What Qualifies a Patient for Skilled Nursing Care? 

When you notice signs that an aging adult could use extra medical support from skilled nurses or therapists, the next step is determining the right level of care. Even if you have an idea that skilled nursing care is right for someone, that might not be enough to qualify them to receive it and coverage for it. In that case, what qualifies a patient for skilled nursing care? 

What Qualifies a Patient for Skilled Nursing Care? 

While skilled nursing services may sound helpful, especially for family caregivers, it takes more than a desire to receive and qualify. So, who qualifies? 

There are a range of situations that could qualify an aging loved one for short-term or long-term skilled nursing care in a facility or for home visits. Here are some examples of when short-term skilled nursing facilities may be needed: 

•     Extra support following surgery or an accident. 
•     Rehabilitation for a medical reason, such as a stroke. 
•     Acute illness or a chronic condition that requires extensive care. 
•     Complex medical needs that require specialized or ongoing care, such as medical monitoring or respiratory care. 

People Who Need Skilled Nursing Staff 

The consideration of whether a loved one requires this kind of care often comes down to the need for trained professionals to help, whether it is for a recovery period in a skilled nursing community or a long-term basis in a nursing home. In many cases, your loved one would not be safe and have their condition properly managed if they were to go home. 

Many people who qualify for skilled nursing or nursing homes are older adults who are at a higher risk of falls, have chronic conditions, and other health problems that may qualify them. Older adults often benefit from services that can improve their quality of life and ability to carry out activities of daily living. 

Insurance Coverage for Care  

It is important to consider Insurance may cover some or part of the cost of care if your loved one qualifies. Of course, it depends on the plan. For example, Medicare Part A covers skilled care in a facility on a short-term basis if certain conditions are met. 

To qualify for a short-term stay with Medicare, a doctor must determine that the individual requires skilled nursing care in a facility.  

Medicare usually will not cover a long-term stay, but the individual and family can see whether their situation qualifies for Medicaid support. They may also be able to pay for this kind of care through long-term care insurance, veteran’s benefits, social security, private assistance, or private pay. 

What Is Included in Skilled Nursing Services? 

This level of care involves health professionals like registered nurses (RNs) or licensed practical nurses (LPNs) to provide skilled nursing services that fit a patient’s needs. It’s designed for when a person needs skilled nursing care to treat, manage, observe, and evaluate medical issues or situations. 

Skilled nursing focuses primarily on medical care and provides skilled professionals to provide it. This differs from other levels of care. For instance, assisted living facilities focus more on a living situation, residential services, and support that doesn’t require the same level of qualification as skilled medical care.  

For instance, staff members may support a person with meals, showering, companionship, and cleaning. There may be some medical services, but they are not provided continuously, as with skilled nursing. 

Types of Skilled Nursing Care 

Skilled nursing services often include: 

•     Rehabilitation: This could include physical, speech, or occupational therapy to improve the person’s abilities and quality of life. 
•     Chronic disease/condition management: A person may need a disease or health condition managed individually that addresses their full health picture. 
•     Medication management: In many cases, people need skilled nursing care to supervise their medication regimen and to properly administer the medications, potentially also monitoring for adverse effects. 
•     Medical monitoring: The professionals in skilled nursing facilities routinely take the patient’s vital signs and monitor their health, adjusting the care plan if needed. 
•     Wound care: Professionals can provide specialized wound care when needed to minimize complications and provide the best conditions for healing. 
•     Pain management: This involves monitoring and assessing pain levels and finding ways to manage the pain and improve comfort. 
•     Medical social services: This type can help coordinate services supporting the patient and caregivers, such as community resources and counseling. 
•       Medical supplies: Generally, specific medical supplies are needed to provide the person’s skilled nursing care. 
•       Transportation: Services may cover transportation by an ambulance if necessary to bring the person to needed skilled nursing care services. 

Care in a Skilled Nursing Care Facility  

Receiving skilled nursing care often involves entering a skilled nursing facility. There is also the possibility of receiving this care at home, but is generally more limited.  

Skilled nursing care facilities provide a higher level of care than many other types in the spectrum of care, such as assisted living facilities or having someone help with activities of daily living. The term skilled nursing care refers to the skill involved, requiring licensed professionals in charge of the care. 

If an older adult stays in a skilled nursing facility to receive this kind of care, they generally receive additional services during the stay as well. These services go beyond medical care but are a part of living. For instance, this tends to include a semi-private room that is cleaned, meals, and dietary counseling. 

In general, the highest type of skilled nursing care takes place in short-term skilled nursing facilities, which are close to the level of care provided in a hospital. Long-term care can take place in a nursing home, which often provides a reduced level of skilled care compared to skilled nursing facilities. 

Qualify for Skilled Nursing Services  

Overall, a doctor needs to state that a person qualifies for skilled nursing care. It’s likely that this will happen due to a hospital stay where the person is being treated for an accident or health condition. If an aging adult cannot safely go home after the hospital stay and needs continuous treatment, our CarePatrol Senior Care Advisors can help you determine the next step for your loved one.