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Adulthood and Aging Midterm Prep > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Who has access to home health?

A

For Medicare:
- You are under the care of a doctor
- Intermittent skilled care (nursing, PT, OT, SLP)
- You are homebound:
> Can’t leave without help
> Leaving isn’t indicated due to medical condition

Home Health is also covered under Medi-Cal and private insurance

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2
Q

T/F: Home health is covered under Medi-Cal, Medicare, and private insurance

A

So T.

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3
Q

T/F: This is role of OT w/ PACE
- Ability to perform daily activities
- Home safety assessment and fall risk
- Reduce risk for additional injury or decline
- Management of chronic health conditions:
(Including medication, diabetes, heart failure, COPD, cognitive conditions, behavioral health)

A

Falso. This is role of home health OT.

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4
Q

In this setting, there are 3 facts of care provided: In home services, Community Services, and ____ Center

A

PACE

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5
Q

What does PACE stand for and who uses it?

A

Program of All-Inclusive Care for the Elderly.

  • Be 55 or older
  • Live in service area of PACE program
  • Certified as needing nursing home-level of care
  • Be able to live safely in community with PACE services
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6
Q

What setting involves Interdisciplinary team?

A

PACE

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7
Q

What are the 3 facts of PACE?

A

> Community services – caregiver come out to home 3-4x a week, home assessment, DME, specialist appointment, E care
In home services – caregiver
PACE center – provide transportation, primary care, meals, activities

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8
Q

T/F: These are the roles of home health OT.

  • 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
A

False. These are roles of PACE OT

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9
Q

What setting is this? Community-based program serving older adults and adults with chronic conditions and disabilities that might otherwise require a higher level of care.

A

Adult Day Health Care (ADHC)

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10
Q

What setting is this? Role of OT is…

  • Restore or maintain optimal capacity for self-care to frail elderly persons or adults with disabilities
  • Delay or prevent inappropriate or personally undesirable institutionalization
A

Adult Day Health Care (ADHC)

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11
Q

T/F: Continuing Care Retirement Communities (CCRCs) cover the full range of levels of care within senior living options (In home, independent living, assisted living, alzheimer’s care, nursing, and hospice care)…

A

False. CCRC’s do not cover “in home” as it is a more independent living situation

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12
Q

What are the 5 principles of a Patient-Centered Medical Home (PCMH)

A

Comprehensive Care, Patient-Centered (in the name), Coordinated Care, Accessible Services, Quality and Safety

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13
Q

You qualify for _____ if you meet at least one of the following:

  • age 65 or older and eligible for SS
  • permanently disabled and receive disability benefits for at least two years
  • End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant)
A

Medicare

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14
Q 
Also known as Hospital insurance...
Inpatient Hospital
Skilled Nursing Facility Rehab 
Skilled is medically necessary not custodial
Hospice
Home Health (skilled)
A

Medicare Part A.

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

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15
Q

How is Medicare funded?

A

Medicare is funded by the Social Security Administration, federally. (correct me if i am wrong) (I.E. Taxpayers lol)

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16
Q

Medicare has 4 parts

A 
->Medicare Part A (hospital insurance) 
Inpatient Hospital
Skilled Nursing Facility Rehab 
Skilled is medically necessary not custodial
Hospice
Home Health (skilled)
  • Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, durable medical equipment, ambulance, yearly wellness visits, and some preventive services.
  • Medicare Part C (Medicare Advantage) includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services. Private insurance that covers all Medicare services and may also offer extra coverage
  • Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Provides a prescription drug plan coverage for individuals who have Medicare Part A and Part B
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17
Q

What Medicare Plan is this?
includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services. Private insurance that covers all Medicare services and may also offer extra coverage

A

C

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18
Q

What Medicare Plan is this? Provides a prescription drug plan coverage

A

D

19
Q

What Medicare Plan is this? Inpatient Hospital
Skilled Nursing Facility Rehab
Skilled is medically necessary not custodial
Hospice
Home Health (skilled)

A

A

20
Q

What is Medicare Plan B?

A 
Out-patient MD
Yearly wellness visit
Therapy (PT/OT, etc.)
DME
ED
HHS
Labs
Ambulance
Ambulatory surgical centers
Supplies and screening
21
Q

How is medicare funded?

A

Part A
Mandatory payroll deduction (FICA tax) of 1.45% of taxable earnings (paid by each employee and the employer for each)

Part B
Premium payments deducted usually from monthly SS benefit checks for those who are voluntarily enrolled in the SMI plan (25%) and through contribution from the general revenue of the federal government (75%)

22
Q

You are eligible for this type of health insurance if you are low income, mothers, children, older adults, disabilities, aged, blind, developmentally disabled, mentally ill, income varies by state

A

Medicaid

23
Q

What kind of health insurance has state federal partnership ?

