Skilled Nursing or Rehabilitation (Post-Acute) Care

Post-acute care may give options to people with cancer who aren’t able to return home after being in the hospital. You may hear it described by the type of care or where it’s given, like skilled nursing care or rehabilitation (rehab) care.

Several types of facilities provide skilled nursing care or rehab care. Each focuses on a specific type of care needed to help people regain the strength and ability to care for themselves.

What is post-acute care?

Post-acute care is medical or supportive care given to a person who is leaving an acute care setting (like a hospital) but isn’t ready to return to their home. Its goal is to improve your ability to care for yourself and become more independent.

Post-acute care:

• Gives options to those who develop short-term disabilities during acute care for cancer and need therapy or additional support while they recover.

• Is used to meet a variety of needs in different types of facilities. Some provide more skilled medical or nursing care while others focus on helping with activities of daily living (ADLs) like bathing, dressing, and eating.
• Is usually less than 100 days. If you need medical or supportive care for longer than that, you will likely need long-term residential care.

For people with cancer, post-acute care is used after hospitalization for cancer treatment or for a complication of treatment. It may also be needed by those getting outpatient treatment if they need help getting stronger and being able to care for themselves.

What are the benefits of post-acute care?

Post-acute care provides options for people who want to return home after a stay in an acute care setting but aren’t strong enough or not yet able to care for themselves. This can be especially helpful for those who don’t have a caregiver who can provide the hands-on care they need.

People who have short term disabilities or need care provided or supervised by doctors, nurses, or therapists (like physical, occupational, or speech therapists) may find that a post-acute care setting can provide those services along with help with ADLs.

Post-acute care has been shown to lower the chance that someone will end up in the emergency room or be readmitted to the hospital. It can also lower the chance that a person will need to be placed in a long-term care facility.

When is post-acute care needed?

People might need post-acute care after being in the hospital for many reasons. This might include people who:

• Have physical or mental limitations that make it unsafe for them to be at home alone
• Are considered fragile because of exhaustion, weakness, weight loss, limited physical activity, and walking ability
• Don’t have someone who can provide the care they need at home
• Need a caregiver around the clock, but don’t have someone who can be with them and lack the resources to hire someone
• Need skilled nursing or other medical care that cannot be provided in the home
• Need intensive rehab such as physical, occupational, or speech therapy

Cancer treatment can leave people weak, exhausted, and unable to take care of themselves. If you or a loved one have concerns about being able to return home safely, talk to your cancer care team about options.

What post-acute care options are available?

There are five main types of post-acute care. The best option will depend on a person’s specific needs.

It’s important to know that many of these post-acute care options don’t provide cancer treatment. If you need to continue cancer treatment, someone from outside the facility may need to provide transportation to medical appointments and treatments.

Inpatient hospice may be a good option for people in the late stages of an incurable illness when their care can’t be managed at home. Inpatient hospice care may be given in a designated hospice unit or facility or may be given in an SNF.

How is post-acute care paid for?

Payment for post-acute care depends on the type of care provided, the type of facility the person is in, and their insurance coverage. Most private and government insurance will cover at least part of the cost of post-acute care if it must be given under the supervision of a doctor, registered nurse, or therapist. On the other hand, most insurances don’t cover the cost of "custodial care," which focuses on helping people with bathing, eating, dressing, and other activities of daily living.

Skilled nursing facilities

Most government and private insurances will cover the cost of care at a SNF. In many cases, you must have been treated in a hospital for at least 3 days and discharged within the last 30 days.

• Medicare covers skilled nursing care for up to 100 days, as long as you continue to need it. It typically pays the full cost for the first 20 days. After that, you may have to pay some of the costs yourself. Medicare won’t cover more than 100 days in a row. However, if you leave the SNF for at least 60 days and then need to return, your 100 days of coverage may start over.

