skilled-nursing benefits. A patient must be admitted to a Medicare-certified facility usually within 30 days of a hospital stay that lasts for at least three days. And a physician must order that nursing care is required every day for the same condition that caused the hospitalization. If those conditions are met, Medicare covers not only the daily rate, meals, drugs and supplies, but also skilled-nursing services. Rehabilitation therapies are covered if they're required at least five days a week, if they're restorative, and not simply to maintain functioning, and if improvement continues.
Payment stops if there's no further improvement.
Many other services, such as routine preventive skin care, routine care for incontinence and assistance with activities of daily living, do not qualify someone for a skilled-nursing stay. But if that person otherwise qualifies based on a need for skilled care, those services are covered as well. Nursing homes aim to keep all beds full. So when openings arise, as they do daily in many facilities, admissions personnel try to fill them as quickly as possible with residents who will contribute most to the bottom line. That usually means Medicare patients get preference.