Submitted by Amy Schultz, Gracewell Administrator
When a loved one experiences a hospitalization, families are often faced with an important question: What happens next? One common next step is a skilled nursing stay, but many people are unsure what that really means.
What is Skilled Nursing Care?
Skilled nursing care is a higher level of medical and rehabilitative care that typically follows a hospital stay. It is designed for individuals recovering from illness, injury, or surgery who are not quite ready to return home independently.
Two of the most common insurance plans are Medicare and Medicare Advantage. Medicare guidelines require a three-night hospital stay before qualifying for skilled care coverage. This hospital stay usually involves treatment for a serious but short-term condition such as pneumonia, fractures, surgery recovery, or other acute medical needs. Medicare Advantage plans do not always require a hospital stay, but most advantage plans do require a pre-authorization for a skilled stay. It is always best to talk with your doctor or hospital team to determine if you qualify.
How the Process Works
If your physician determines that skilled care is needed, the hospital will send a referral. At that point, Gracewell—located on the Eventide campus—steps in to provide the next level of care and support.
A Goal-Focused Approach to Recovery
At Gracewell, the goal of our rehab program is to help each resident return to their highest level of independence. For many, that means regaining strength and function so they can safely return home or to their previous living setting.
That focus on progress and independence is what makes a meaningful difference for residents. As recent skilled resident, Donnie Neumann, shared, “If it wasn’t for the staff and therapy, I wouldn’t be able to go home as quickly as I did.”
Residents must actively participate in therapy and show progress toward their goals to continue a skilled stay. Our team works closely with each resident—and their family—to set meaningful goals and track progress along the way.
A True Team Approach
Recovery at Gracewell is a collaborative effort. Our skilled nursing team and the Blue Stone Therapy team work together to provide individualized care plans that may include:
- Physical, Occupational, and Speech Therapy
- Lymphedema Therapy and Vestibular (balance) training
- Assistance with activities of daily living (ADLs), transfers, and strengthening
- Fall prevention education
- Nutritional counseling by a Registered Dietician
- Patient and family education for a successful transition home
For those with more complex medical needs, skilled care may also include:
- Wound care
- IV therapy and PICC line management
- Tube feedings
- Tracheostomy care
- Home evaluations prior to discharge
Comfort, Healing, and Support
Gracewell is dedicated to making each stay as comfortable as possible so residents can focus on healing. Our environment combines clinical excellence with a welcoming atmosphere, offering:
- A large therapy center with personalized treatment plans
- Spacious private rooms
- Life enrichment opportunities and social engagement
- Weekly church services
- Private outdoor courtyards
- On-site hair salon
- Cable TV and wireless internet
- Visitors welcome day and night
- Local medical transportation
For many residents, it is not just the care—but the people—that make the experience meaningful. Marlene Schneider reflected on her skilled care, saying, “It’s been great to get my strength back, more than I could have done on my own. Everyone was very good to me, and I truly enjoyed working with all the staff. Thank you for getting me back to my normal.”
Partnering With You Every Step of the Way
We believe the best outcomes happen when residents, families, and care teams work together. From admission through discharge, we are here to communicate, support, and guide you through the recovery journey.
At Gracewell, you are never alone. We are here to help you heal, regain strength, and return to what matters most.
Understanding the Difference: Skilled Care vs. Long-Term Care
| Skilled Care (Short-Term Rehab) | Long-Term Care |
| Short-term stay focused on recovery | Ongoing, extended stay |
| Typically follows a hospital stay | For those who need daily assistance long-term |
| Covered by Medicare/Medicare Advantage (if criteria met) | Typically private pay or Medicaid |
| Requires active participation in therapy | Therapy may be limited or maintenance-based |
| Goal is to return home or prior living setting | Goal is to maintain quality of life and safety |
| Includes Physical, Occupational, Speech Therapy | Focus on daily care, comfort, and support |
| 24-hour nursing care with rehab focus | 24-hour nursing care for ongoing needs |
