Families often call us asking for "a nurse" when what they need is help with bathing and meals — and just as often they ask for "a caregiver" when the situation actually calls for a licensed nurse. The difference matters, because it changes who is legally allowed to provide the care and how that care is authorised.

Skilled nursing versus personal care

Skilled nursing is care that requires the judgement, training, and licence of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). It includes wound care and dressing changes, IV therapy and infusions, injections, catheter and ostomy care, tube feedings, medication administration, and the clinical assessment of a condition that is changing.

Personal care and homemaker services — bathing, dressing, grooming, meals, light housekeeping, companionship, transportation — do not require a nursing licence. They are provided by home health aides, CNAs, and companions, and in our agency those staff are supervised by a nurse and work from the same written plan of care.

Most of our clients receive both. A nurse may visit twice a week to manage a wound while an aide comes daily to help with bathing and meals.

Who typically qualifies

Skilled nursing at home is usually appropriate when someone:

• Has just been discharged from a hospital, rehab facility, or emergency department
• Has a surgical incision, pressure injury, diabetic ulcer, or other wound that needs professional care
• Needs IV antibiotics, infusion therapy, or regular injections
• Has a catheter, ostomy, feeding tube, or tracheostomy
• Is managing a serious chronic condition — heart failure, COPD, diabetes, kidney disease — that keeps landing them back in hospital
• Has a medication regimen that has become too complex or too risky to manage alone
• Is homebound, or leaving home takes a considerable and taxing effort

How care actually starts

Skilled nursing and therapy are provided under a physician-ordered plan of care, but you do not have to arrange the paperwork yourself. In practice it works like this:

1. You call us. Tell us the diagnosis, the recent hospital stay if there was one, and what is going wrong at home.
2. A Registered Nurse visits, free of charge. The assessment covers medical history, medications, mobility, fall and safety risks, nutrition, cognition, and the home environment itself.
3. We write the plan of care — what will be done, by whom, how often, and what the goals are — and confirm it with your physician.
4. Care begins, every visit is documented, and findings go back to your doctor. The plan is adjusted as the client improves or declines.

What to have ready when you call

It speeds everything up if you can put your hands on the diagnosis and discharge paperwork, a current medication list including over-the-counter products, your physician's name and phone number, and your insurance or long-term care policy details.

If you are not sure which level of care is needed, that is exactly what the free in-home assessment is for. Call us and a nurse will tell you plainly what the situation calls for.