The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 187
Skilled nursing units (SNU) are based in hospitals, either housed inside the hospital or in
a separate building. They typically provide only short term care and rehabilitation
services. The skilled nursing unit does not have a separate license because it is part of a
licensed hospital. They are sometimes called Step-Down Units, to reflect the fact that
patients are moved there subsequent to the original hospital stay, once hospital level
care is no longer required. These units provide sub-acute care, a level of care "between
hospital and home". This form is also offered in skilled nursing facilities. It is care for
patients of all ages who have been discharged from a hospital but need rehabilitation or
complex medical services for recuperation before they can return home. Specialized,
short term services may include extensive wound care, cardiac or stroke rehabilitation,
intensive rehabilitation following joint replacement, multiple fracture or trauma
rehabilitation, medically complex care and pain management. The goal of subacute care
is to prepare patients to return home after restoring their mobility and independence.
Nursing Homes - also called Residential Health Care or Skilled Nursing Facility: is the
general term for facilities offering long term nursing care. A freestanding SNF is a
nursing home that provides skilled nursing care and is not attached to a hospital. A
hospital-based SNF is a unit of an acute care hospital, and does not fall under the group
of nursing home facilities.
Residents are admitted from their homes, other health care facilities and hospitals. It
provides multi-disciplinary care to maintain residents at their highest functional level. A
skilled nursing facility can serve for those who need short-term care following a hospital
stay or long-term nursing supervision because of health issues or disabilities. Each
facility defines its own level of care; not all facilities accept residents with complex
medical problems.
• SKILLED NURSING FACILITIES (SNF) are licensed to provide
twenty-four hour nursing care. Skilled nursing facilities are required to
provide medical, rehabilitative and personal care.
• SKILLED NURSING FACILITIES - DISTINCT PART (SNF-DP) are
skilled nursing facilities, which are a distinct part of an acute care
hospital. In general, persons are admitted to these units from the
acute care units of hospitals.
• SKILLED NURSING FACILITIES-SPECIAL TREATMENT PROGRAM
(SNF-STP) are skilled nursing facilities with a special treatment
program such as providing treatment to the mentally ill.
Inpatient rehabilitation facilities (IRF) can be independent or hospital based, but the vast
majority (about 80%) is hospital based. IRFs provide intensive rehabilitation services—
such as physical, occupational, or speech therapy—in an inpatient setting. Beneficiaries
generally must be able to tolerate and benefit from three hours of therapy per day to
be eligible for treatment in an inpatient rehabilitation facility. Medicare is the principal
payer for IRF services.
To qualify as an IRF for Medicare payment, facilities must meet the Medicare conditions
of participation for acute care hospitals and must meet all of the following additional
criteria:
• have a preadmission screening process to determine that each
prospective patient is likely to benefit significantly from an intensive
inpatient rehabilitation program;
• have close medical supervision by a physician with experience or
training in rehabilitation;
• have a director of rehabilitation, with training or experience in
rehabilitation of patients, who provides services in the facility on a fulltime
basis;
• provide 24-hour rehabilitation nursing;
• use a coordinated multidisciplinary team approach;