GAPP Knowledge Center
Skilled nursing vs. personal care: what's the difference?
GAPP authorizes two distinct types of in-home support: skilled nursing (performed by licensed nurses) and personal care (performed by personal care aides). Understanding which services fall into each category helps families know what to expect from their GAPP care plan.
Side-by-Side Comparison
Skilled nursing and personal care compared
Performed by
Registered Nurses (RN) and Licensed Practical Nurses (LPN)
Requires
Active state nursing license
Examples
Ventilator management, tracheostomy care, medication administration, wound care, clinical assessment, tube feeding management
Authorization
Higher prior authorization standard (requires documented medical necessity for skilled tasks)
Supervision
RNs practice independently; LPNs under physician/RN direction
Performed by
Personal Care Aides (PCA)
Requires
GAPP-compliant PCA training and certification
Examples
Bathing, dressing, grooming, toileting, mobility assistance, meal preparation, light housekeeping related to care
Authorization
Based on documented need for assistance with activities of daily living
Supervision
Under oversight of supervising RN from the agency
Which Does My Child Need?
Most GAPP children receive both
Many children enrolled in GAPP receive a combination of skilled nursing and personal care hours. Skilled nursing is required for any medically complex procedure that requires a licensed clinician — ventilator management, tracheostomy suctioning, tube feeding, medication administration. Personal care addresses the daily living assistance needs that don't require clinical licensure but are essential to the child's well-being and safety.
| Child's Need | Service Type |
|---|---|
| Child requires ventilator management | Skilled Nursing (RN/LPN) |
| Child requires tracheostomy suctioning | Skilled Nursing (RN/LPN) |
| Child requires tube feeding administration | Skilled Nursing (RN/LPN) |
| Child requires medication administration | Skilled Nursing (RN/LPN) |
| Child needs bathing and hygiene assistance only | Personal Care (PCA) |
| Child needs mobility and transfer support only | Personal Care (PCA) |
| Child has both clinical and ADL needs | Both skilled nursing and personal care authorized |
Can a personal care aide perform tracheostomy care?
No. Tracheostomy care (suctioning, tube changes) is a skilled nursing task requiring a licensed nurse. A PCA cannot perform these procedures.
Can an RN also provide personal care tasks during a shift?
Yes. A nurse on a skilled nursing shift can provide personal care as part of the overall plan of care. The reverse is not true — a PCA cannot perform skilled nursing tasks.
What if my child only needs personal care?
Children who require assistance with activities of daily living but do not have medical needs requiring a nurse may be authorized for personal care hours only. The authorization type is based on the documented clinical needs.
How does Core Health Group Corp. staff skilled nursing vs. personal care shifts?
Core Health Group Corp. employs both licensed nurses and trained PCAs. We staff shifts based on the authorized service type for each time period. Families can have a nurse on one shift and a PCA on another, depending on the authorization.
Can my child's authorized mix of skilled nursing and personal care change over time?
Yes. If the child's medical needs change, the authorization can be updated through a new prior authorization request with updated physician documentation. Core Health Group Corp. manages reauthorization on your behalf.
Free Eligibility Screening
Not sure what services your child qualifies for?
Core Health Group Corp. assesses each child's medical and daily living needs to determine the right mix of skilled nursing and personal care. Start with a free eligibility check — no cost, no commitment.