What exactly is "skilled" nursing? Aren't we all skilled?

nutella, MSN, RN · Mar 10, 2016

At least in the basics? If they want acute care exp, they ask for that. Same with med surg....So doesn't skilled fall under a basically experienced nurse?

It is a specific term that is used to describe the need for nursing care that has to be done by a nurse (RN or LPN ). Skilled nursing plays a huge role in medicare reimbursement. If somebody needs just longterm care without skills in a long term care facility - that kind of care is often called "custodial care".

Wound care is a skill. Drawing blood peripherally is not a skilled need - because it can be done by a phlebotomist cheaper. Let's say a patient is home bound but does not have a skilled need and the doctor want the patient to get blood drawn by the VNA - just drawing blood without skilled nursing need is not reimbursable. Let's say the patient also has CHF and needs a skilled nursing assessment and medication teaching. The nurse can draw blood when she goes there to perform the skilled nursing services.

Confused? yeah a lot of people are confused about this...

TheCommuter, BSN, RN · Mar 10, 2016

It is a specific term that is used to describe the need for nursing care that has to be done by a nurse (RN or LPN ).

I totally concur. In addition, the admitting diagnosis plays a huge role in whether a post-acute patient receives skilled nursing services.

Unspecified dementia is a common admission diagnosis in skilled nursing facilities. However, most patients/residents with dementia are placed in the long-term care section because it is immensely difficult to justify provision of skilled services to someone with that diagnosis alone.

On the other hand, an admission diagnosis of COPD exacerbation would definitely qualify for skilled services, especially after a 72-hour stay at an acute care hospital. A post-acute patient with an admission diagnosis of COPD exacerbation needs skilled services such as licensed nursing assessments, oxygen therapy, nebulizer updrafts, patient teaching on breathing exercises, and perhaps IM solumedrol injections.

In addition, the deconditioning that happens during a COPD exacerbation would qualify the patient for skilled PT and OT services.

To recap...many dementia patients can be taken care of in a custodial setting such as memory care units without skilled services or licensed nurses, whereas someone with COPD exacerbation is justified is receiving a variety of skilled nursing services.

SunnyPupRN · Mar 17, 2016

Very helpful answers, thanks!

elkpark · Mar 17, 2016

I agree there's a lot of confusion about the terminology. I used to work on the general med-surg unit of a small community hospital that had converted some of its beds to skilled nursing beds, and was always amused that little old people who were being transferred (stepped down) to a skilled bed had the idea, from the name, that they were going to be getting better care because they were going to be taken care of by "skilled" nurses rather than us ignorant slobs on the acute unit. :) People don't really get that the "skilled" reference is to nurses with skills versus care by nonprofessionals with no "skills," not nurses who are more "skilled" than other nurses.

TheCommuter, BSN, RN · Mar 17, 2016

People don't really get that the "skilled" reference is to nurses with skills versus care by nonprofessionals with no "skills," not nurses who are more "skilled" than other nurses.

You worded it saliently and succinctly.

'Skilled care' refers to care that must be provided by a licensed nurse, whereas 'custodial care' can be delivered by unlicensed staff (e.g. direct care workers, CNAs, medication techs, home health aides).

Examples of settings where custodial care takes place include adult daycare, assisted living, personal care group homes, locked memory care units, and so forth.