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Daily Skilled Nursing

If in an exceptional circumstance (e.g., when progress is noted in wound healing and daily visits need to continue for a specific amount of time), daily skilled nursing (SN) care is needed beyond 21 days, then a finite and predictable endpoint to the daily skilled nursing care is needed.

Helpful hints to document an endpoint:

  • Use a finite date, e.g. "Daily SN ending May 1"
  • Be reasonable and realistic, e.g. if diabetic wound will take up to three months to heal, use this date.
  • Remember, the end-point is for the daily visits, not the care.
    • If able to teach another caregiver who is available on weekends, that would be the end-point.
    • Collaborate with physician for alternate wound treatment, if daily visits for wound care.
    • Use your best clinical judgment, along with the physician and patient history to project the date when daily SN services can be reduced.
  • Avoid using 21 days or end of certification periods repeatedly.
  • Reassess need for daily SN by asking:
    • How long has the patient been seen daily?
    • Has his or her condition changed?
    • Would a different treatment that requires less than daily care be as effective?
    • Is there another caregiver that can do care at least one day/week?
    • Is there a realistic end-point or should it be changed?

Posted: 09.28.11

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