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LTC Review > 4 HR Training/Renewal > Flashcards

4 HR Training/Renewal Flashcards

1
Q

ADLs (6)

A
  • eating
  • bathing
  • dressing
  • toileting
  • maintaining continence
  • transferring
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2
Q

Instrumental ADLs (7)

A

Tasks required for independent community living

  • using the telephone
  • driving
  • shopping
  • preparing meals
  • light housework
  • taking medications
  • managing money
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3
Q

Factors that influence risk of needing LTC

A
  • Age
  • Marital Status
  • Gender
  • Lifestyle (diet, exercise, etc.)
  • Health and family history
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4
Q

“chronic” care meaning

A

the aim of management, control of symptoms, and maintenance of function

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5
Q

“Acute” care meaning

A

medical care aimed at treating physical problems directly in an attempt to permanently cure or control them

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6
Q

Baby-boomer demographics

A

2008 - 9M over 65 needed LTC

2020 - increases to 12M

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7
Q

Percentage using LTC that are aged 18-64

A

40%

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8
Q

Formal vs Informal Care

A

Unpaid care from friends and family is termed informal care. Formal care is furnished by nurses, home aides, homemakers, and other paid providers.

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9
Q

Home-Based Care

A
  • Personal care services
  • Homemaker services
  • Telephone reassurance/friendly visitor/companion services
  • Meal delivery services
  • Transportation services
  • Home health aides
  • Case managers/geriatric care managers
  • Hospice support
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10
Q

Community-Based Care

A
  • Adult day services programs
  • Senior centers
  • Respite care
  • Caregiver support groups
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11
Q

Facility-Based Care

A
  • Board and care homes
  • Assisted living
  • Adult foster care
  • Congregate housing/senior retirement communities
  • Continuing care retirement communities (CCRCs)
  • Skilled nursing facilities (SNFs)
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12
Q

Primary funding source of LTC

A

Medicaid

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13
Q

comprehensive policies

A

combine home and facility care

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14
Q

noncomprehensive policies

A

nursing home only policies (now outlawed in some states)

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15
Q

“Visits”

A

2 to 4 hour blocks of time for health services

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16
Q

Typical Home care costs

A

$19/hr for homemaker service

$20/hr for home health aid service (not medical care)

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17
Q

Community Based Care costs

A

$65/hr

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18
Q

Assisted Living Facilities Costs

A

1 bed unit….3.5k monthly and about 35% have a one time fee ranging form $25 to $120,000

19
Q

Nursing Home costs

A

Private room…$240/day

Double room…$212/day

20
Q

Medicare Coverage

A

100% first 20 days in SNF, co-pay for days 21-100

21
Q

Medicare Coverage Requirements

A
  • The nursing home must be a Medicare-certified SNF providing 24-hour nursing care to convalescent patients.
  • The patient must require daily continuous skilled nursing care or skilled rehabilitation services, as defined by federal law.
  • The patient must have spent at least three consecutive days in a hospital, and admission to the SNF must occur within 30 days after discharge from the hospital.
  • A physician must certify that SNF services are needed for the same or related illness for which the person was hospitalized
22
Q

What skilled nursing services does Medicare cover?

A
  • a semiprivate room
  • custodial care
  • meals, including special diets
  • regular physician and nursing services
  • rehabilitation services
  • laboratory tests
  • drugs furnished by the facility
  • medical supplies
23
Q

What home care services does Medicare cover?

A

Limited to reasonable, necessary, part-time or intermittent skilled nursing care and home health aide services and some therapies that are ordered by a physician and provided by a Medicare-certified home health agency. Does not pay for ongoing personal care or custodial care needs

24
Q

Medicaid qualifications (3)

A

General - 65, permanently diabled, or blind US citizen living in the state where applied

Functional - functional assessment administered by a medical specialist and is used to determine where the care should be delivered

Financial - asset (

25
Q

Medicaid must cover what basic services (8)

A
  • inpatient and outpatient hospital services
  • laboratory and X-ray services
  • skilled nursing services
  • home health services
  • physician and certified nurse practitioner visits
  • family planning
  • periodic health check-ups
  • diagnosis and treatment for children
26
Q

