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10 Cards in this Set

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  • Back
Long Term Care definition
A range of services that addresses the health, personal care and social needs of individuals who lack some capacity for self care
Dependence of an individual on the services of another for a prolonged period of time
Long Term Care Facilities Criteria for Admission
Skilled Nursing Facility (SNF):
72 hours hospitalization OR
Within 30 days of a hospital admission
Require 4-6hrs of skilled care in a 24 hr period OR
Be able to tolerate a minimum amount of therapy each day: up to 3 hours a day 6 days a week from 203 therapeutic rehab disciplines
Long Term Care Facilities Criteria for Admission
Nursing Facility (NF): “Nursing Home”
Nonskilled needs: custodial care
Skilled Nursing Facility Coverage Requirements for Medicare Part A
Must enter facility no more than 30 days after a hospitalization that itself lasted > 3 days; observation status does not count
Care in the facility must be for the same condition, or medically related to, the condition that caused the hospitalization
Patient must receive a “skilled” level of care in the facility that cannot be provided on an outpatient basis
Medicare: Part A: Benefits/ coverage
Inpatient services , acute post-hospital, hospice
100% rehab/skilled nursing for 20 days
80% for a maximum of 100 days
Medically necessary part-time and intermittent skilled nursing care and home health aid services
PT, OT, ST, Social services, DME (durable med equipment)
No limit; reordered every 60 days by MD or NP
Medicare covers 100 skilled days and has thus become a provider of 10% nursing home revenue
Pays 20 days 100%; remaining 80 days $119/day co-pay
Medicare Part B:
Benefits/Coverage
Financed in part by monthly payments; 75% of Part B costs are subsidized by federal general revenues
Medicare Part B: covers
Physician, NP services
Outpatient diagnostics
Outpatient PT, OT, ST
Audiologists
Some ambulance service
Home health services and supplies not covered by part A
Medicare will pay for these preventative measures
Some preventive measures:
Immunizations: pneumo, flu, hep B, herpes zoster, post-injury tetanus
Mammogram yearly
Pap every 2 years
Bone Density Testing every 2 years
Medicare does not pay for these services
Custodial care
Dental/denture
Hearing aids, glasses
Routine physical exams
MDS Criteria
Minimum Data Set (MDS) objectively collect clinical information on nursing home residents
Activities
Falls
Nutritional status
Feeding tubes
Dehydration/fluid maintenance
Dental care
Pressure ulcer
Antipsychotic drug use
Physical restraint
Delirium
Cognitive loss/dementia
Visual function
Communication
ADL functioning/rehabilitative potential
Urinary incontinence/indwelling catheters
Psychosocial well-being
Mood state
Behavioral problems
Life expectancy less than 6 months may be demonstrated by the following findings
Terminal dementia:
Progressive weight loss
Decubitus ulcers formation
Recurrent pneumonia
Recurrent urinary tract infections
Inability to ambulate without assistance
Unable to track with eyes
Vocabulary less than 6 words