Inpatient Rehab vs. Skilled Nursing Facilities: A 2025 Guide

Choosing the right level of care after a hospital stay isn’t always straightforward. 

Whether it’s for post-surgical recovery, stroke rehabilitation, or managing a chronic condition, patients and their families often find themselves comparing inpatient rehab vs. skilled nursing facility options — each offering different levels of therapy, medical oversight, and recovery timelines.

But what truly sets them apart?

In this article, we’ll break down:

• The differences between inpatient rehab vs. skilled nursing

• Who benefits most from IRF vs. SNF care

• How costs, insurance, and recovery times compare

What is an inpatient rehab facility (IRF)?

An inpatient rehab facility (IRF) is designed for patients who need intensive therapy and medical supervision to regain strength and independence after a major health event.

Unlike skilled nursing facilities (SNFs), which focus on long-term recovery or maintenance care, IRFs provide structured, high-intensity rehabilitation tailored to short-term recovery goals.

Who needs inpatient rehab?

IRFs are ideal for patients who are medically stable but need structured, high-intensity therapy to regain mobility, function, and independence as quickly as possible.

The faster recovery timeline makes IRFs a strong choice for patients who:

• Have experienced a stroke, brain injury, or spinal cord injury

• Are recovering from major surgeries like joint replacements or organ transplants

• Have complex fractures or multiple injuries from an accident

• Need to relearn basic motor skills or speech due to neurological conditions

For these patients, the intensive, fast-paced nature of IRF care can mean the difference between needing months of assistance and regaining their independence much sooner.

What makes IRFs different?

If you’ve ever seen a patient go from struggling to walk after surgery to regaining their independence within weeks, you’ve seen inpatient rehab in action.

One of the biggest differences between an IRF and a skilled nursing facility is the intensity of therapy. Patients in an IRF must be able to tolerate at least three hours of therapy per day, five to seven days a week.

That means a structured schedule of physical therapy, occupational therapy, and sometimes speech therapy, all tailored to push recovery forward.

For example, a patient recovering from a stroke may need to relearn how to use their affected arm, rebuild leg strength, and work on speech therapy — all in the same day.

At an IRF, therapy sessions are carefully coordinated so that every minute counts.

Physician oversight

In an IRF, a rehabilitation physician is actively involved in patient progress every single day. This is a major difference from skilled nursing facilities, where physician visits are less frequent.

Daily medical oversight ensures that any setbacks — whether it's pain, medication side effects, or unexpected mobility challenges — are addressed quickly.

A multidisciplinary team

Another key factor that sets IRFs apart is the team-based approach. Instead of patients seeing a therapist here and a doctor there, an IRF has a coordinated team of rehabilitation specialists working together.

This team typically includes:

• Physical therapists

• Occupational therapists

• Speech therapists

• Rehabilitation nurses

• Social workers & case managers

Having every specialist working together under one roof makes recovery faster and more effective.

How long can a patient stay in an inpatient rehab facility?

The length of stay in an IRF varies based on the patient’s condition, progress, and insurance coverage, but most patients stay between 10 to 28 days. Medicare and private insurers typically require measurable progress to continue coverage, meaning patients must actively participate in therapy and show improvement.

For example, a stroke survivor relearning to walk may stay for a few weeks, while someone recovering from a severe spinal cord injury might need a longer stay to build strength and mobility.

What is a skilled nursing facility (SNF)?

An SNF provides around-the-clock medical care and rehabilitation for patients who need continued support after a hospital stay but do not require the high-intensity therapy of an IRF.

This includes help with medications, wound care, mobility support, and chronic condition management. The focus is more on gradual recovery, stabilization, and long-term care if needed, rather than rapid rehabilitation.

Who needs SNF care?

Patients in SNFs typically fall into three main categories:

• Post-hospital recovery: Patients recovering from surgery, infections, or prolonged hospital stays who need continued monitoring and moderate rehabilitation.
  
