Final Exam: Week 6 Dementia and Long Term Care Flashcards
Patient-Driven Payment Model (PDPM)
New payment system for SNFs to support and promote patient-focused care, basing care on unique characteristics, needs and goals of each patient
T/F Medicare does not limit the amount of therapy you can receive in a SNF
True
Note: Therapist’s judgement is a key factor in determining the amount of therapy needed
T/F Medicare dictates the forms of therapy that can be delivered
False- Medicare refers to state law and the treating clinician
T/F A portion of SNF therapy treatment must be provided in a group
False- Medicare does not require patients to receive group therapy, however expects that the needs of the patient to be met if group therapy is an effective intervention
T/F Medicare will pay for services that improve or maintain a patient’s function
True
Note: improvement or progress is not required
T/F Medicare must cover maintenance therapy
True but only when medically appropriate
T/F Medicare does not pay for therapy for certain diagnoses
False- certain diagnoses may trigger additional payments but medicare requires SNFs to provide all medically necessary services regardless of diagnosis
What is a skilled nursing facility (SNF)?
Health care given when you need skilled nursing or therapy staff to treat, manage, observe and evaluate your care
What is not considered skilled care?
Care that can be given by non-professional staff
Medicare coverage for SNF
Benefit period is up to 100 days if the requirements are continued to be met
Does Medicare cover custodial care?
Yes, but not if it’s the only kind of care needed
Short term care medicare coverage
- Days 1-20 full cost is covered
- Days 21-100 you pay daily coinsurance
- Days beyond 100 Medicare pays nothing
Long term care medicare coverage
Most health insurance does not pay for LTC because it is considered “custodial care” which is help with basic ADLs
Where can you receive long term care?
At home, in the community, in an assisted living facility, or in a nursing home
Reasons for needing skilled nursing
- Help improve your condition
- Maintain current condition and preventative care
Main points of skilled nursing care
- Continues care after maintenance program is set up
- Ensures safe and effective services
- Helps you get better, function independently, and help learn how to take care of your health needs
Medicaid
A joint federal and state program that helps with medical costs for some people with limited incomes and resources
Original Medicare
Fee-for-fee service health plan with Part A and Part B
Medicare Part A
Hospital insurance (inpatient, SNF, hospice care)
Medicare Part B
Medical insurance, medicare pays approved amount and you pay coinsurance or deductible
Medicare Advantage Plan (Part C)
Private company that works with Medicare to provide individuals with Part A and Part B benefits, payment is through private health insurance NOT Medicare
Medicare Preferred Provider Organization (PPO) Plan
Individual pays less if they receive care from provides in the plan’s network
Medicare Prive Fee-for-Service (PFFS) Plan
You can receive treatment from any doctor using original medicare if the doctor/hospital agrees to treat you, has strict rules
Medigap policy
Medicare supplemental insurance sold by private insurance companies to fill gaps in original medicare coverage
Benefit period
- The way that medicare measures your use of hospital and SNF services
- Begins the day you’re admitted
- Ends when you haven’t receive any care for 60 days in a row
- No limit to # of benefit periods
Coinsurance
An amount you may be required to pay as your share of the cost for services after you pay a deductible, usually a %
OT for dementia patients in long term care
DICE
DICE
Non-pharmalogic management of neuropsychiatric symptoms
DICE- Describe
Caregiver describes problematic behavior
DICE- Investigate
Possible cause of problematic behavior
DICE- Create
Caregiver team collaborate to create and implement treatment plan
DICE- Evaluate
Evaluate if the Create interventions have been implemented and if they are safe and effective
OT consultation in long term care
- Patient is demonstrating aggression, agitation, depression, anxiety, delusions, hallucinations, and disinhibition
- Provide generalized strategies and targeted strategies (SMART goals)
