Lecture 5 - Overview of Settings, Social Policy

Question 1

Home Health?

Who has access?

Answer 1

• health services provided at home
• purpose: provided skilled care in home setting

Access?

• 80% is paid by Medicare/Medicaid
• For medicare: you are under the care of a doctor, intermittent skilled care, and you are homebound

Question 2

Role of OT in Home health?

Answer 2

• ability to perform ADLs
• home safety assessment and fall risk
• reduce risk for additional injury
• management of chronic conditions

Question 3

Program for All-Inclusive Care for the Elderly (PACE)

Answer 3

Comprehensive services: all medical and supportive
- in home services
- community services (emergency care, dental, specialists)
- PACE center - all-inclusive care
+ Attending an ADHC is mandatory

Question 4

Who uses PACE/ has access?

Answer 4

• be 55+
• live in service area of PACE program
• certified need of nursing home level of care
• be able to live safely in the community with PACE services

Question 5

What is the role of OT in PACE programs?

Answer 5

• perform assessments
• home visits and home safety assessment
• evaluate need for DME
• skilled treatment
• supervise maintenance exercises and groups
• report progress, problems and recommendations to IDT

Question 6

Adult Day Health Care (ADHC)

Answer 6

• community-based program serving older adults and adults with chronic conditions and disabilities that might otherwise require a higher level of care
• respite for caregivers; pt do not receive DME

Question 7

What are the objectives of ADHC?

Answer 7

1. restore or maintain optimal capacity for self-care to frail elderly persons or adults with disabilities
2. delay or prevent inappropriate or personally undesirable institutionalization

Question 8

What is the role of OT in ADHC?

Answer 8

• similar role to that of PACE

- maintaining current fx or any skilled therapy for chronic conditions; lots of case management

Question 9

Continuing Care Retirement Communities (CCRC)

Answer 9

• provide lifetime care within one community (aging in place)
• residents move there while still independent then change residences within community if med/personal care services are needed

Question 10

Patient-Centered Medical Homes (PCMHs)

Answer 10

1. Comprehensive Care
2. Patient-Centered
3. Coordinated Care
4. Accessible Services
5. Quality and Safety

Question 11

What is the eligibility for Medicare?

Answer 11

• 65+ and people with disabilities

- pay into medicare system in younger years by paying taxes levied on employment income

Question 12

What are the benefits? (Part A-D)

Answer 12

Part A: hospital insurance
Part B: supplemental insurance
Part C: managed care
Part D: prescription drug plan

Question 13

Medicare Part A

Answer 13

Setting: inpatient hospital, SNF, hospice, home health

-benefits start when the individual first enters a hospital and ends when there has been a break of at least 60 days consecutive days since inpatient hospital or skilled nursing care was provided

Question 14

Medicare Part B

Answer 14

• outpatient MD, yearly wellness visit, therapy, DME, ED, home health, labs, ambulance, ambulatory surgical centers, supplies and screening
• optional insurance

Question 15

Medicare Part C

Answer 15

• medicare approved private health insurance plans for individuals enrolled in part A and B
• includes HMOs and PPOs

Question 16

Medicare Part D

Answer 16

• provides prescription drug plan coverage for individuals who have Medicare Part A and Part B

Question 17

What is the eligibility for Medicaid?

Answer 17

• social welfare program that targets low income individuals
• low income mothers and children
• aged, blind, disabled
• developmentally disabled
• mentally ill
• income eligibility varies by state

Question 18

What does Medicaid provide?

Answer 18

• hospital services, physician services, nursing home care, home health care, laboratory and x-ray services, some optional includes vision and dental

Question 19

Long Term Services and Supports (LTSS)

Answer 19

• broad range of assistance needed/received by people with disability (that prevents them from functioning independently)
• can be received in nursing home, community, consumer’s home, assisted living
• goal: the consumer’s needs, preferences, and goals are integrated into the plan of care

Question 20

What services does LTSS provide?

Answer 20

• personal care services (bathing, meal prep)

- medical services (OT,PT, nursing)

Question 21

Older American’s Act (OAA)

Answer 21

• provide support, restorative services, aging services, older adult rights

Question 22

American’s with Disabilities Act (ADA)

Answer 22

• prohibits discrimination against individuals with disabilities in public areas of life
• purpose: to ensure that people with disabilities have the same rights and opportunities as everyone else

Question 23

Affordable Care Act

Answer 23

• improved health (better outcomes)
• efficient high quality care (value-based care)
• improve the patient’s experience (increased transparency, public reporting)

Question 24

Value based health care

Answer 24

-Reimbursement is based on: healthcare provider’s achieved rates of pre-specified patient outcomes, adherence to patient-centered scientifically grounded best practice guidelines

Question 25

Impact Act of 2014 requires:

Answer 25

Providers in all 4 post acute settings to collect and report 3 types of data:

1. pt assessments
2. quality measures
3. resource use measures