  

• Chronic illness management: Individuals with conditions like Parkinson’s, heart failure, or COPD who need skilled nursing support but not intensive therapy.
  
  

• Long-term care patients: Those who need ongoing medical supervision due to dementia, severe mobility issues, or complex medical conditions that make independent living impossible.

For example, a patient recovering from pneumonia or a hip fracture who still requires oxygen therapy or assistance with daily activities may stay in an SNF to regain strength gradually.

Similarly, an elderly person with Alzheimer’s disease who needs regular medical care but not active rehabilitation may reside in an SNF long-term.

Inpatient rehab vs. skilled nursing facility: Less intensive therapy, more nursing-driven care

One of the biggest differences between inpatient rehab vs. SNF care is the intensity of therapy. In an IRF, patients must tolerate multiple hours of rehab daily, but in an SNF, therapy is less demanding and scheduled based on patient tolerance and goals.

SNFs work like this:

• Physical therapy and occupational therapy are available but often limited to three to five sessions per week instead of daily.
  
  

• Rehabilitation is balanced with medical care, meaning a patient recovering from surgery may focus on wound healing and pain management first, with therapy progressing at a slower pace.
  
  

• SNFs provide daily medical care, which can include IV medication administration, feeding tube management, diabetes monitoring, and wound care.

If a patient isn’t strong enough to participate in intensive rehab but still needs medical supervision, an SNF provides a bridge between hospital care and independent living.

Are skilled nursing facilities considered long-term care?

Some SNFs provide long-term care, while others focus on short-term rehabilitation. Skilled nursing facilities serve both short-term rehab patients and long-term residents who need ongoing medical supervision.

For example:

• Short-term SNF stays typically last a few weeks to a few months for patients recovering from surgery, illness, or injury before transitioning home or to assisted living.
  
  

• Long-term SNF care is for patients with chronic illnesses, severe mobility limitations, or cognitive impairments that require continuous nursing support.

For example, a stroke patient may stay in an SNF for a few months to rebuild strength before going home, while an Alzheimer’s patient in later stages may reside in an SNF permanently due to increasing medical needs.

Can a patient transition from an SNF to an inpatient rehab?

Yes, but it depends on eligibility. A patient in an SNF can move to an IRF if they meet the medical and functional criteria for intensive therapy. This typically means:

• A doctor determines they can tolerate at least three hours of rehab per day.

• Their condition has improved enough to benefit from intensive therapy.

• Insurance approves the transition based on medical necessity.

For example, if a patient was initially too weak for intensive therapy after a stroke and started with low-intensity rehab in an SNF, but later gained enough strength, they may qualify for an IRF stay to accelerate recovery.

However, insurance approval can be a challenge, as insurers often require patients to enter an IRF directly from a hospital.

In cases where an SNF patient progresses beyond what skilled nursing can offer but still needs rehab, families and care teams should advocate for reassessment and IRF admission if appropriate.

Inpatient rehab vs. skilled nursing facility: Key differences in care

Choosing between an IRF and an SNF comes down to the level of therapy, medical oversight, and recovery goals a patient needs.

While both provide post-hospital care, IRFs focus on intensive rehabilitation for a faster recovery, while SNFs offer medical care with a slower, more gradual rehab approach.

Here’s a side-by-side comparison of the key differences:

IRF vs. SNF: Cost and insurance coverage 

Cost and insurance coverage differ significantly between IRF and SNFs. While both are covered under Medicare, Medicaid, and private insurance, eligibility and out-of-pocket costs vary.

Medicare & Medicaid coverage

• IRFs: Medicare covers up to 90 days per benefit period, but patients must show progress in therapy to continue coverage. A 3-hour daily therapy requirement applies.
  
  
  

• SNFs: Medicare covers up to 100 days per benefit period with full coverage for the first 20 days, then a daily copay applies. Medicaid may cover long-term SNF care, but rarely IRFs.

Private insurance & out-of-pocket costs

Most private plans mirror Medicare rules, but preauthorization is often required. Without coverage, costs can be high:

• IRFs: Average costs are $1,500–$2,500 per day.

