A nursing home,  also known as a skilled nursing facility, has registered nurses who help provide 24-hour care to people who can no longer care for themselves due to physical, emotional or mental conditions.  A licensed physician supervises each patient care, and a nurse or other medical professional is almost always on the premises.  Most nursing homes to have two basic types of services: Skilled medical care and custodial care.

Skilled medical care includes services of trained professionals that are for a limited period of time following an injury or illness:

• A registered nurse doing wound care and changing dressing after a major surgery, or administering and monitoring intravenous antibiotics for a sever infection.
• A physician therapist helping to correct strength and balance problems that have made it difficult for a patient to walk or get on and off the bed, toilet or furniture. 
• A speech therapist helping a person regain the ability to communicate after a stroke.
• An occupational therapist helping a person relearn independent self-care in areas such as dressing, grooming and eating.

Skilled care also might be needed on a long-term basis if a resident requires injections, ventilation, or other treatment of that nature.  Custodial or personal care includes assistance with what are know as activities of daily living, such as bathing; dressing; eating; grooming; getting in and out of bed or walking around; or toileting (incontinence care).

People who are able to recover from a disabling injury or illness might temporarily need the custodial care s they are getting back to being independent again.  For people who are losing their ability to function due to chronic disease and increasing
frailty, custodial care might be a long-term need.  In the most severe cases where a person is bed-bound ongoing supervision by a registered nurse is necessary,  along with custodial care, to ensure proper hydration and nutrition and to prevent skin breakdown.  

If a custodial care resident becomes ill or injured,  they might spend a period of time in skilled care, and then return to custodial care.  Whether a resident is under skilled or custodial care it is important in terms of who provides the care and who pays for the services provided.
Source of this article – Heritage Media 2014 Resource Guide.

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