Skilled Home Health Care
Skilled Nursing at Home
You cannot buy skilled nursing at home. A doctor has to order it. That single fact means the first phone call most families make is to the wrong number, and the second thing worth knowing is that "homebound" does not mean what almost everyone assumes it means. Focus Family Care provides skilled nursing at home across seven South Florida and Treasure Coast counties.
What Happens on a Skilled Nursing Visit
Wound Care
Sterile dressing changes, surgical sites and pressure injuries, with clinical judgment about healing.
IV Therapy and Injections
Intravenous antibiotics, fluids and infusions, plus injections the household cannot give.
Catheter and Ostomy Care
Routine changes, site care and troubleshooting when something is not right.
Disease Management
Diabetes, heart failure, COPD and other conditions monitored between doctor visits.
Medication Management
Reconciling the discharge list, administering what the household cannot, and watching for interactions.
Post-Hospital Follow-Through
Carrying out the discharge plan in the house, which is where most readmissions are prevented.
Clinical Assessment
Noticing that something has changed and escalating it to the doctor before it becomes an emergency.
Teaching
Showing the patient and family how to manage the condition and the equipment between visits.
Quick Answer
Skilled nursing at home is medical care delivered in the house by a licensed RN or LPN, in intermittent visits, under a physician's order. Medicare covers it when a doctor certifies the need and the patient is homebound. Many people who would qualify never apply, because they think homebound means housebound. It does not.
Key Takeaways
- Skilled nursing at home is prescribed, not purchased. The first call is to the doctor, not to an agency.
- Homebound does not mean bedbound. The test is effort, not confinement.
- You remain homebound while leaving for medical treatment, religious services and adult day care.
- It is delivered in intermittent visits, not continuous shifts. That is private duty nursing, funded differently.
Prescribed, not purchased
This is the difference between skilled nursing and every other kind of help at home, and it changes the order in which you do things.
A home health aide you can simply hire. Private duty nursing you can buy privately by the shift. Skilled nursing at home is medical treatment, and like any medical treatment it starts with a physician deciding it is needed.
What that means practically is that the first call is to the doctor, not to an agency. You are asking whether they will order home health, and specifically for a skilled nursing evaluation. If they agree, they write the order and complete a face-to-face encounter that documents the need. Only then does an agency get involved.
Families routinely spend two weeks calling agencies before anyone tells them this. If you call us and it turns out you need an order first, we will say so on the first call and tell you exactly what to ask the doctor for. That takes five minutes and it is free.
What homebound actually means
Here is the misconception that costs people coverage they are entitled to.
Homebound does not mean bedbound. It does not mean you never leave the house. Medicare's test is about effort and difficulty, not confinement.
Broadly, you are considered homebound if leaving home requires a considerable and taxing effort, and if you either need help to leave, whether that is a walker, a wheelchair, a cane, special transport or another person, or your doctor advises against leaving because of your condition.
And you are still homebound if you leave for the following.
- Medical treatment and appointments: Including dialysis, chemotherapy and outpatient therapy.
- Religious services: Attending worship does not disqualify anyone.
- Adult day care: You can still receive home health care while attending.
- Short, infrequent absences for other reasons: A family occasion or a haircut, for example.
People disqualify themselves, and they should not
We meet people every month who assumed they were disqualified because they went to church last Sunday, or because a daughter drove them to lunch. They were not disqualified. They simply never asked.
If you are unsure, ask the doctor. It is their determination to make, and it costs nothing to raise.
Intermittent, not continuous
Skilled nursing at home is delivered in visits, typically a few times a week, each lasting under an hour. It is not someone staying in the house.
If what you need is a nurse present for hours at a time, that is private duty nursing, it is funded differently, and it is usually private pay or long-term care insurance rather than Medicare.
Assessment is the part families undervalue and clinicians never do. The nurse is there to notice things.