Countable assets or non-exempt assets

A
  • cash
  • checking and savings accounts
  • certificates of deposit and money market accounts
  • stocks, mutual funds, bonds, and other investment holdings
  • IRAs and other retirement investments
  • nonresident property
27
Q

noncountable assets

A

primary residence—A primary residence is not countable as long as the home’s equity is less than $500,000…exempt if a spouse, a child under the age of 21, or a blind or permanently disabled child is living in the home.
• automobile—One automobile of any value is exempt if one spouse is institutionalized. One auto of any value is exempt if the spouse needs the auto for employment or if the vehicle has been modified to be handicapped accessible.
• household belongings
• personal possessions
• business property essential to self-support—A business property is exempt if it produces income sufficient to justify possession of the business assets (equipment and supplies, inventory, cash on hand).
• burial contracts
• burial plot
• cash surrender value of life insurance—The cash value of any life insurance owned is exempt as long as the value of all such policies does not exceed a certain amount.

28
Q

Countable income

A
  • salaries and wages
  • pensions
  • Social Security
  • veterans’ benefits
  • interest earnings and dividends
29
Q

non-countable income

A
  • Temporary Aid to Needy Families (TANF) payments
  • supplemental security income (SSI)
  • food stamps
  • Low Income Home Energy Assistance Program (LIHEAP) benefits
  • foster care payments
  • certain housing subsidies
30
Q

Allowable Transfers

A

For example, a transfer to a spouse, a transfer to a third party for the benefit of a spouse, a transfer to a child over age 21 living in the home for at least two years before the applicant’s institutionalization and who provided care to delay institutionalization, and transfers to disabled children are allowed and will not result in a Medicaid penalty period, even if made during the look-back period.

31
Q

An indemnity basis policy

A

Policy for a specified amount

32
Q

A reimbursement basis policy

A

A policy for actual costs incurred

33
Q

Section 7702B

A

establishes standard requirements for qualified LTC contracts, subject to certain rules and restrictions

34
Q

Tax Qualified Policy Requirements (5)

A
  • provides insurance only for LTC services.
  • cannot provide for a cash surrender value.
  • guaranteed renewable.
  • must use standard benefit triggers (2 of 6 ADLs or cognitive impairment) and must pay its benefits if the insured is certified as chronically ill
  • must specify that once the insured qualifies for benefits an approved plan of care developed by a licensed health care practitioner must be in place.
35
Q

Tax treatment of premiums

A

If the policy is qualified, they can be itemized (only helps if health costs are more than 10% of AGI)

36
Q

Tax treatment of benefits

A

Non taxable for a reimbursement policy. Tax free (up to $330/day) for indemnity policies.

37
Q

LTC Disability Policy

A

benefits are paid when the insured qualifies for benefits, regardless of whether the insured is actually receiving care or incurring expenses.

38
Q

gatekeeper

A

The person who verifies that coverage has been triggered.

39
Q

Policy Exclusions (6)

A
  • alcohol and drug addiction
  • illnesses and/or injuries caused by acts of war
  • self-inflicted injury, such as attempted suicide
  • treatment covered by Medicare
  • services delivered by family members or friends
  • some mental and nervous disorders
40
Q

dollar-for-dollar method

A

asset protection is equal to the amount of benefits paid from the partnership policy. For example, if Tom buys a partnership policy with a maximum lifetime benefit of $100,000, he would be entitled to up to $100,000 worth of LTC benefits paid by his policy.

41
Q

total asset protection method

A

all assets are protected from Medicaid

42
Q

DRA 2005 minimum standards for partnership (6)

A
  • Insured must be a resident of state when the policy is issued.
  • The policy must meet the definition of a tax-qualified LTCI policy.
  • The policy must meet specific requirements of the NAIC’s Long-Term Care Model Act and Regulations.
  • The policy must include some measure of inflation protection for purchasers younger than 76 and the offer to purchase inflation protection for those who are 76 and older.
  • Issuers of partnership policies must conform to certain reporting requirements and must make this information available to the agency that administers the state’s partnership program.
  • The state cannot impose any requirement affecting the terms or benefits of a partnership policy unless it imposes the same requirements on all LTC insurance policies.
43
Q

Partnership requirements for home care

A

Must be at least half of the full benefit

LTC Review (1 decks)

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