Section 9/Week 9 Flashcards
What types of long-term care does Medicare cover?
- 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
What types of long-term care does Medicaid cover?
- Ongoing custodial care
- Nursing home care
- Home and community based services
What is the Medicaid “spend-down”?
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.
How long can Medicaid look back on your finances?
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.
What is the structure/goal of hospice
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.
What is a life-care community
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.
What are the 3 different levels of care
- independent living
- assisted living
- custodial care
How can residents get into a life care community
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.
Braveman et al. 1994 Study
Medicaid patients did not have as ready access to providers as privately insured patients. FFS patients fared worse than HMO patients.
Effect of Out-of-Pocket Expenses-RAND
Higher co-pay = lower utilization.
Importantly though, patients do not discern between necessary and unnecessary care when forgoing treatment because of co-pays.
Living Conditions And Access to Care-Lozano, Connell, and Koepsell 1995
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.
Racial Barriers to Access to Care-VA Study
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
According to the Institute of Medicine Report meta-analysis, what are the 3 categories of factors affecting patient access to care
- Patient’s approach to medical care-mistrust
- Health care system-systemic barriers (language, coordination)
- Physician’s approach -application of racial stereotypes (unconscious racial bias)
Skilled Nursing Facility
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
Custodial Care
long term care provided by non-professionals to those who need assistance with ADLs (activities of daily living)
Statistical Bias
individual making a seemingly rational decision based on data about differences in behavior among racial groups.
Unconscious Bias
harboring some type of negative feelings or association toward blacks or other minorities without even realizing it.
In the next 40 years. which segment of our population will be the fastest growing?
-people 85+
Why do people need long-term care?
- physical inability to do typical activities of daily living
- serious mental impairment
- both
Who pays for Long Term Services and Supports
-Medicaid 40%
-Medicare Post-Acute 21%
-Out of Pocket 15%
-Other 18%
Private 7%
What are the two types of nursing home care under Medicare
- Skilled nursing care
- Custodial Care
***Medicare only pays for skilled nursing care
Skilled nursing care
requires ongoing, skilled treatment for a problem that will improve with treatment
Custodial care
requires assistance with activities of daily living; no expectation of significant improvement
Requirements to qualify for skilled nursing care under Medicare
- Patient requires regular skilled nursing or rehabilitation
- patient was in a hospital for @ least 3 days
- patient began skilled nursing care within 30 days of being in the hospital
- required care is for a condition treated in the hospital
- a physician or other professional certifies the care is necessary
Medicare Advantage (MA) option
-doctor in MA plan may treat a patient in a skilled nursing facility at their own discretion
What if you only need custodial care but cant pay for it???
Medicaid will cover it!
What are the 2 types of long-term care Medicaid will pay for
- Nursing home care
- Home health and other community-based services
How has Congress changed the Medicare home health care program
- 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
When will Medicare pay the full cost of Hospice care under certain conditions
- 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
What is the Median hospice duration before death
11 days
What’s the new policy issue regarding Medicare
-Medicare pays the same daily rate for all hospice care, regardless of diagnosis, even though different diagnoses require different levels of care
Knox Todd Study
Black receive less main medication. So doctors either prescribe it less often, or the black patients don’t accept.
What are the 4 types of racial bias
- Conscious Bias
- Institutional Bias (hospitals based on race/social class)
- Statistical Bias (taxi driver, blacks are more likely to XYZ)
- Unconscious Bias (blink heavier)
