Is long term nursing home care considered post-acute care?

According to the American Hospital Association, post-acute care settings include skilled nursing facilities, which can be part of a nursing home. This reveals that while some services overlap, long-term nursing home care is not considered post-acute care in its entirety, but rather a distinct, broader category of care.

Quick Summary

Long-term nursing home care is a broader category that includes post-acute services, but is not exclusively post-acute care. Post-acute care is typically shorter in duration and focused on recovery, while long-term care addresses ongoing, chronic needs and daily assistance.

Key Points

• Not the same: Long-term nursing home care is a broader category of care, while post-acute care is a specific, short-term service focused on recovery after a hospital stay.

• Purpose differs: Post-acute care aims for rehabilitation, while long-term care provides ongoing support for chronic conditions and daily needs.

• Duration is key: Post-acute stays are limited, often covered by Medicare for a short period. Long-term care is open-ended and requires different funding.

• Overlapping settings: A single nursing home can provide both short-term post-acute care in a skilled nursing facility and long-term custodial care.

• Financial impact: The distinction has major implications for cost and insurance coverage, as Medicare and Medicaid rules vary significantly between the two types of care.

Differentiating Between Long-Term and Post-Acute Care

For families navigating the complex world of senior healthcare, understanding the distinctions between different levels of care is crucial. The terms 'long-term care' and 'post-acute care' are often used interchangeably, but they refer to two separate, though sometimes overlapping, types of medical and rehabilitative services. This guide will explain what defines each category, highlighting the core differences in purpose, duration, and patient needs.

What is Post-Acute Care?

Post-acute care refers to the services a patient receives after a stay in an acute care hospital, such as following a surgery, serious illness, or injury. The primary goal is rehabilitation and recovery, helping the patient regain their independence and functional ability to return home or transition to a lower level of care. Post-acute services are typically short-term and intensive. Examples of post-acute care include:

• Inpatient rehabilitation: Intensive therapy in a specialized facility.
• Skilled nursing facilities: Provides 24-hour medical care and rehabilitative services.
• Home health care: Medical and rehabilitative services delivered in the patient's home.

What is Long-Term Care?

In contrast, long-term care is designed for individuals with chronic illnesses, disabilities, or other health-related conditions that limit their capacity for self-care over an extended period. Unlike post-acute care, which is rehabilitative and goal-oriented toward recovery, long-term care is focused on providing ongoing support and assistance with activities of daily living (ADLs). These services may be required for months or even years. The setting for long-term care can vary widely, from assisted living communities to nursing homes.

Can a Nursing Home Provide Both Types of Care?

Yes, a nursing home can and often does provide both post-acute and long-term care services. This is a primary source of the confusion between the two terms. A person may enter a skilled nursing facility (often a part of a larger nursing home) for a short, post-acute rehabilitation stay after a hospital visit. Once they complete their therapy and if they cannot return home, they may transition into a long-term care residency within the same facility to receive ongoing support.

Here’s how this can play out in practice:

• Scenario 1: Post-Acute Patient: A patient has a hip replacement and requires intensive physical therapy. They are discharged from the hospital to the skilled nursing unit of a nursing home for a 3-week rehabilitation program. This is a classic example of post-acute care.
• Scenario 2: Long-Term Care Resident: An elderly individual with progressive dementia requires 24/7 supervision and assistance with bathing, dressing, and medication management. This individual resides in a nursing home indefinitely, receiving custodial care. This is long-term care.
• Scenario 3: The Transition: A stroke patient receives post-acute care in a nursing home for two months to recover motor function. Their recovery plateaus, but they still require substantial assistance. They are then transitioned to the long-term care section of the same facility for ongoing support.

Key Differences at a Glance

Feature	Long-Term Care	Post-Acute Care
Purpose	Ongoing assistance with daily living activities (ADLs) and chronic conditions.	Recovery and rehabilitation after a hospital stay.
Duration	Extended period, potentially for months or years.	Short-term, intensive care with a specific end goal.
Patient Profile	Individuals with chronic illnesses, disabilities, or significant cognitive impairment.	Patients recovering from a surgery, illness, or injury.
Primary Goal	Maintaining quality of life, comfort, and safety.	Restoring function and helping the patient return home or to a lower-care setting.
Primary Payor	Often private pay, Medicaid, or long-term care insurance.	Typically covered by Medicare Part A or private insurance for a limited time.
Typical Setting	Can be in a nursing home, assisted living, or at home.	Often in a skilled nursing facility, inpatient rehab facility, or home health agency.

