Skilled Care Facilities

Static number... Since 1990 the number of assisted living facilities has risen dramatically, while the total of 16,400 Medicare / Medicaid certified nursing homes, has remained relatively unchanged.

Certification... as a nursing home, certified as a nursing facility under Medicare or Medicaid, identified as a nursing care unit of a retirement center, or determined to provide nursing or medical care. Meanwhile, the number of hospitals in the United States has constantly decreased from its earlier 6,000 to 5,300.

Statutory definition... The following is the statutory definition at §1819(a) and 1919(a) of the Social Security Act (the Act) for an SNF:

"Skilled nursing facility" is defined as an institution (or a distinct part of an institution) which is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; has in effect a transfer agreement (meeting the requirements of §1861(1) with one or more hospitals having agreements in effect under §1866; and meets the requirements for a SNF described in subsections (b), (c), and (d) of this section.

Highest acuity level in the industry... Nursing facilities offer the highest intensity level of long term care and are characterized primarily by the need for 24-hour nursing care. Few persons enter a nursing facility as a matter of choice.


Short-term care... Hospital services are normally defined as short term care (under 30 days). While hospitals are not part of the long term care continuum they complete the continuum of intensity of care, offering it at the most sophisticated and expensive level.