Skilled Nursing Facility vs. Nursing Home: What’s the Difference?
Trying to understand the difference between working as a nurse in a skilled nursing facility vs. nursing home settings? While the two workplaces are similar in some ways, there are key differences to be aware of, and your qualities might be suited to one more than the other. Let’s compare nursing home vs. skilled nursing facility (SNF) workplaces for nursing professionals.
About 6% of all RNs work in residential care facilities, which include SNFs, nursing homes, long-term care facilities, and assisted living facilities. While this work might not be associated with the fast-paced clinical demands of the ICU or med-surg, nurses who work in these settings have an opportunity to make life better for residents and their families.
Defining SNFs and Nursing Homes
Nursing homes and SNFs serve different purposes and slightly different patient populations:
- Skilled nursing facility: Closer to acute care or rehab, with patients who stay for a limited time and move on when their major needs have resolved. Qualifying patients may have a SNF stay of up to 20 days completely covered by Medicare Part A.
- Nursing home: Tends to be a more permanent living facility, where residents can live indefinitely and get help with activities of daily living (ADLs). Nursing home stays do not qualify for Medicare and are typically paid for privately, but they still need to meet certain guidelines set by the Centers for Medicare and Medicaid Services (CMS).
Patient Populations in a SNF vs. Nursing Home
What types of patients and illnesses might you see in these settings? Nurses in SNFs tend to see patients for a shorter length of time — some research shows an average stay of three weeks — with a focus on recovery and regaining mobility. Patients might be discharged to home, a nursing home, or an assisted living facility.
Patients in nursing homes are typically there for much longer, often until death, and the average length of stay is over 13 months. Goals in a nursing home are typically more focused on quality of life rather than rehabilitation, and residents and their families pay for services themselves or through long-term care insurance.
See our table comparing patient problems you’ll likely encounter in each setting:
| Skilled Nursing Facility | Nursing Home |
|---|---|
| Hip fracture rehabilitationPost-stroke recoverySurgical wounds
Tracheostomy and vent weaning Pneumonia recovery Patients are often full code |
Ongoing diabetes managementDementia and Alzheimer’s careChronic fall risk
Swallowing precautions Inability to perform ADLs such as cooking, cleaning, washing, etc. Patients may be a partial code or DNR |
Nursing Responsibilities in a Skilled Nursing Facility vs. Nursing Home
Nurses in SNFs typically perform tasks — such as urinary catheter and tracheostomy management — that require a license. In nursing homes, tasks can often be performed by someone who does not hold a nursing license, such as a nursing assistant or aide. An RN may assess patients, supervise care, and provide assistance as needed, while LPNs and CNAs assist with ADLs and basic nursing care.
Nursing professionals are more likely to assist in the dying process while working in a nursing home, because nearly 27% of all deaths happen in nursing homes and long-term care facilities. It’s common for nursing homes to include hospice wings, or partner with hospice agencies, to help residents remain comfortable during the final stages of life.
See a breakdown of some responsibilities you might have as an RN in these settings:
| Skilled Nursing Facility | Nursing Home |
|---|---|
| Assessments for short-term, unstable, or post-acute patients
Administer IV therapies (antibiotics, fluids, meds) Complex wound care (surgical wounds, VAC therapy, advanced dressings) Pain control and mobility plans for post-surgical recovery Coordinate physical therapy, occupational therapy, and speech therapy services Foley insertion and management |
Routine, ongoing assessments for stable long-term residents
Administer oral, subcutaneous, and occasionally intramuscular medications Provide basic wound care and monitor skin integrity Support chronic disease management and track changes in baseline health Coordinate long-term care plans and family communication Toileting assistance supervision |
Interprofessional Collaboration in a SNF vs. Nursing Home
Whom might you work with, and what’s the structure of each of these facilities like? SNFs maintain higher staff-to-patient ratios and include more medically trained professionals — not just RNs, LPNs, and CNAs, but also therapists (physical, occupational, speech) and physicians or nurse practitioners. Nursing homes rely more heavily on CNAs and LPNs, and have fewer specialized therapy staff. Medical care is present but less intensive than in SNFs.
SNFs typically use a nursing hierarchy similar to acute care. Depending on the size of a nursing home, they may use a similar leadership structure as well. Smaller nursing homes may have fewer structural levels — i.e., a staff nurse may report directly to the Director of Nursing (DON).
Salary Differences Between a SNF vs. Nursing Home Role
RNs in residential care facilities earn an average of $87,370 per year, according to the Bureau of Labor Statistics. BLS does not differentiate between SNF and nursing home salaries, so it’s likely that the pay is quite similar between the two types of facilities. LPNs in residential care earn an average of $67,420 per year.
SNF vs. Nursing Home Comparison Table
| Item | Skilled Nursing Facility | Nursing Home |
|---|---|---|
| Who delivers most care? | RNs and LPNs provide frequent skilled assessments; CNAs support ADLs but nurses handle more complex tasks. | CNAs provide the majority of daily care; RNs/LPNs oversee meds, assessments, and chronic condition management. |
| Patient population | Short-term, post-acute, higher acuity. Includes post-surgical patients, stroke recovery, IV therapy, complex wounds. | Long-term residents with stable or slowly declining chronic conditions, mobility limitations, or dementia. |
| Patient goals | Recovery, rehabilitation, and discharge back to home or a lower level of care. | Long-term maintenance, safety, stability, and quality of life. Some may transition to hospice. |
| Patient turnover | Moderate: Admissions and discharges every few weeks. | Low: Residents often remain for months or years. |
| Typical RN responsibilities | Frequent assessments; IV therapy; complex wound care; trach/oxygen management; rehab coordination; pain management; discharge planning. | Routine assessments; chronic disease management; medication administration; skin integrity monitoring; dementia care support; family communication. |
Skilled Nursing Facility vs. Nursing Home vs. Assisted Living
Let’s throw assisted living facilities into the mix. These residential facilities provide a lower level of care than nursing homes or SNFs, with a focus on assistance with ADLs like getting dressed, cooking meals, and cleaning. Residents who live in assisted living typically have private apartments or homes, with the option to have services come to them, and they are not covered by Medicare. In comparison, both SNFs and nursing homes provide more intensive, round-the-clock care.
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