• SNFs: Average fees are $250–$850 per day, with long-term care exceeding $8,000/month.

How PDPM affects SNF payments

The Patient-Driven Payment Model (PDPM) changed SNF reimbursements from therapy-based to patient complexity-based payments. SNFs now receive higher payments for medically complex patients rather than those needing only therapy. This shift affects who SNFs prioritize for admission.

Factors to consider when deciding if your facility can serve a patient

Medical needs & complexity

• IRFs handle patients needing intensive therapy (e.g., stroke, brain injury, major surgery).

• SNFs manage chronic conditions, wound care, and lower-intensity rehab.

Patient mobility & rehab goals

Doctor recommendations & insurance approvals

• IRF admission requires medical necessity and therapy tolerance.

• SNFs accept patients needing nursing care but less intensive rehab.

• Insurance preapproval is required, and transitions from SNFs to IRFs can be challenging.

Bottom line: Facilities must assess medical complexity, functional goals, and financial viability to determine the best fit for each patient.

Frequently asked questions

Does Medicare cover both inpatient rehab and skilled nursing?

Yes, Medicare Part A covers both inpatient rehab facilities (IRFs) and skilled nursing facilities (SNFs), but with different rules.

IRF stays require daily physician oversight and at least 3 hours of therapy per day, while SNF stays require 24/7 nursing care but allow for lower-intensity therapy. Coverage limits and copays apply based on length of stay.

Which facility is best for stroke recovery — IRF or SNF?

It depends on the patient's needs. IRFs are best for stroke patients who can tolerate at least 3 hours of daily therapy and need intensive rehabilitation to regain mobility and independence.

SNFs are better suited for those who need slower-paced therapy combined with 24/7 nursing care, especially if they have other medical conditions requiring close monitoring.

Is inpatient rehab the same as a rehabilitation hospital?

Yes, an inpatient rehab facility (IRF) is often referred to as a rehabilitation hospital because it provides hospital-level care with intensive daily therapy for patients recovering from strokes, spinal cord injuries, surgeries, and other major health events.

In contrast, SNFs offer less intense rehab combined with nursing care.

How do you know if insurance covers inpatient rehab or SNF care?

The best way to check coverage is by reviewing the patient’s insurance benefits or contacting their insurer directly. Medicare, Medicaid, and private insurance all have specific criteria for IRF vs. SNF coverage, including required hospital stays, therapy intensity, and medical necessity.

Facilities should also verify preauthorization requirements and cost-sharing details before admission.

How ExaCare helps providers navigate post-acute care

Choosing between an inpatient rehab center vs. a skilled nursing facility is just one part of the post-acute care puzzle. The bigger challenge is ensuring that the right patients get placed in the right facilities — quickly and efficiently.

SNFs and IRFs depend on steady referrals to maintain census, but the admissions process can often be a bottleneck.

Most facilities still rely on manual referral reviews, multiple disconnected platforms, and time-consuming document processing — leading to delayed responses, missed referrals, and strained hospital relationships.

ExaCare streamlines your admissions process

ExaCare uses AI-driven technology to simplify and speed up referrals, helping your facility secure more patients, protect revenue, and maintain strong hospital partnerships. 

Here’s how:

• AI-powered referral screener that processes hospital packets in minutes, identifying key clinical and financial data instantly.
  
  

• Centralized referral management to bring all your sources like PointClickCare and EPIC Care into one platform.
  
  

• Built-in analytics to track response times, denial reasons, and referral trends so you can optimize your strategy.
  
  

• Automated insurance verification, high-cost med alerts, and reimbursement analysis to ensure financial viability.
  
  

• A unified communication hub that streamlines decision-making between clinical and admissions teams.

ExaCare helps you cut down response times, reduce manual work, and ensure every referral is a smart business decision. See how ExaCare can help your facility improve admissions and grow census.

Schedule a demo.