Final Exam: Week 6 Dementia and Long Term Care

Question 1

Patient-Driven Payment Model (PDPM)

Answer 1

New payment system for SNFs to support and promote patient-focused care, basing care on unique characteristics, needs and goals of each patient

Question 2

T/F Medicare does not limit the amount of therapy you can receive in a SNF

Answer 2

True
Note: Therapist’s judgement is a key factor in determining the amount of therapy needed

Question 3

T/F Medicare dictates the forms of therapy that can be delivered

Answer 3

False- Medicare refers to state law and the treating clinician

Question 4

T/F A portion of SNF therapy treatment must be provided in a group

Answer 4

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

Question 5

T/F Medicare will pay for services that improve or maintain a patient’s function

Answer 5

True
Note: improvement or progress is not required

Question 6

T/F Medicare must cover maintenance therapy

Answer 6

True but only when medically appropriate

Question 7

T/F Medicare does not pay for therapy for certain diagnoses

Answer 7

False- certain diagnoses may trigger additional payments but medicare requires SNFs to provide all medically necessary services regardless of diagnosis

Question 8

What is a skilled nursing facility (SNF)?

Answer 8

Health care given when you need skilled nursing or therapy staff to treat, manage, observe and evaluate your care

Question 9

What is not considered skilled care?

Answer 9

Care that can be given by non-professional staff

Question 10

Medicare coverage for SNF

Answer 10

Benefit period is up to 100 days if the requirements are continued to be met

Question 11

Does Medicare cover custodial care?

Answer 11

Yes, but not if it’s the only kind of care needed

Question 12

Short term care medicare coverage

Answer 12

• Days 1-20 full cost is covered
• Days 21-100 you pay daily coinsurance
• Days beyond 100 Medicare pays nothing

Question 13

Long term care medicare coverage

Answer 13

Most health insurance does not pay for LTC because it is considered “custodial care” which is help with basic ADLs

Question 14

Where can you receive long term care?

Answer 14

At home, in the community, in an assisted living facility, or in a nursing home

Question 15

Reasons for needing skilled nursing

Answer 15

• Help improve your condition
• Maintain current condition and preventative care

Question 16

Main points of skilled nursing care

Answer 16

• 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

Question 17

Medicaid

Answer 17

A joint federal and state program that helps with medical costs for some people with limited incomes and resources

Question 18

Original Medicare

Answer 18

Fee-for-fee service health plan with Part A and Part B

Question 19

Medicare Part A

Answer 19

Hospital insurance (inpatient, SNF, hospice care)

Question 20

Medicare Part B

Answer 20

Medical insurance, medicare pays approved amount and you pay coinsurance or deductible

Question 21

Medicare Advantage Plan (Part C)

Answer 21

Private company that works with Medicare to provide individuals with Part A and Part B benefits, payment is through private health insurance NOT Medicare

Question 22

Medicare Preferred Provider Organization (PPO) Plan

Answer 22

Individual pays less if they receive care from provides in the plan’s network

Question 23

Medicare Prive Fee-for-Service (PFFS) Plan

Answer 23

You can receive treatment from any doctor using original medicare if the doctor/hospital agrees to treat you, has strict rules

Question 24

Medigap policy

Answer 24

Medicare supplemental insurance sold by private insurance companies to fill gaps in original medicare coverage

Question 25

Benefit period

Answer 25

• 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

Question 26

Coinsurance

Answer 26

An amount you may be required to pay as your share of the cost for services after you pay a deductible, usually a %

Question 27

OT for dementia patients in long term care

Answer 27

DICE

Question 28

DICE

Answer 28

Non-pharmalogic management of neuropsychiatric symptoms

Question 29

DICE- Describe

Answer 29

Caregiver describes problematic behavior

Question 30

DICE- Investigate

Answer 30

Possible cause of problematic behavior

Question 31

DICE- Create

Answer 31

Caregiver team collaborate to create and implement treatment plan

Question 32

DICE- Evaluate

Answer 32

Evaluate if the Create interventions have been implemented and if they are safe and effective

Question 33

OT consultation in long term care

Answer 33

• Patient is demonstrating aggression, agitation, depression, anxiety, delusions, hallucinations, and disinhibition
• Provide generalized strategies and targeted strategies (SMART goals)