Lecture 2 Flashcards
What model is the basic expectation from medical care that it will make a difference. Why geriatric care can be frustrating because their conditions may not get better.
Therapeutic model
What model is usually associated with social services. Plan of care developed to address identified deficits and allows patient to enjoy as normal a lifestyle as possible.
The Alternative Model
What are 2 things that a good geriatric care requires?
Communication
Rely on other healthcare professionals
Insurance-type program
People are entitled to after contributing a certain amount
Medicare
A welfare program Eligibility based on need/poverty To become eligible Must prove illness Exhaust personal resources Big payer of nursing home care
Medicaid
what public program is associated with nursing homes
medicaid
is medicare all inclusive?
No, out-of pocket expenses still >20% income
If you don’t enroll in Medicare when you are 65 what will happen?
10% fee for each 12-month period that you could have had medicare Part B but didn’t take it
What is medicare- part A?
Hospital insurance
Covers most medically necessary hospital, skilled nursing facility (100 days worth), home health and hospice care
when can you get on medicare part A?
free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years)
if there coverage for medications for medicare part A?
No
Medicare part A covers 20 days of skilled nursing then facility after a hospitalization of at least 3 days 100% for the first 20 days and __% for the last 80 days
80
do you have to pay for medicare part B?
Yes, monthly premium
Is there pharmacy coverage with medicare part B?
No
what medicare cover prescription drug coverage. Provided only through private insurance companies that have contracts with the government- it is never provided directly by the government
Medicare D
Allows private health insurance companies to provide Medicare benefits
Must offer at least the same benefits as Original Medicare
Medicare C “Medicare Advantage Plans”
what is the major public payer for long-term care?
Medicaid
In order to get medicaid what must you have?
Nothing
Medicare gives the same amount of compensation per admissions based on the ____________
admitting diagnosis- Diagnosis-related group (DRG)
Does medicare cover readmissions within 30 days?
No
Medicare does cover ____-acute care
sub
A level of care or rehabilitation that no longer requires inpatient admission but cannot be provided at home
Subacute care settings (ex- skilled nursing facilities “SNF”)
Some eligibility for sub acute care?
IV meds enteral tube feedings Wound care PT and OT (show certain amount of activity first) chemo dialysis TPN ventilator support
A range of services that addresses the health, personal care and social needs of individuals who lack some capacity of self-care
long term care setting
Is most long term care provided by a health care professional?
No
who is most homecare provided by?
family/ friends with or w/o formal caregivers
for medicare coverage, physician must certify that the patient is homebound and that intermittent skilled care is necessary and needs to be provided by who?
nurse, PT or ST (speech therapist)
what is PACE?
Program for All-Inclusive Care for the Elderly
What does PACE do?
freestanding adult health center with pharmacy, recreational therapy, PT, OT and a full service medical clinic
Who qualifies for PACE?
Over 55, live within the area, be eligible for nursing home care and demonstrate ability to live safely at home when not at a PACE center
With increase use of skilled nursing facilities, ____________ are seeing decrease in long-stay business
nursing homes
Issues with nursing homes
Hard to get PMH
first contact with acute changes not by skilled provider
lack of advanced directives
Patients admitted to a nursing home must receive physician assessment within _______ of admission and then every _________
48-72 hours
30-60 days
what must be sent with the patient to the nursing home?
A copy of the patient’s entire record from a hospitalization and any recommendations and physician orders
how often must a licensed nurse assess each resident?
Daily
