Short-Term Rehab or Long-Term Care: How to Choose a Nursing Home for Each
Most nursing homes do two different jobs: helping people recover after a hospital stay, and caring for people who live there for months or years. A home can be very good at one and only average at the other.
When a family starts looking at nursing homes, they are usually looking for one of two very different things. Knowing which one you need changes what to look for, what to ask and who pays.
Short-term rehab
Short-term rehab (sometimes called subacute or post-acute care) is for someone recovering after a hospital stay, for example after a hip replacement, a stroke, heart surgery or a serious infection. The goal is to get stronger and go home, usually within a few weeks. A typical day includes physical, occupational or speech therapy and skilled nursing such as wound care or IV medicines.
Original Medicare can pay for a rehab stay after a qualifying inpatient hospital stay of at least three days: in full for the first 20 days and with a daily coinsurance for days 21 to 100. Estimate the cost with our Medicare calculator.
Long-term care
Long-term care is for someone who can no longer live safely at home and needs help every day with things like bathing, dressing, eating, moving around or taking medicines, often because of dementia or several chronic conditions. The nursing home becomes their home.
Medicare does not pay for this kind of care. Families usually pay privately at first, sometimes with long-term care insurance, and Medicaid pays once the person’s income and savings are low enough. See how long savings would last with our cost planner.
Why the difference matters when you compare homes
Medicare rates the quality of care separately for short-stay (rehab) residents and long-stay residents, because the two groups need different things. A home with an excellent rehab unit may be only average for long-term residents, or the other way round. On every facility page in this directory, look for “Short-term rehab or long-term care?”, which shows both ratings and the outcomes that matter most for each.
- For rehab, look at: how often patients are sent back to the hospital, how often they need an emergency room visit, therapy staffing, and whether the home helps plan a safe return home.
- For long-term care, look at: falls with major injury, pressure sores, use of antipsychotic medicines, weight loss, staff turnover (residents do better with familiar caregivers) and the inspection record over several years.
Questions to ask
- For rehab: How many hours of therapy a day can my parent expect, and on weekends? What percentage of your rehab patients go home? Who arranges equipment and home care at discharge?
- For long-term care: How many residents does each aide care for on day and night shifts? How long have most of your aides worked here? How do you care for residents with dementia?
- For both: If a rehab patient later needs long-term care, can they stay, and is a Medicaid bed available?