Health Services & Long term care

Question 1

Monitor caregiver’s signs of
stress, depression, & ↓ health

Answer 1

• Acknowledge caregiver stress
• Be proac;ve in helping
  manage the toll of caregiving
• Recognize early signs of
  problems & make effec;ve
  referrals

Question 2

Potential Manifestations of Caregiver Stress

Answer 2

• 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

Question 3

Physical qualifications:
Inpatient Hospital care and/or Rehab

Answer 3

Patients recovering from a
serious illness/injury or
major surgery, AND need
a more intense recovery
setting
* E.g. stroke, burns, other
neurologic disorders

Question 4

Medicare Requirements for Inpatient Hospital care and/or Rehab

Answer 4

• 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

Question 5

Services:
Inpatient Hospital care and/or Rehab

Answer 5

• 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

Question 6

Medication Management:
Inpatient Hospital care and/or Rehab

Answer 6

• 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

Question 7

Social services:
Inpatient Hospital care and/or Rehab

Answer 7

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

Question 8

Resident rights:
Inpatient Hospital care and/or Rehab

Answer 8

• 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

Question 9

The FuncOonal Independence Measure

Answer 9

used to monitor funcOonal status
progress

Question 10

Necessary patient assessment:
Inpatient Hospital care and/or Rehab

Answer 10

• 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

Question 11

Patient Transferring:
Inpatient Hospital care and/or Rehab

Answer 11

• 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.

Question 12

Patient is NOT meeting inpatient
hospital requirements:

Answer 12

• Refusing 3+ hr intensity
  requirement
• Not showing any measurable
  funcOonal improvement
• Not compling with expectaOons
  laid out in behavioral contract

Question 13

Medicare coverage:
Inpatient Hospital care and/or Rehab

Answer 13

• 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

Question 14

Skilled Nursing Facility

Answer 14

• 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.

Question 15

Physical Qualifications:
Skilled Nursing Facility

Answer 15

• 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

Question 16

Social services:
Skilled Nursing Facility

Answer 16

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

Question 17

Resident rights in a SNF

Answer 17

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

Question 18

Patient assessment to qualify for a SNF must be completed ____

Answer 18

Completed w/in 14 days of admission
with 3 quarterly reviews & 1 full
assessment every 12 months

Question 19

Patient assessment to qualify for a SNF inlcudes:

Answer 19

• 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

Question 20

Patient transfer from SNF to Assisted Living

Answer 20

• 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

Question 21

Medicare coverage for SNF Services

Answer 21

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

Question 22

Assisted Living concept:

Answer 22

• 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

Question 23

Physical requirements for a patient to qualify for Assisted Living

Answer 23

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

Question 24

Medication management in Assisted Living

Answer 24

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

Question 25

Respite Care Services

Answer 25

• 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

Question 26

Facility Responsibilities for respite care

Answer 26

• Coordinate delivery of services
  with all provider agencies
• Complete service agreement
• The plan of care
• Document person’s response to
  respite placement

Question 27

Resident rights in Assisted Living

Answer 27

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

Question 28

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

Answer 28

T

Question 29

Home Health Care & Independent Living

Answer 29

• Health care services given in the home for an illness or injury
• Less expensive, more convenient, & just as effective as hospital or SNF care

Question 30

Physical requirements for a patient to qualify
for Home Health Care & Independent Living

Answer 30

• Physically & mentally capable of
  living alone
• Gold standard = ADLs &
  iADLs
• Able to manage their own health
• No major health conditions
• Often initiated after
  hospitalization

Question 31

= End of independent living

Answer 31

↑ Fall risk

Question 32

Respite / Adult Day Care Qualifications

Answer 32

• 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

Question 33

Medicare coverage for Home Health Care & Independent Living

Answer 33

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

Question 34

Medicare Covered home health services include:

Answer 34

• 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