Health Services & Long term care Flashcards
Monitor caregiver’s signs of
stress, depression, & ↓ health
- Acknowledge caregiver stress
- Be proac;ve in helping
manage the toll of caregiving - Recognize early signs of
problems & make effec;ve
referrals
Potential Manifestations of Caregiver Stress
- Sleep disturbance
- Poor coping behaviors
- Unexpected weight loss or gain
- ↑ fears about abuse or anger
- ↓ comfort level with medication
management - ↓ relationship quality
- ↑ guilt
- Disturbed family
dynamics - local and distant
- ↓ feelings of competence
- Anticipatory grieving
Physical qualifications:
Inpatient Hospital care and/or Rehab
Patients recovering from a
serious illness/injury or
major surgery, AND need
a more intense recovery
setting
* E.g. stroke, burns, other
neurologic disorders
Medicare Requirements for Inpatient Hospital care and/or Rehab
- Medical Provider must certify need
- 3 hrs/day, 5 days/week of
physical, occupational rehab
and/or speech therapy - Full-time access to a doctor/rehab
nurse to meet other medical needs
Services:
Inpatient Hospital care and/or Rehab
- Medical care & rehabilitation
nursing - PT, OT, & Speech Therapy
- Social and Psychological services
- Orthotic and prosthetic services/
Orthopedic Rehabilitation - Assistance with ADL’s
- A semi-private room and meals
- Medicare does NOT cover
private nursing, private room,
personal care items, TV & a
telephone in a patient’s room - General nursing care
- Medically necessary medications
- Daily Medical Provider visits
Medication Management:
Inpatient Hospital care and/or Rehab
- Medication reconciliation
- Consolidation, dispensing, and reconciliation duties fall on nursing
- Medication education
- Facility must employ a licensed pharmacist
- Therapeutic drug regimen of each resident is reviewed at least 1x/month
- The facility must maintain an emergency drug supply
Social services:
Inpatient Hospital care and/or Rehab
Patient Advocacy
* Social, financial, & emotional advocacy for both the
patient & families
* Help with communication between patients, their
families, & their personal healthcare team
Patient Education
* Patients taught about their illness & treatment options, & the roles of members of their recovery team
Psychosocial
Assessments
Coordinate discharge
Post-hospital care
Crisis Intervention
Resident rights:
Inpatient Hospital care and/or Rehab
- File a grievance
- Participate in the planning &
delivery of care - Exercise autonomy
- Ability to refuse treatment
- Create advance directives &
hospital staff & practitioners
comply with these directives - Personal privacy
- Be free from verbal or physical abuse
or harassment - Confidentiality of their clinical records
- Ability to reasonably access their
clinical record information - Be free from restraints & seclusion
used as a means of coercion, discipline,
convenience, or retaliation by staff
The FuncOonal Independence Measure
used to monitor funcOonal status
progress
Necessary patient assessment:
Inpatient Hospital care and/or Rehab
- The FuncOonal Independence Measure
- used to monitor funcOonal status
progress - PaOent requires face-to-face visits
with medical provider 3+ days/week - PaOent requires mulOple therapy
disciplines (PT, OT, SLP) - Medical status must be stable
- Able to tolerate the intensity
of therapy for 3+ hours/day - PaOent must acOvely
parOcipate in & benefit from
the intensive rehab therapy
Patient Transferring:
Inpatient Hospital care and/or Rehab
- A patient needs a transfer if they
no longer meet the requirements
to be an inpatient at the hospital. - Admitting order should state #
of nights needed for care - e.g. 2+ nights
- The utilization review committee
of the hospital will approve the
stay if the patient qualifies.
Patient is NOT meeting inpatient
hospital requirements:
- Refusing 3+ hr intensity
requirement - Not showing any measurable
funcOonal improvement - Not compling with expectaOons
laid out in behavioral contract
Medicare coverage:
Inpatient Hospital care and/or Rehab
- Patients must qualify for Medicare Part A
- Normally automatic by age 65
- Following hospitalization for 3 days, a SNF is covered
- Medicare will pay for the first 60 days + the current patient deductible
- Unless already charged a deductible for care in a prior hospitalization
within the same benefit period) - Medicare covers the 60th-90th days along with the current patient
coinsurance
Skilled Nursing Facility
- Medicare-approved skilled nursing
faciliOes provide 24-hour nursing
care - Medical care providers must be
available 24/7, they supervise care
& can visit the paOents less
frequently. - Interdisciplinary care may not
occur, although therapy services,
dietary, pharmacy, & social
services are available. - No requirements for intensity or
duration of therapy sessions - This setting allows for a slower
rehabilitation pace - 24-hour nursing care benefit for
persons who are unable to care
for themselves or who do not
have caregivers at home.
Physical Qualifications:
Skilled Nursing Facility
- Patients recovering from
surgery, injury, or acute illness - Chronic conditions requiring
constant medical supervision - Unable to perform
1+ ADLs independently - Minimum Data Set (MDS)
- Determines conOnued SNF
care
Social services:
Skilled Nursing Facility
Social Work
* Ensures needs are met
* Social, financial, community, systems
issues
* Social/emoConal support for the resident
* May assist with discharge
* Coordinate with paCent advocates in all
situaCons
* Help transiCon to other seLngs
* Family & resident educaCon
Resident rights in a SNF
The Right to:
* Be informed of their rights, services
available & their current health status.
