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10 Cards in this Set
- Front
- Back
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Long Term Care definition
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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 |
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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 |
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Long Term Care Facilities Criteria for Admission
Nursing Facility (NF): “Nursing Home” |
Nonskilled needs: custodial care
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Skilled Nursing Facility Coverage Requirements for Medicare Part A
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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 |
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Medicare: Part A: Benefits/ coverage
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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 |
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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 |
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Medicare will pay for these preventative measures
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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 |
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Medicare does not pay for these services
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Custodial care
Dental/denture Hearing aids, glasses Routine physical exams |
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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 |
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Life expectancy less than 6 months may be demonstrated by the following findings
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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 |
