What is Skilled Care & How Does It Work?

A physical therapist can provide skilled therapy at home, in a clinic, in a hospital, or in a nursing home. Image © Clarissa Leahy/Getty Images

Skilled care is care that requires the services of a licensed health care professional due to the inherent complexity of the care. It requires advanced medical assessment skills, technical skills, or medical decision-making skills such that it must be performed by or supervised by a licensed health care professional.

Licensed health care professionals commonly involved in skilled care include registered nurses, licensed practical nurses, physical therapists, speech-language pathologists, occupational therapists, and medical social workers.

Examples of Skilled Health Care

You have a large, complicated wound that’s healing poorly due to problems with your circulation. A registered nurse comes to your home to perform a complex dressing change, assess your wound, and educate you or a caregiver in techniques to promote wound healing and prevent further skin breakdown.

After intestinal surgery, you’re sent home from the hospital with an implanted central intravenous catheter. You require IV nutritional infusions (TPN) every night. A registered nurse comes to your home to teach you or a caregiver how to safely infuse the TPN. After you’ve learned how to administer your infusion, the nurse continues to visit every few days to evaluate and manage your IV site. In this case, the RN is performing part of the skilled care and supervising part of the skilled care. She’s performing the teaching and the IV site management; she’s supervising your TPN administration.

You’re discharged from the hospital after hip replacement surgery, but you live alone in a home that can only be accessed by going up several stairs, something you’re not yet able to do. Instead of going home, you go to an inpatient rehabilitation facility.

There, a physical therapist evaluates your mobility, strength, and balance and creates an intensive physical therapy regime.

You work with the physical therapist several hours daily during which your strength, balance, and mobility improve. You also work on regaining physical skills necessary for safety and independence such as entering and exiting a car, sitting down on a toilet and getting up again, and stepping over the edge of the bathtub to safely enter a shower.

Where Skilled Care Takes Place

Skilled care takes place in acute care hospitals, rehabilitation facilities, skilled nursing facilities (nursing homes), outpatient clinics, infusion centers, hospices, and in private homes. However, it’s the nature of the care involved, not where the care takes place, that determines whether or not the care is considered skilled care.

Skilled Care Vs Custodial Care

Care that isn’t skilled care is considered custodial care or non-skilled care. While medically necessary skilled care is sometimes covered by health insurance, custodial care usually isn’t covered by health insurance. Custodial care may be covered by long-term care insurance.

See also “Home Health Care & Health Insurance—Understanding Your Coverage.”

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