Skilled Nursing

skilled nursing

Our highly trained staff of professional nurses can accommodate all of your home care nursing needs. We offer free assessments and work closely with your physician and family to determine the best course of treatment.

In order for skilled nursing care to be covered by the Medicare home health benefit, your care must be necessary and ordered by your doctor for your specific condition. You must be homebound and only need care on a part-time or intermittent basis (not full time).

Skilled nursing services are given by either a registered nurse (RN) or a licensed practical nurse (LPN). If you get services from a LPN, your care will be supervised by a RN. Home health nurses provide direct care and teach you and your caregivers about your care. They also manage, observe, and evaluate your care. Examples of skilled nursing care include: giving IV drugs, injections, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse, isn’t skilled nursing care.

Usually, once your doctor refers you for home health services, staff from the home health agency will come to your home to talk to you about your needs and ask you some questions about your health. The home health agency will also talk to your doctor about your care and keep your doctor updated on your progress. Doctor’s orders are needed to start care.

Our skilled nurses will:

  • Provide safe, effective care that can only be given by a licensed professional.
  • Evaluate and monitor your medical conditions.
  • Perform skilled procedures and teach you and your caregivers about your medications, treatments, and conditions.

A typical home health visit from a skilled nurse may include:

  • Skilled assessment and evaluation of your medical condition, signs and symptoms of complications or infections and your response to medications.
  • Checking your vital signs and other procedures such as blood draws, suture/staple removal, dressing changes and wound care, catheter care, and pain management.
  • Helping you take your medication(s).
  • Teaching you about your medical condition, medications and treatments, emergency procedures and safety precautions.

The following are technical terms and Colorado and Medicare rules for Home Health Nursing:

  1. A3-3118.1, HHA-205.1 To be covered as skilled nursing services, the services must require the skills of a registered nurse, or a licensed practical (vocational) nurse under the supervision of a registered nurse, must be reasonable and necessary to the treatment of the patient’s illness or injury as discussed in §40.1.1, and must be intermittent as discussed in §40.1.3.
  1. A3.3118.1.C, HHA-205.1.C The law, at §1861(m) of the Act defines intermittent, for the purposes of §§1814(a)(2) and 1835(a)(2)(A), as skilled nursing care that is either provided or needed on fewer than 7 days each week, or less than 8 hours each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is finite and predictable.)

To meet the requirement for “intermittent” skilled nursing care, a patient must have a medically predictable recurring need for skilled nursing services. In most instances, this definition will be met if a patient requires a skilled nursing service at least once every 60 days. The exception to the intermittent requirement is daily skilled nursing services for diabetics unable to administer their insulin (when there is no able and willing caregiver).

  1. Nursing care will be provided in accordance with the patient’s plan of care, under the supervision of a registered nurse as permitted by Colorado Nursing Practice Act (Colorado Revised Statues, Title 12, Article 38).
  1. Professional nursing service will be provided by a registered nurse and include:
  • Initial and ongoing comprehensive assessments of the patient’s needs, including Outcome and Assessment Information Set (OASIS) assessments at appropriate time points.
  • Initiating the plan of care and revising as necessary.
  • Providing those services and/or treatments requiring substantial and specialized nursing skill. For example the skilled observation, assessment and/or evaluation of:
    • Signs and symptoms of complications and infections
    • Response to medication
    • Physical and mental limitations
    • Changes in activities of daily living
    • Coping mechanisms and advocacy needs
    • Environmental safety factors
  • Providing treatments and procedures as prescribes, such as:
    • Neuro signs/mental status   
    • Venipuncture for lab, drug levels   
    • Dressing changes and wound care   
    • Suture/staple removal   
    • Skeletal traction site care   
    • Foley catheter changes/management   
    • Suprapubic catheter changes/management   
    • Administer medications: IM , IV , SC, etc.
    • Pain management   
    • Bowel/bladder care    
    • Patient/Family Teaching of Care for:  
    • Disease process – care management   
    • Medication administration, side effects     
    • Activity level/safety precautions   
    • Emergency procedures   
    • Skin care, turning, positioning,  ROM   
    • Diet, bowl regime   
    • Dressing changes   
    • Cast care   
  • Counseling and educating the patient and family regarding the disease process, self-care techniques and prevention strategies.
  • Initiating appropriate preventive and rehabilitative nursing procedures.
  • Preparing clinical and progress notes.
  • Coordination of services.
  • Referrals to other services as needed.
  • Informing the physician and other staff of changes in the patient’s needs.
  • Evaluating the effectiveness and outcomes of care.
  • Supervising LVN/LPNs and paraprofessionals providing services.
  • Planning for the discharge from service.
  • Participating in in-service programs.
  • Assigning home health aide to a specific patient
    • Provide for the management and evaluation of the car plan for:
    • Prolonged/extended home health care need
    • Continued personal care services
    • Multiple services and caregivers for complicated/complex care
    • Terminal supportive care   
    • High potential of changes for the at risk patient
  • The Licensed Practical Nurse or Licensed Vocational Nurse (LPN/LVN) will supplement the nursing care needs of the patient as provided by the Registered Nurse and include:
    • Providing services in accordance with Agency policies.
    • Preparing clinical and progress notes.
    • Assisting the Registered Nurse or physician in performing specialized procedures and duties.
    • Assisting the Registered Nurse in carrying out the plan of care.
    • Assisting the patient in learning appropriate self-care techniques.