The Four Essential Services Skilled Nursing Can Provide in the Home


Written by Amedisys

1. Skilled Observation and Assessment

Medicare allows for observation and assessment by a nurse. If you have a patient with a recent illness, prolonged hospitalization or a reasonable potential for exacerbation, home care can work with that patient to assess, observe and intervene to avoid further complications. This admission criteria is broad. These regulations specifically allow us to admit patients with even a reasonable potential for exacerbation for up to three weeks. That care can be extended beyond three weeks if complications arise. 

2. Teaching and Training

Even when basic education for a newly-diagnosed condition is given in the hospital, most patients continue to need education and follow-up upon discharge to the home. This teaching, as well as teaching the caregiver or a new caregiver, is allowed under Medicare home care teaching guidelines. Teaching may include, but is not limited to, instruction regarding medication, diet, disease process, care procedure or signs and symptoms to report to the physician.

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3. Technical Skills

Several skills routinely done in the hospital can be performed in the home. Examples include wound care services, administering injections to patients who cannot self-inject and administering certain drugs allowable under Medicare guidelines. Often, home care focuses on teaching caregivers these skills if necessary. 

4. Management and Evaluation

This unique home care service focuses on ensuring the patient or caregiver follows the plan of care ordered by the physician. The goal of these admission criteria is to implement, evaluate and modify the plan of care to promote the patient's successful recovery and safety in the home. For example, a patient admitted to home care with a complex medication regimen and an active caregiver may need management and evaluation services to ensure the caregiver knows how to administer the medication correctly. This service focuses on successful implementation of the physician's treatment regimen rather than the assessment of the patient's physical condition. 

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