* Refuse treatment & make a advance
direcJve
* Have advanced noJce of discharge or
transfer
* Manage personal finances
* Voice grievances & recommend
changes in policies/services.
* Access the long term care ombudsman
program
* Be free of physical abuse & chemical
or physical restraints
* Confidential treatment
* treated with respect
* Make choices about all aspects of
life in a facility.
* Receive personal mail that is
unopened.
* Allow relatives or responsible
persons to visit critically ill
residents at any time
Patient assessment to qualify for a SNF must be completed ____
Completed w/in 14 days of admission
with 3 quarterly reviews & 1 full
assessment every 12 months
Patient assessment to qualify for a SNF inlcudes:
- Medically defined conditions & prior
mental history - Medical status measurement
- Physical & mental functional status
- Sensory & physical impairments
- Nutritional status & requirements
- Special treatments or
procedures - Mental & psychosocial status
- Discharge, acOviOes, & rehab
potenOal - Dental condiOon
- CogniOve status
- Drug therapy
Patient transfer from SNF to Assisted Living
- No longer requires ADL assistance → assisted living or independent living
- Patient trauma; E.g. patient fx a hip → inpatient hospital care/rehab
Type 1: ambulatory/mobile &
capable of taking life saving action in
an emergency without assistance of
another person
Type 2: total assistance from staff or
other in >3 ADLs…cogniOvely
impaired or physically disabled but
able to evacuate the facility with
limited assistance of one person
Medicare coverage for SNF Services
Medicare Part A Covers if:
* There are days left in the
pt benefit period
* Qualifying in-hospital stay
* Medical care provider
certifies need
* Medicare-certified SNF
1. A hospital-related medical
condition treated during a
qualifying 3-day inpatient hospital
stay (not including the day of
discharge), even if it wasn’t the
reason original admission dx.
2. A condition dx’d in the SNF while
being cared for #1
Assisted Living concept:
- Service recipients need not lose
their personhood & their autonomy
to get care. - Goal = Maximize a resident’s sense
of self & independence as much as
possible
Provides care services, prn - Supposed to more closely
resembles a person’s home. - Residents still live in institutional
settings that house many people
within the same facility - Maximizes efficiency of service
delivery - Residents are treated as tenants & has control over their living unit.
- Minimumally, each individually occupied dwelling unit contains space for living
& sleeping, a bathroom, & at least minimal cooking facilities
Physical requirements for a patient to qualify for Assisted Living
Cognitively impaired or physically disabled, but able to direct their own
care; assisted living is sub-classified by mobility status:
Type 1: Independent mobility
Type 2: Mobility w/ assistance
Medication management in Assisted Living
Type I
* Self-administered or Self-direct
medication w/ assistance, prn
* Family or staff may administer
medications
Type 2
* Staff Administer medications
* Directed by licensed
healthcare professionals
Respite Care Services
- Short-term stay
- caregiver needs a vacation or relief
from caregiving - < 14 days for any single respite stay
Capable of carrying out - Physician treatment orders
- Prescribed medications
- Assistance with ADLs
- Diet orders
Facility Responsibilities for respite care
- Coordinate delivery of services
with all provider agencies - Complete service agreement
- The plan of care
- Document person’s response to
respite placement
Resident rights in Assisted Living
Right to:
* Access personal information
* Privacy & confidentiality
* Exercise Autonomy
* Receive medical & personal care
* Decent living environment
* Communicate with family, friends,
or others
* Complain & seek help
* Perform social & spiritual activities
* Suggest policy changes
* Safety & respect
T/F Medicare does not cover the cost of assisted living facilities or any other
long-term residential care
* Eg. nursing homes or memory care
T
Home Health Care & Independent Living
- Health care services given in the home for an illness or injury
- Less expensive, more convenient, & just as effective as hospital or SNF care
Physical requirements for a patient to qualify
for Home Health Care & Independent Living
- Physically & mentally capable of
living alone - Gold standard = ADLs &
iADLs - Able to manage their own health
- No major health conditions
- Often initiated after
hospitalization
= End of independent living
↑ Fall risk
Respite / Adult Day Care Qualifications
- Insurance
- Medicaid
- Medicaid’s Home & Community-Based Care Services (HCBS) waiver
program provides waivers - Not provided by every state
- Medicare
- 5 consecutive days of respite care
- Medicare Advantage
- Offered by some, but are not required to
Medicare coverage for Home Health Care & Independent Living
Covered by Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical
Insurance) as long as part-time or intermittent skilled services are needed when the
patient is “homebound,” because of an illness or injury.
* The patient has trouble leaving home without:
* assistive devices
* special transportation
* help from another person) Leaving your home isn’t recommended because of
your condition.
* Normally unable to leave home due to effort involved
Medicare Covered home health services include:
- Medically necessary part-time or intermittent skilled nursing care
- Physical, Occupational & Speech therapy
- Medical social services
- Part-time or intermittent home health aide care (if also recieving skilled nursing care)
- Injectable osteoporosis drugs for women
- Durable medical equipment
- Medical supplies for use at home
