It’s easy for individuals or families exploring senior home health care to get lost in the jargon. In particular, understanding the difference between “skilled” home health services and “unskilled” or “private duty” home care can be confusing.
Intuitively, it seems like everyone should want skilled services – you’d want a skilled chef at a restaurant, or a skilled golf instructor for your lessons. In home health care, however, skilled refers not to how good a professional is at their job, but rather to the level of education and licensure needed to perform certain activities.
Skilled services, therefore, refer to healthcare services performed by a nurse, a physical or occupational therapist, a speech pathologist or a medical social worker. By contrast, unskilled services are provided by a home health aide or nursing assistant; these services, in support of activities of daily living, are called unskilled no matter how excellent or experienced the homecare aide is.
With a physician’s prescription, Medicare and Medicare Advantage plans will cover the cost of skilled services. If a patient wants to received skilled services without a doctor’s order, they may have to pay privately; the most commonly requested type of such service is a weekly visit by a nurse to lay out medication.
Many people begin the search for their aging parents’ home health care needs by looking for a “nurse”, and while nursing visits can make sense as part of a larger care plan (as in the medication example), most families are really thinking of the services performed by a home health aide when they are imagining general in-home care for their elderly parents.
Most skilled services are used following a change of some sort in a patient’s health or ability to get around. This often coincides with surgery, a stroke, an injury or fall, or a wound that requires close attention. However, a physician may refer a patient for home therapy if they notice a chronic decline in mobility, even if there is no triggering incident.
If Medicare is covering skilled services, patients are generally enrolled, or admitted, in 30- or 60-day increments. This means that the home health agency you are working with will design a plan of care for the next month, which will be reevaluated at the end of the period. If you still require services, you will be readmitted for another 30 days.
Medicare does not generally pay for unskilled services, though some Medicare Advantage plans do. The only use of a home health aide that is covered by Medicare is a bathing visit, but a doctor’s prescription is still required for coverage.
Generally speaking, skilled home health care services are provided by a local Medicare-certified home health agency. A home care agency or nurse registry arranging unskilled services does not have to be Medicare-certified, but you should make sure they are appropriately licensed in the state(s) in which they operate. For either skilled or unskilled services, the number of years that the home healthcare agency has been in business, as well as any institutions, associations or health systems they are affiliated with, can be a good indicator of their professionalism and reliability.
Boca Home Care Services is a licensed nurse registry operating in Palm Beach and Broward Counties. We primarily help clients arrange unskilled home health care, but can also refer and help coordinate privately paid-for nursing or therapy visits. We have been locally owned and operated for over 25 years, during which time we’ve arranged home caregivers for thousands of our elderly neighbors.
As a member of the CareGivers of America network, we are also affiliated with three Medicare-certified home health agencies. Our care coordinators regularly help clients transition from unskilled to skilled services and back as their needs change. Aides we refer can begin to support clients at home or even while still in the hospital or rehab facility. Clients benefit by working with a team of professionals who can collaborate and align their plans of care around the client’s needs. The CareGivers of America network prides itself on servicing the client’s full orbit of care, wherever their homecare journey takes them.