• Private insurance plans vary in what they cover for skilled nursing care. Most provide some coverage but may require that the person receive care at an in-network facility or from an in-network provider. Some plans will cover out-of-network facilities, but you will be responsible for more out-of-pocket costs.
• Medicaid covers the cost of skilled nursing care in Medicaid nursing homes. Covered services vary from state to state, so you will need to check with your state plan about what they cover.
• The Veterans Administration (VA) usually covers the cost of care at an SNF as long as the care is considered medically necessary. Check your VA benefits or talk to your cancer care team.

Inpatient rehabilitation (rehab) facilities

Medicare and most private insurance plans will help pay for inpatient rehab if certain criteria are met.

• Medicare will cover some or all of the cost for a certain number of days.
• Most private insurance plans will cover some of these costs, but there may be restrictions about where you can go for these services. Your insurance provider should be able to give you a list of approved facilities.
• Medicaid plans differ by state, but many will cover the cost of inpatient rehab, as long as the person meets the state’s guidelines for this level of care.
• The VA provides inpatient rehab in some of its facilities.

Nursing homes

Most private and government insurance plans don’t pay for nursing home care.

• In certain situations, Medicare may pay for medically necessary skilled nursing care given in a nursing home. Also, some Medicare Advantage or other Medicare Health Plans may cover nursing home care if the nursing home has a contract with the plan.
• Medicaid covers the cost of care in facilities licensed and certified as Medicaid Nursing Facilities. This is for people who qualify for Medicaid and have no other way to pay for the needed care.
• The VA may pay for nursing home care if the person is already enrolled in the VA Medical Benefits Package and meets certain criteria.

Assisted living facilities

Most health insurance plans don’t cover the cost of assisted living facilities (or ALFs). Assisted living is considered "custodial care" and focuses on activities of daily living (ADLs), like bathing, dressing, and eating.

Some states offer Medicaid waivers and may cover some assisted living costs if care and financial requirements are met.

Long-term care hospitals (LTCHs)

Because LTCHs provide services similar to those in acute care hospitals, most government and private insurance will cover the costs in the same way as hospitals. Certain requirements must be met, and the person must either have been transferred directly from a hospital or have been discharged from a hospital in the last 60 days.

Long-term care insurance

For some people who need long-term care that isn’t covered by their health insurance plans, long-term care insurance may be an option. However, this type of insurance can be expensive and often doesn’t start paying right away. If you don't already have long-term care insurance, you may not be eligible for it if you have certain health problems or already need long-term care.

How can I find a post-acute care facility?

Identifying your needs

If you or a loved one needs continued care after leaving the hospital, your care needs and goals must be identified. For example:

• What are the goals of care?
• Does the care need to be given by or overseen by physicians, nurses, or therapists?
• How complex is the medical care the person needs?
• Is the main need to improve physical strength and functioning?
• Is physical, occupational, or speech therapy needed? If so, is the person strong enough for 3 hours of therapy a day?
• Can the person perform their ADLs on their own, or do they need help?
• Is help needed to make sure that medicines are being taken as prescribed?
• Does the person have issues that could create safety risks, like memory issues or risk of falls?
• Will the person continue cancer treatment or need to see a health care team at an outside facility?
• What type of insurance coverage does the person have? Do they have long-term care insurance?

Knowing your post-acute care needs can guide the decision about which type of facility might be best. Input from you, your family, and caregivers, and the cancer care team will be needed. A physical therapist, social worker,discharge planner, case manager, or patient navigator can also help.

Finding a facility

Ask if your cancer center or hospital has staff who can help you find the best post-acute care options to meet your needs. There might be a social worker, discharge planner, case manager, patient navigator, or someone in a similar role.  

Some questions you might want to ask to help with the search include:

• Does your cancer center or hospital have an affiliated facility?
• Are there facilities your cancer or primary care team thinks are a good fit for you?
• Does your insurance have a list of post-acute care facilities that are in network?
• What post-acute care does your insurance help pay for? Do they only cover the cost of care in certain facilities?
• How close to caregivers, family, and friends do you want to be? How far is too far?
• Has anyone you know been in the same type of facility? What was their experience like?

You can also compare facilities at medicare.gov/care-compare/ to help guide your decision.