Nursing Care communities are licensed by the state and offer furnished rooms and health care to residents who require consistent and ongoing medical care with physician oversight, yet do not require hospitalization. There are three levels of nursing care: skilled, intermediate, and custodial. Skilled care is the highest level of service. It must be prescribed by a physician and may only be performed by or under the supervision of technical personnel, such as a Registered Nurse, Licensed Practical Nurse, or physical therapist. Intermediate care is less intensive than skilled care and is appropriate for individuals who do not need 24-hour attention. Custodial care is appropriate once specific technical personnel are not needed for daily care but the individual is not likely to make further significant improvement