Section 9/Week 9

Question 1

What types of long-term care does Medicare cover?

Answer 1

• Skilled nursing care for 20 days (must have been in hospital for acute care before)-copayment for up to 100 days
• Hospice care
• Home health care

Question 2

What types of long-term care does Medicaid cover?

Answer 2

• Ongoing custodial care
• Nursing home care
• Home and community based services

Question 3

What is the Medicaid “spend-down”?

Answer 3

In order to qualify for long-term care coverage in Medicaid, you must spend all of your finances toward care down to $2,000 before Medicaid will cover your long term care costs.

Question 4

How long can Medicaid look back on your finances?

Answer 4

5 years. If you’ve given money away in the last 5 years you must make up money and spend it on your long-term care before Medicaid kicks in.

Question 5

What is the structure/goal of hospice

Answer 5

A whole comprehensive health care team including physicians, nurses, psychologists, social workers, etc. Shifts the emphasis of care to symptom control and emotional support, focuses on relieving suffering rather than prolonging life, also provides respite care for family.

Question 6

What is a life-care community

Answer 6

A permanent place for seniors to live, in which their needs for assistance with living will be taken care of no matter how long they need it.

Question 7

What are the 3 different levels of care

Answer 7

1. independent living
2. assisted living
3. custodial care

Question 8

How can residents get into a life care community

Answer 8

They must enter at the independent living level and demonstrate sufficient income to pay monthly maintenance fees for the rest of their lives. This helps life-care communities avoid adverse selection.

Question 9

Braveman et al. 1994 Study

Answer 9

Medicaid patients did not have as ready access to providers as privately insured patients. FFS patients fared worse than HMO patients.

Question 10

Effect of Out-of-Pocket Expenses-RAND

Answer 10

Higher co-pay = lower utilization.

Importantly though, patients do not discern between necessary and unnecessary care when forgoing treatment because of co-pays.

Question 11

Living Conditions And Access to Care-Lozano, Connell, and Koepsell 1995

Answer 11

Even when controlled for socio-economic and coverage type, there is differential access to care between different groups. Indicates that there may be other variables in regards to living conditions, like access to transportation or housing, that affect health care outcomes.

Question 12

Racial Barriers to Access to Care-VA Study

Answer 12

Blacks were receiving less treatment than whites following heart attack. Lead to a series of studies exploring the role of race in access to care

Question 13

According to the Institute of Medicine Report meta-analysis, what are the 3 categories of factors affecting patient access to care

Answer 13

1. Patient’s approach to medical care-mistrust
2. Health care system-systemic barriers (language, coordination)
3. Physician’s approach -application of racial stereotypes (unconscious racial bias)

Question 14

Skilled Nursing Facility

Answer 14

where the elderly or people with temporary disabilities are sent for recovery/rehabilitation services. The reason why you go to a long term care facility is to get improve

Question 15

Custodial Care

Answer 15

long term care provided by non-professionals to those who need assistance with ADLs (activities of daily living)

Question 16

Statistical Bias

Answer 16

individual making a seemingly rational decision based on data about differences in behavior among racial groups.

Question 17

Unconscious Bias

Answer 17

harboring some type of negative feelings or association toward blacks or other minorities without even realizing it.

Question 18

In the next 40 years. which segment of our population will be the fastest growing?

Answer 18

-people 85+

Question 19

Why do people need long-term care?

Answer 19

• physical inability to do typical activities of daily living
• serious mental impairment
• both

Question 20

Who pays for Long Term Services and Supports

Answer 20

-Medicaid 40%
-Medicare Post-Acute 21%
-Out of Pocket 15%
-Other 18%
Private 7%

Question 21

What are the two types of nursing home care under Medicare

Answer 21

• Skilled nursing care
• Custodial Care

***Medicare only pays for skilled nursing care

Question 22

Skilled nursing care

Answer 22

requires ongoing, skilled treatment for a problem that will improve with treatment

Question 23

Custodial care

Answer 23

requires assistance with activities of daily living; no expectation of significant improvement

Question 24

Requirements to qualify for skilled nursing care under Medicare

Answer 24

1. Patient requires regular skilled nursing or rehabilitation
2. patient was in a hospital for @ least 3 days
3. patient began skilled nursing care within 30 days of being in the hospital
4. required care is for a condition treated in the hospital
5. a physician or other professional certifies the care is necessary

Question 25

Medicare Advantage (MA) option

Answer 25

-doctor in MA plan may treat a patient in a skilled nursing facility at their own discretion

Question 26

What if you only need custodial care but cant pay for it???

Answer 26

Medicaid will cover it!

Question 27

What are the 2 types of long-term care Medicaid will pay for

Answer 27

• Nursing home care

- Home health and other community-based services

Question 28

How has Congress changed the Medicare home health care program

Answer 28

• Instituted a co-payment to discourage over use
• Place limits on the frequency of visits
• Shifted home health care from Part A to Part B

Question 29

When will Medicare pay the full cost of Hospice care under certain conditions

Answer 29

• a physician must certify that the patient has less than 6 months to live
• patient must agree not to seek intense hospital care in addition to hospice care

Question 30

What is the Median hospice duration before death

Answer 30

11 days

Question 31

What’s the new policy issue regarding Medicare

Answer 31

-Medicare pays the same daily rate for all hospice care, regardless of diagnosis, even though different diagnoses require different levels of care

Question 32

Knox Todd Study

Answer 32

Black receive less main medication. So doctors either prescribe it less often, or the black patients don’t accept.

Question 33

What are the 4 types of racial bias

Answer 33

1. Conscious Bias
2. Institutional Bias (hospitals based on race/social class)
3. Statistical Bias (taxi driver, blacks are more likely to XYZ)
4. Unconscious Bias (blink heavier)