Skilled Nursing

Skilled nursing is medical care that legally requires a licensed nurse — a registered nurse (RN) or, for a narrower set of tasks, a licensed practical nurse (LPN) working under RN supervision. The defining tasks include complex wound care (staged pressure ulcers, surgical wounds, wound vacs), IV therapy and infusion management, injections including insulin titration, indwelling and intermittent catheter management, ostomy care, tracheostomy and ventilator support, complex medication administration, ongoing assessment of changing medical conditions, and skilled teaching of family members on any of the above.

Skilled nursing is delivered in two main settings. In a skilled nursing facility (SNF, often colloquially called a "nursing home" though many SNF stays are short-term rehab rather than long-term residence), Medicare typically covers up to 100 days following a qualifying 3-day hospital stay, with full coverage for the first 20 days and a substantial co-pay thereafter. In the home, skilled nursing is delivered through a Medicare-certified home health agency under a doctor's order — covered when the patient is homebound and needs skilled care intermittently. Private-duty nursing for shift-based home nursing care exists too but is rarely covered by traditional Medicare.

The bright line that matters for families: non-medical home care does not include skilled nursing. The trained personal care attendants and home health aides we staff can perform a wide range of personal care, transfers, meal preparation, light housekeeping, medication reminders, and observation — but they cannot push pills, give injections, manage IV lines, perform sterile wound care, or administer prescription patches. When a client needs both skilled and non-medical support — common after a hospital discharge, with an active wound, or with complex IV therapy — families combine a Medicare-certified home health agency for the skilled visits with a non-medical home care agency like ours for the daily ADLs and IADLs that fill the hours between nurse visits.

Practically, the home-health visit is short — usually 30–60 minutes a few times per week — and the rest of the week, day, and night is when the non-medical agency provides the continuity. Personal care at $29–$37/hr in Southeast Michigan, with mandatory pricing attribution, is the typical service tier when a client is recovering and also has hands-on personal care needs. Specialized care at $35–$42/hr applies when the underlying condition (advanced dementia, Parkinson\'s, post-stroke complexity) warrants it.

When a client's needs are primarily skilled nursing — for example, an active complex wound that needs daily nursing or an IV antibiotic course — that is not within our scope and we will tell families directly and connect them to home-health and private-duty nursing options rather than stretch our service. The cleanest hospital discharge plans pair both. Visit /compare/home-care-vs-skilled-nursing-facility for the side-by-side comparison.