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Skilled vs. Unskilled Home Health Care

Posted 07-15-2020 by Theresa Stephens, RN

What is Home Health Care? It is exactly what it sounds like, health care provided to an individual at his or her home. It is supportive care provided to an individual in his/her home related to illness or injuries. But many do not know that there is a difference between regular at-home health care (unskilled or sometimes known as “custodial care”) and skilled home health care.

There is only one main difference between skilled home health care and unskilled home health care. That difference is the words “licensed” or “certified”. All skilled home health cares to provide licensed employees for the patient. The different types of licensed workers include:

  • Registered Nurses (RNs)
  • Licensed Practical Nurses (LPNs)
  • Certified Nursing Assistant (CNAs)
  • Physical Therapist (PTs)
  • Physical Therapist Assistant (PTAs)
  • Occupational Therapist (OTs)
  • Speech-Language Pathologist (SLPs)
  • Medical Social Worker (MSWs)
  • Certified Occupational Therapy Assistant (COTAs)
  • Home Health Aide (HHA)

                Every skilled home health care provider has any, if not all the certified employees listed above. They are licensed and trained to treat patients inside of his/her home or residence. Skilled care is medically necessary care that can only be provided by or under the supervision of licensed medical personnel. Some examples of skilled care are physical therapy, wound care, IV infusions, catheter care, etc. Medicare will ONLY cover skilled home health care, as well as other private insurances. All skilled home health care patients must be referred or prescribed by a physician. Typically, skilled care usually lasts an hour depending on the therapy prescribed to the patient. Patients often receive this type of care as a result of a short-term medical condition they are expected to recover from, or palliative care.

                Now, this brings us to the unskilled home health care. What that means is anyone who is not licensed or certified can go to a patients’ home and help treat them. Medicare does NOT cover unskilled home health care, meaning it is all coming out of the patients’ pocket for treatment. Services may include bathing, grooming, housekeeping, and running errands, basically anything that is not direct medical treatments. Shifts vary from 4 hours up to 24 hours of service. Some may consider unskilled home health care as “custodial care”. Most patients receiving this type of care have a chronic condition where recovery is not expected. Please note, some private care facilities that fall under this category may have RNs or nurses available for privately paid care.

                To conclude, it is always necessary to do your research before choosing what type of care your spouse, mother/father, grandparent, even children need. Skilled care is typically for short-term patients. Long-term patients fall more under unskilled or custodial care.

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