Current through Register Vol. 18, September 20, 2024
(1) The goal of
skilled care is to provide care for patients who require general medical
management and skilled nursing care on a continuing basis, but who do not
require the constant availability of physician services ordinarily found only
in the hospital setting.
(2)
Skilled nursing care includes components which distinguish it from supportive
care. Supportive care does not require professional health training. One
component is the observation and assessment of the total needs of the patient.
Another component is the rendering of direct services to a patient where the
ability to provide the services requires specialized training, such as a
registered or a licensed practical nurse.
(3) In evaluating whether the services
required by the patient are the continuous skilled services which constitute
skilled care, several basic principles are considered.
(a) Since skilled care represents skilled
nursing care on a continuous basis, the need for a single skilled service --
for example, intramuscular injections twice a week -- would rarely justify a
finding that the care constitutes skilled care.
(b) The classification of a particular
service as skilled is based on the technical or professional health training
required to effectively perform or supervise the service. For example, a
patient, following instructions, can normally take oral medication.
Consequently, the act of giving an oral medication to a patient who is too
senile to take it himself would not be skilled service, even when a licensed
nurse gives the medication.
(c) The
importance of a particular service to an individual patient does not
necessarily make it a skilled service. For example, a primary need of a
non-ambulatory patient may be frequent changes of position in order to avoid
development of decubiti. If changing the patient's position is the only regular
and frequent service provided, it would not be a skilled service. Routine
prophylactic and palliative skin care such as bathing, application of creams,
etc. does not constitute skilled services. Presence of a small decubitus ulcer,
rash or other relatively minor skin irritation does not generally indicate a
need for skilled care. Existence of extensive decubiti or other widespread skin
disorder may necessitate skilled care. Physicians' orders for treating the
skin, rather than diagnosis, are the principal indication of whether skilled
care is required.
(d) The
possibility of adverse effects from improper performance of an otherwise
unskilled service -- for example, improper transfer of patients from bed to
wheelchair -- does not change it to a skilled service.
(4) Any of the following treatment services
or care indicate need for skilled nursing care:
(a) oral administered medications requiring
constant changes of dosage upon sudden undesirable side effects;
(b) oral medication before routine dosage
established and must be watched for reactions;
(c) gastrostomy feedings;
(d) nasopharyngeal aspiration;
(e) recent postoperative colostomy and
ileostomy care;
(f) repeated
catheterizations during recent postoperative period;
(g) special services in application of
dressings involving prescribed medications;
(h) initial phases of operation of inhalation
equipment;
(i) physical therapy
directed by the physician;
(j)
intravenous or instramuscular injections except for the well controlled
diabetic;
(k) patient on narcotics
for pain;
(l) the very hostile,
belligerent and demanding patient who is disruptive to other patients and
staff, constantly refusing to take medication or treatment, may be destructive,
may attack other patients or personnel, may have frequent periods of agitation
and needs constant and close supervision; and
(m) the patient with severe impairments, or
who is so withdrawn to the degree that he no longer can communicate and his
needs must be anticipated.
Sec.
53-6-113
and
53-6-402,
MCA; IMP, Sec.
53-6-101,
53-6-131
and
53-6-402,
MCA;
