What Qualifies a Patient for Skilled Nursing Care?

A patient qualifies for skilled nursing care if they require daily care to rehabilitate from an injury, illness, condition or surgery. This is especially true for people recovering from strokes, surgeries, accidents or other significant illnesses when their treatment plan requires procedures that must be provided by a licensed nurse. However, skilled nursing is specifically for care needs that are unlikely to last long enough for the individual to need to be admitted to a hospital.

Often, each state has its own guidelines regarding who qualifies for skilled nursing care. Medicare and Medicaid also have their own guidelines related to when they cover skilled nursing care. Generally speaking, for skilled nursing coverage to be provided by Medicaid, the senior must have been admitted as an inpatient in a hospital for at least 3 days, not including the day of discharge or time in the emergency room. The individual must also have a need for a skilled level of care that only a practicing nurse can provide, such as wound care, IV therapy, injections or complex disease management. Physical, occupational and speech therapies are also considered skilled nursing level of care services.

Most frequently, skilled nursing care is provided in skilled nursing facilities, sometimes referred to as nursing homes. Some of these are short-term care units within long-term care skilled nursing facilities. In these facilities, round-the-clock care is provided by licensed nurses and nursing aides who monitor the patients. This service is also sometimes offered in assisted living communities as an amenity, providing an around-the-clock nursing team to tend to rehabilitative needs on-site.

In many cases, with the right home health services support, skilled nursing care can be offered in the home by visiting nurses. In-home health care often involves licensed nurses visiting seniors’ homes and performing exercises, treatment and care. However, this care is rarely as extensive as care provided in a facility. The visiting nurses don’t typically stay at the individual’s home 24/7, and they may not help with activities of daily living, such as grooming, cooking or eating. In many states, Medicare and Medicaid often cover a portion of or all in-home skilled nursing services and other in-home services as long as the cost is the same as or less than the cost to live in a skilled nursing facility and it’s safe for the senior to remain home.

Skilled nursing facilities often provide short-term and long-term programs. Short-term skilled nursing admission provides care for seniors rehabilitating from illness or injury with the intention of returning them home once they’ve healed enough to no longer require such extensive care. The average stay is 28 days, according to the Centers for Medicare & Medicaid Services.

Long-term skilled nursing care facilities often house seniors for a longer period of time or indefinitely. They typically admit those with medical needs that prevent long-term independent living, such as a serious health condition that necessitates regular, specialized medical care and monitoring. This is often the case with people with Alzheimer’s, dementia or similar cognitive decline, though anyone with a debilitating medical condition necessitating around-the-clock nursing home levels of care can qualify for placement. In short-term and long-term care, health care is provided by licensed nurses and nurse aides trained to act as primary caregivers to the seniors residing in the facility.