Why Understanding the Difference Matters

Knowing the distinction is vital for several reasons, particularly for making financial and care-planning decisions. The difference directly impacts a patient's insurance coverage, with Medicare covering post-acute care for a limited period, while long-term care is largely the responsibility of the individual. For example, Medicare will only cover post-acute care in a skilled nursing facility for a maximum of 100 days under specific conditions. Without a clear understanding, families may face unexpected and significant costs.

Furthermore, the goals of care are fundamentally different. Post-acute care is forward-looking toward recovery, while long-term care accepts and manages a chronic condition. This difference influences the daily activities, therapeutic goals, and overall approach to the resident's health and wellness. Families can better advocate for their loved one and ensure their care plan is appropriate by being informed.

Conclusion

While a nursing home may provide both, long-term care and post-acute care are not the same. Post-acute care is a rehabilitative, short-term service following a hospital stay, often provided in a skilled nursing facility. Long-term care is ongoing, custodial care for individuals with chronic needs. The nursing home can serve as a setting for either or both. Recognizing these distinctions is essential for making sound decisions about a loved one's health, finances, and overall quality of life. For more information, visit the official website of the National Institute on Aging for reliable resources.

References

American Hospital Association. (n.d.). Post-Acute Care Advocacy Alliance. AHA.org. Retrieved from https://www.aha.org/advocacy/long-term-care-and-rehabilitation Advantis Medical Staffing. (2024, March 29). Post-Acute Care vs. Skilled Nursing: Key Differences Explained. Advantismed.com. Retrieved from https://advantismed.com/blog/post-acute-care-vs-skilled-nursing National Center for Biotechnology Information (NCBI). (2024, August 27). Overview of Post-acute and Long-term Care Providers.... NCBI.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK607299/ The New Jewish Home. (2023, April 13). Acute vs. Post-Acute Care: Understanding the Differences. Jewishhome.org. Retrieved from https://jewishhome.org/news/acute-vs-postacute-care/ National Center for Biotechnology Information (NCBI). (2024, August 27). Overview of Post-acute and Long-term Care Providers.... NCBI.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK607299/ Prelude Services. (2020, June 12). The Differences Between Post-Acute and Long-Term Care. Preludeservices.com. Retrieved from https://www.preludeservices.com/blog/the-differences-between-post-acute-and-long-term-care/ Eden Senior Care. (2022, July 30). The Differences Between Post-Acute and Long-Term Care for Seniors. Edenseniorhc.com. Retrieved from https://www.edenseniorhc.com/the-differences-between-post-acute-and-long-term-care-for-seniors-what-you-need-to-know/ Bella Vista Health Center. (2018, January 22). The Difference Between Post–Acute and Long-Term Care. Bellavistahealth.com. Retrieved from https://www.bellavistahealth.com/blog/difference-between-post-acute-and-long-term-care National Center for Biotechnology Information (NCBI). (2024, August 27). Overview of Post-acute and Long-term Care Providers.... NCBI.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK607299/ Country Meadows Retirement Communities. (2024, June 28). What is Post-Acute Care?. Countrymeadows.com. Retrieved from https://www.countrymeadows.com/blog/what-is-post-acute-care

Frequently Asked Questions

Does Medicare cover long-term nursing home care?

Medicare generally does not cover long-term nursing home care, which is considered custodial care. It will, however, cover short-term, post-acute care in a skilled nursing facility under specific conditions for a limited number of days.

What kind of services are included in post-acute care?

Post-acute care services typically include physical, occupational, and speech therapy, as well as skilled nursing services like wound care or respiratory therapy, following an acute medical event.

How do you pay for long-term nursing home care?

Payment for long-term care often comes from private funds, long-term care insurance, or Medicaid for those who qualify financially. It is not typically covered by standard health insurance or Medicare.

What is the difference between a nursing home and a skilled nursing facility?

A nursing home is a residence that can provide both long-term custodial care and skilled nursing services. The term 'skilled nursing facility' often refers to the part of a nursing home dedicated to providing short-term, post-acute medical and rehabilitative care.

Can a person transition from post-acute care to long-term care in the same facility?

Yes, it is common for a person who enters a facility for short-term post-acute care to transition to long-term care if their needs dictate it after their rehabilitation goals have been met.

How long does a post-acute care stay last?

The duration of a post-acute care stay is short-term and can vary depending on the patient's progress. For Medicare coverage, a stay is typically limited to a maximum of 100 days and requires a preceding hospital stay.

Is assisted living considered long-term care?

Yes, assisted living is considered a form of long-term care, as it provides ongoing assistance with daily living activities for individuals who require support but not the intensive medical care provided in a nursing home.