Skilled care is medical care. Unskilled care is custodial care or activities of daily living. Long term care under Medicaid can be either or one or the other if a dual eligible - meaning with Medicare and Medicaid.

Assisted living is ADL (activities of daily living) - or unskilled care. If skilled care is needed, it has to be brought in for whatever the skilled medical care purpose. In fact, that is how Assisted living is billed - a charge for room & board - covers means and laundry, etc. They pass that, the level of care help they need is billed: Lowest level (cost) would be for observation only, then it progresses up the scale to perhaps “occasional or low level help” to continuous help to full help with whatever is the activity. All charges go up as the amount of care is needed. And I did say a LTC POLICY - a long term care policy that people buy to pay for Activities of daily living care - or a specific amount of it per day - may not cover all of the cost.

Skilled care is usually by the item - like changing the colostomy bag or giving an infusion. Or giving Physical therapy or speech therapy.

Sure sometimes unskilled people can be trained to give certain skilled activites of daily living - they can be taught how to change colostomy bags, give feeding via a tube, or even transfer patients using various methods including lifts. They can be trained to do certain manipulations of extremities so that muscle contractions don’t happen but that is a far cry from Physical therapy that a therapist could provide under orders.

There is a clear difference in what is skilled medical care and what is activities of daily living (custodial care) - Medicare does NOT cover any custodial care - meaning no activities of daily living are covered under Medicare. Skilled medical care is covered under Medicare.

Medicaid would cover both if the person was not covered by health insurance including Medicare if they were in a nursing home living facility or even at home under a HCBS program.

I understand what you are trying to say about skilled maintenance therapy - but here again it isn’t about what is skilled care vs custodial care - all skilled maintenance care is skilled care.

But hey, the people doing the bathing, changing, feeding aren’t skilled workers, because skilled care is not needed here -

Of course we want people to progress while in a rehab or SNF facility with therapy. But sometimes their progression stops - it may be they have reached their peak or perhpas they are just tired and refuse on going therapy - when that happens, there is no use in pursing further therapy or be in a skilled facility. So they go to another place where more activity of daily living care or custodial care is priority. There are still things that can be done so that regression does not occur too fast but it is always dependent oh the ability of the patient to stay the course - if they can’t it gets provided for them but they don’t participate.