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Skilled nursing care provides health care related to skilled rehabilitation services, observation
and assessment of the patient’s condition, patient teaching and training, direct skilled nursing
services (such as tube feedings), and management and evaluation of the patient’s care plan
(Hawryluk, 1999). People who need close monitoring during and after hospitalization and
those progressing toward independent care are recognized as having skilled nursing needs. An
RN must be in charge of the care. The designation of skilled care originated in Medicare and
Medicaid legislation and has been adopted by insurers and managed-care providers. The
assumption is that all hospital care requires skilled nursing care but that only some long-term care requires skilled nursing. Long-term acute care and transitional care qualify as providing
skilled nursing services. Skilled nursing care also may take place in nursing homes designated
as skilled nursing facilities, often referred to as SNFs (pronounced “sniffs”) and in the home.
Reimbursement for skilled nursing care provided outside the hospital depends on careful documentation by the care provider of the specific skilled nursing tasks required by the patient.