When a hospital stay ends, questions begin. Can your parents get Skilled Nursing at Home instead of going to a facility? What exactly is skilled nursing care at home, how does Medicare view it, and what will it cost? This guide keeps it simple for Alexandria families. We’ll outline what’s included, who qualifies, how to plan visits, and how to talk to your discharge team with confidence.

What Is Skilled Nursing Care at Home?

Skilled nursing care at home means a licensed nurse delivers clinical tasks that require professional training. Typical skilled nursing services at home include wound care, injections, IV therapy, complex medication management, catheter care, ostomy care, monitoring of vitals, and teaching the family safe techniques. In Medicare terms, these are intermittent, medically necessary services ordered by a physician and delivered by a Medicare-certified home health agency.

Quick clarity
“Skilled” is about complexity and clinical necessity—not about the location. If your need can be safely performed by a trained nurse only (and not a layperson), it likely fits Skilled Nursing at Home criteria.

What’s Included: A Practical Checklist

Your at home skilled nursing care may include:

• Wound and surgical-site care: dressing changes, infection checks, negative-pressure therapy, and documentation.
  
• Medication management: new med reconciliation, injections, IV antibiotics, titration per orders, and monitoring for side effects.
  
• Chronic disease oversight: heart failure weight checks, COPD pulse-ox monitoring, diabetes teaching.
  
• Catheter and ostomy care: insertion changes, leakage troubleshooting, and skin integrity checks.
  
• Caregiver teaching: the nurse shows you how to do day-to-day tasks safely and when to call the doctor.
  

Because many recoveries need multiple disciplines, Skilled Nursing at Home is often paired with physical, occupational, or speech therapy and, if needed, a home health aide for personal care—when ordered and medically necessary.

Who Qualifies for Skilled Nursing at Home in 2025

You may qualify when:

1. A physician (or NP/PA where allowed) writes orders establishing medical necessity and a plan of care.
   
2. You need intermittent skilled services, not 24/7 residency in a facility
   
3. You are homebound for Medicare’s home health benefit, meaning leaving home requires considerable effort or assistance. (There are exceptions; your agency will assess this.)
   
4. Services are clinically appropriate at home under Virginia regulations and delivered by a licensed organization according to a written plan of care.
   

Virginia note
The Virginia Administrative Code requires that skilled services (like nursing) follow a physician-directed plan of care specifying frequency and duration. This keeps care focused, safe, and compliant.

Medicare Rules vs. Skilled Nursing Facilities

Medicare covers home health services (including Skilled Nursing at Home) when criteria are met under Parts A and/or B. That’s different from skilled nursing facility (SNF) care, which is covered under Part A after a qualifying inpatient stay and is limited in duration. If you can safely receive skilled nursing at home, you may not need an SNF—your discharge planner can help you compare.

Tip for families
Ask your hospital’s case manager: “Given the orders, could we start medicare skilled nursing at home instead of going to a facility?” Then request a same-day referral to a home health agency if appropriate.

What About Costs?

Families often ask about the cost of skilled nursing care at home. With Medicare eligibility, approved services are typically covered (subject to program rules). Your agency will give you written notice if something isn’t covered. If you are comparing private-pay options, ask for visit-based pricing and what’s included.

Budgeting help

• Clarify whether supplies are bundled.
  
• Ask how many visits are planned in week one vs. week two.
  
• If needs are mostly personal care (bathing, dressing), Medicare may not cover that alone. Your nurse can suggest a blended plan using private-pay aide hours for non-skilled support.
  

Visit Cadence: What to Expect in the First Two Weeks

Early weeks usually bring more frequent visits that taper as you stabilize. A typical pattern might be:

• Nurse: 2–3 visits first week, then 1–2 the next, based on healing and vitals.
  
• Therapy: as ordered (for mobility, safety, or speech/cognition).
  
• Care team calls: to adjust meds, confirm follow-ups, and coordinate with your physician.
  

If the nurse identifies risks that require ongoing clinical oversight, your plan of care can be extended. If the need becomes primarily custodial, the nurse may recommend shifting toward non-medical support while remaining available for check-ins per orders.

Common Scenarios Where You May Qualify

• Surgical recovery with complex dressings or drains
  
• IV antibiotics at home after hospital discharge
  
• New heart failure regimen requiring close monitoring
  
• New insulin start with teaching and glucose tracking
  
• Complicated catheter or ostomy care and skin checks
  

In each case, what is skilled nursing care at home comes down to whether a nurse’s specialized skill is required to keep you safe and to help you meet your health goals at home.

How to Request Skilled Nursing at Home (Step-by-Step)

1. Ask early in the hospital. Tell the discharge planner you prefer Skilled Nursing at Home if appropriate.
   
2. Confirm the plan of care. Make sure orders specify the skilled tasks, frequency, and duration.
   
3. Choose a qualified agency. Look for Medicare-certified home health agencies serving Alexandria. Your hospital can provide a list
   
4. Prepare your home. Clear pathways, set up a clean area for dressings/meds, keep a running list of vitals and symptoms.
   
5. Know who to call. Keep your nurse’s number, the on-call line, and your physician’s office handy for urgent questions.
   

24-Hour Needs vs. Intermittent Care

Families sometimes ask about 24 hour skilled nursing care at home. Medicare’s home health benefit is designed for intermittent skilled care—not continuous 24/7 coverage. If you truly need round-the-clock monitoring, your team will discuss alternatives and combine supports (e.g., private-pay aides overnight, plus nurse visits) to keep you safe.

Medicare Language You’ll Hear (Plain English)

• Homebound: Leaving home takes a lot of effort or help; you go out infrequently and briefly.
  
• Intermittent: Skilled nursing is needed, but not around the clock.
  
• ABN: Advance Beneficiary Notice you receive if something is not covered.

Knowing these terms helps you secure medicare skilled nursing at home smoothly and avoid delays.

Local and Regulatory Context (Why It Matters)

Virginia regulations require that skilled nursing at home care be prescribed and delivered under a written plan, including your diagnosis, functional limits, and exact visit frequency. This protects you and ensures quality. If your needs change, the plan is updated.

Realistic Expectations for Families

• Nurses are punctual but may arrive within a time window.
  
• Visits focus on clinical tasks first, then teaching and coordination.
  
• You’ll get a clear escalation plan—who to call for urgent issues, and when to go to the ER.
  
• When goals are met, services discharge; your nurse will hand off to your physician and recommend community support.
  

If you also need help with meals, laundry, or errands, consider adding non-medical support. For a practical overview of home support tasks, see daily living assistance tips on this resource: daily living assistance (helpful planning guide and checklists).

FAQs (Fast Answers)

Does Medicare pay for skilled nursing at home near me?
If you meet criteria (plan of care, homebound status, intermittent skilled need), yes—skilled nursing at home Medicare coverage may apply through a certified agency.

How much is the cost of skilled nursing care at home if I’m private pay?
Costs vary by visit length and complexity. Ask agencies for per-visit pricing and what supplies are included to estimate the skilled nursing care at home costs accurately.

Can we start with skilled nursing at home care and then switch to an aide?
Yes. As wounds heal or meds stabilize, plans often transition from skilled nursing services at home to personal-care support if needed.

Take the Next Step

If your loved one is being discharged soon, ask the care team about at home skilled nursing care and whether you qualify now. Bring a simple list: current meds, new orders, and follow-up appointments. With clear orders and the right partner, Skilled Nursing at Home can keep recovery safe, comfortable, and close to family.