Friday, December 18, 2015
Skilled Nursing Facilities and YOU!
At one time, if a person was admitted into a Nursing Home, the expectations would be that they would live out the remainder of their lives in that setting. While this may still be the case in many situations, the likely hood of someone who has been recently admitted into a Nursing Home for only a “Short Stay” has increased dramatically.
A person is now admitted to a Nursing Home with the expectation of going back to their home after only a short period of time. This period of time could be anything from one week to twenty days. The actual length of any one person’s stay will vary depending on their condition and their source of payment. Many Private Health Insurances will seek to have a resident discharged within a two week window. If the payment source is Medicare, they will pay 100% of the services for only the first twenty days.
Many of the short term admissions could be due to the need for some form of Rehabilitation services such as Physical Therapy, Occupational Therapy or some other Medical Service that is required to strengthen the person before going back to their home.
Long Term Care (Skilled Nursing Facility) provides a range of services that supports the personal care of each individual person. This model differs from the “Medical Model” in that various surgeries and other such services are generally not performed in a Nursing Home Setting.
How do you know if a loved one might require Long Term Care?
In general, someone is admitted to a Nursing Home if they are in need in areas termed “Activities of Daily Living” (ADL’s). The Activities of Daily Living are basic self-care tasks that include the following:
Selecting Proper Attire
Putting on clothes
Transferring (could be from bed to wheelchair etc.)
These activities of daily living are routines that most take for granted each day and are generally learned in early childhood.
Slightly more complex skills that should also be addressed when evaluating if a person is capable of living on their own are:
Handling Transportation (driving or using public transit)
Using the telephone and other communication devices
Housework and basic home maintenance
Who assesses these ADL’s?
Nurses in the Hospital
Geriatric Social Workers
Each of the above may perform these functional assessments.
Unless a person admitted to a Skilled Nursing Facility will pay privately, someone must perform some or all of the above tasks if the Nursing Home expects payment. If someone will be under Medicare services, they must have the proper approval and assessment from a doctor. Currently, Medicare requires an admission of 3 days in a hospital before they will approve payment to a Nursing Home. Many HMO’s and other potential payers have waived the 3 day hospital stay. Even if a person has private insurance that will pay for the services, the Nursing Home must receive the proper authorization from the insurance company before they can expect payment. While Medicaid generally pays for Nursing Home Care for those who financially qualify for the state services, an individual must “prove” that there is also a Medical need and thus be assessed from someone in the above group. In general, the person conducting the assessment will either be a physician or a Geriatric Social Worker that is not affiliated with any one Nursing Home.
Assessing a seniors functional abilities helps the family and medical professionals determine that person’s plan of care. Over time, periodic assessments can be equally valuable by showing patterns, predicting future needs and measuring either progress or decline.
Whether the senior is able to perform all of the activities of daily living independently, needs help in a few areas only or needs help with most if not all of them, the assessment will help tailor the care plan to meet these needs.
What is the best Healthcare Setting to receive care?
Of course, if you are a Nursing Home Administrator, the best care can be given “at your Nursing Home”!! Depending on the level of care required, a nursing home setting may very well be the ideal location for a person to receive care. However, there are many alternatives to Nursing Home care including home care services. Home care and assisted living has taken a sizable chunk out of the business in recent years. There are many positives and negatives to each situation and there might be many variables that must be taken into account before deciding which locale is best for you and your loved one. The decision as to what setting is the best for any one person is beyond the scope of this presentation. There are many web-sites available that provide assistance in helping decide the best situation for you and your loved one. As always, a conversation should be held with your physician before making a decision.
How is Long Term Care funded?
In a sense, we all do since the vast majority of NH Residents are either on Medicare or Medicaid. As such, these services are generated through the Federal Government (even though Medicaid is a State program, they are funded mainly from the Federal Government).
Many of the “Medicare Supplement” Insurance programs are still funded through Federal Government programs.
Medicare is a Federal Program that will pay for a Residents stay in a Skilled Nursing Home for up to 100 days for any one spell of illness.
Speaking in very general terms, what a Private Insurance Company will pay for skilled services depends on the specific policy in place. Most will follow the “Medicare” guidelines to some extent and only pay for skilled services.
Most any Nursing Home will gladly accept a Resident who is willing to pay privately.
Taking the premise that most Residents who require long term care will not be paying privately for an extended length of time, the main source of funding for a nursing home who accepts long term residents is then Medicaid.
Some insurances will pay for long term care but again, one needs to know the exact circumstances that payment will be made and exactly how long and what amounts.
Finding the right setting that meets your needs
A conversation with your Physician is always a great start. Your Physician should be able to provide some valuable insight into exactly what services and in what setting might be best.
Most Hospitals will employ either a Nurse or a Social Worker who will act in the capacity of a Discharge Planner. When a resident is being prepared for placement beyond the Hospital, the Discharge Planner is available to assist in this process by reaching out to area Health Facilities that might best match the resident’s needs.
There are many web sites that will also list the various health care settings in your immediate area.
These web sites not only provide a list of names, but also present a summary that compares each Home to each other. This summary can include how the facility has performed in their annual State Survey.
Some of helpful web sites are:
The four web sites above was helpful in compiling the information used in this article.
This article was provided by Charles Carrozza, Adjunct Faculty member at Saint Joseph's College.
Posted by Twila Weiszbrod at 11:42 AM