Who pays for skilled nursing at home
- Medicare: Covers skilled nursing at home when a physician orders it, certifies the need face to face, and the patient is homebound. This is how most skilled nursing at home is funded.
- Florida Medicaid: Covers skilled nursing for eligible adults and children, with broader coverage for children under twenty-one.
- Private insurance: Most plans cover skilled home health under a physician's order. Focus Family Care verifies coverage at no charge before the first visit.
- Private pay: Available where there is no order or no coverage, though in that situation an aide or private duty nursing is often the better fit.
When skilled nursing is the wrong answer
If nothing in the visit list above applies, this is not the service you need, and saying so is more useful than selling it to you.
When the real need is bathing, dressing, meals, supervision or company, that is aide work. See home health aides and personal care, which cost considerably less.
When someone needs a nurse present continuously rather than for a short visit, that is private duty nursing. When a child needs authorized nursing hours, that is pediatric private duty nursing.
And when there is no physician order and the doctor does not think one is warranted, no agency can create one. We will tell you that rather than book an assessment you do not need.
What we can tell you about staffing
Focus Family Care has 100 RNs and LPNs available for skilled visits across the seven counties we serve.
From receiving a physician order, the typical time to a first visit is 48 hours. A registered nurse writes and supervises every plan of care.
Where we provide skilled nursing at home
Across Palm Beach, Broward, Miami-Dade, Martin, St. Lucie, Indian River and Okeechobee counties, with city pages for West Palm Beach, Boca Raton, Boynton Beach, Delray Beach, Jupiter, Palm Beach Gardens, Fort Lauderdale, Hollywood, Miami, Stuart, Port St. Lucie and Vero Beach.
How We Know This
Focus Family Care is a Florida-licensed home health agency and nurse registry (License NR #30211928, HHA #299995403) accredited by ACHC. Guidance on this page is reviewed by the agency's Director of Nursing, and coverage details are verified with each family's insurance before care begins.
Sources
Insurance & Payment
We Accept Medicare, Medicaid, Private Pay, and 100+ Insurance Plans
Focus Family Care accepts Medicare, Florida Medicaid, private pay, and more than 100 private insurance plans, including most long-term care policies. We verify your coverage at no charge before the first visit.
Not sure what your plan covers? Call (561) 693-1311 for free insurance verification, no obligation.
Frequently Asked Questions
My mother leaves the house for church. Is she still homebound?
Very probably yes. Religious services, medical appointments, adult day care and short, infrequent outings do not disqualify someone. The test is whether leaving home takes considerable and taxing effort. Ask her doctor, because the determination is theirs to make.
Do I need a doctor's order for skilled nursing at home?
Yes. Skilled nursing at home is medical treatment, so a physician must order it and complete a face-to-face encounter documenting the need. If you call Focus Family Care without one, we will tell you exactly what to ask the doctor for.
Does Medicare pay for skilled nursing at home?
Yes, when a physician orders it, certifies the need, and the patient is homebound and needs part-time or intermittent skilled care. Medicare does not fund a nurse present for a full shift, which is private duty nursing and is funded separately.
How often does the nurse come?
Typically a few times a week, with each visit lasting under an hour. The frequency is set by the plan of care and changes as the patient's condition changes.
What is the difference between skilled nursing and private duty nursing?
Skilled nursing at home is intermittent visits under a physician's order, usually funded by Medicare. Private duty nursing is continuous one-to-one nursing in shifts of eight to twenty-four hours, usually funded by private pay or long-term care insurance.
What happens when the skilled nursing visits end?
The episode ends when the skilled goal is met or the patient is no longer homebound. Many families then need ongoing help with daily life, which Medicare does not fund. Arrange that before the last visit rather than after it.
Request Home Health Care Today
Focus Family Care starts care in as little as 24 hours. Call now or request an in-home assessment. We answer around the clock.
515 N Flagler Drive, Ste 350, West Palm Beach, FL 33401