Skilled nursing at home is one of Medicare's most under-utilized benefits. This guide explains what it is, when it applies, and what families should expect.
What is skilled nursing care?
Skilled nursing care is professional nursing care that requires the training, judgment, and license of an RN or LPN. It is delivered intermittently — typically 1–3 visits per week, lasting 60–90 minutes each — under a doctor's order.
Common reasons for a skilled nursing referral
- Wound care (surgical, pressure, diabetic)
- IV therapy and antibiotics
- Injection administration (insulin, B12, biologics)
- Medication management and reconciliation
- Disease education (diabetes, CHF, COPD, post-stroke)
- Catheter care
- Ostomy management
- Post-surgical assessment
What happens on the first visit
The initial assessment is comprehensive — typically 90 minutes:
- Vital signs and head-to-toe assessment
- Review of all medications (bring every bottle)
- Wound or condition-specific evaluation
- Home environment safety check
- Caregiver interview and training plan
- Care plan development with your physician
- Schedule of follow-up visits
Documentation is filed in your electronic chart within 24 hours and shared with your ordering doctor.
Frequency and duration
A standard Medicare home health episode is 60 days. Visit frequency is determined by clinical need — wound care may need 3x/week, while diabetes teaching may taper to 1x/week then 1x/month. Re-certification can extend coverage when medically necessary.
Who pays
- Original Medicare: 100% covered for eligible patients
- Medicare Advantage: 100% covered (often with expanded benefits)
- Illinois Medicaid: covered for eligible patients
- Commercial insurance: typically covered with copay
- Private pay: $150–$250/visit average
RN vs. LPN at home
RNs (Registered Nurses) handle assessments, complex cases, IV therapy, and care plan management. LPNs (Licensed Practical Nurses) handle routine visits like wound dressing changes, medication administration, and follow-ups. Both are licensed by the State of Illinois and bring identical clinical compassion to every visit.
Coordination with your doctor
Every skilled nursing episode starts and ends with the patient's physician. Your doctor signs the order, reviews the assessment, approves the care plan, and gets weekly updates. Optimum communicates directly with the ordering MD's office throughout.
Call (773) 878-8738 to verify coverage and start care within 48 hours.