A

Medicaid

24
Q

What does Medicaid provide?

A 
Hospital Services
Physician Services
Nursing home care (including custodial)
Home health  care
Laboratory and X-ray services
Some optional programs also include services such as dental and vision care
25
Q

What are Dual Eligible Patients?

A

“Dual eligible beneficiaries” is the general term that describes individuals who are enrolled in both Medicare and Medicaid. The term includes individuals who are enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits and/or assistance with Medicare premiums.

8.9 million people
Twice as expensive for Medicare
21% of Medicare enrollees
15% of Medicaid enrollee (60% 65+)
39% of Medicaid costs
Covers benefits that Medicare does not
Medicare is first payer
Medicaid supplements by paying premiums, co-pays, and deductibles
26
Q

The _______ population is poorer and in general in worse health than people of comparable age in Medicare or in commercial plans.

A

The Medicaid population is poorer and in general in worse health than people of comparable age in Medicare or in commercial plans

27
Q

T/F: Combined Medicare-Medicaid benefit is rich in terms of benefits and is generally coordinated

A

False. Combined Medicare-Medicaid benefit is rich in terms of benefits but it is generally uncoordinated

28
Q 
\_\_\_\_\_ can be received in these settings:
Nursing home
Community (home and community-base services)
A consumer’s home/ apartment
Assisted living
A

Long Term Services and Supports (LTSS)

29
Q

What are some Long Term Services and Supports (LTSS) services?

A 
Personal care services
Bathing
Meal preparation
Medical care (OT, PT, nursing)
Goal of LTSS:  the consumers needs, preferences, and goals are integrated into the plan of care
30
Q

T/F: Medicaid is the primary payer across the nation for long-term care services

A

True

31
Q

What funds LTSS?

A

40% of the LTSS spending is paid by Medicaid
2% by the aging network (e.g. Meals on wheels)
Private funding
Informal caregivers
Long-term care insurance
Medicaid Waiver programs

32
Q

This service include assistance with activities of daily living (ADLs) and/or instrumental activities of daily living
for older adults (65+) and individuals with disabilities who cannot perform
these activities on their own due to a cognitive, physical, or chronic
health condition. These services and supports help these individuals preserve the ability to live in their community or remain employed.

A

Long term services and support

33
Q

Passed 1965 to improve community social services for older persons by establishing:
Provide grants to States for community planning and social services, research and development projects, and personnel training in the field of aging.

A

Older American’s Act (OAA)

34
Q

These are examples of ______ program initiatives:

Nutrition programs
Area Agencies on Aging
Senior centers
State long-term care ombudsman programs
Prevention of elder abuse, neglect, and exploitation
Elder rights and legal assistance development
Intergenerational programs

A

Older American’s Act (OAA)

35
Q

A civil rights law that was passed in 1990
Prohibits discrimination against individuals with disabilities in all areas of public life, including:
Jobs
Schools
Transportation
Public and private places that are open to the general public
The purpose: to ensure that people with disabilities have the same rights and opportunities as everyone else

A

Americans with Disabilities Act (ADA)

36
Q

Affordable Care Act’s aims to…

A 
- Improved health
Better outcomes
- Efficient high quality care
Value-based care
-Improve the patient’s experience
Increased transparency
Public reporting
37
Q

T/F: Healthcare reform is calling for a shift to value-based care

A

True. Payments are based on the provision of high quality care, not volume of care
(minutes in therapy < performance)

38
Q

Value Based Healthcare reimbursement is based on….

A
  • providers’ achieved rates of pre-specified patient outcomes
  • Adherence to patient-centered scientifically grounded best practice guidelines
39
Q

Facility or provider payments are tied to performance on defined outcomes

  • Targeted outcomes have strong evidence-based interventions
  • Poor performance is tied to financial penalties
  • Objective is to incentivize providers to deliver high quality care
A

Value-Based Payment

40
Q

Care Innovation?

A 
Care Collaboration	
-Engaging the patient and caregiver
-Shared decision making
-Caregiver &amp; patient training
Bundled Payment Initiatives
-Accountable Care -Organizations
-Comprehensive Joint Replacement Initiative
41
Q

What is IMPACT act of 2014?

A 
Standardize post-acute care assessment data
-Quality
-Payment
-Discharge planning
Standardized measures across settings
-Functional status &amp; cognitive function
-Skin integrity
-Major falls
-Medical needs &amp; conditions
42
Q

IMPACT act stands for…

A

Improving Medicare Post-Acute Care Transformation Act

43
Q

Here are more details about IMPACT act!

A

Requires the submission of standardized data by Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs).

Specifically, the IMPACT Act requires, among other significant activities, the reporting of standardized patient assessment data with regard to quality measures, resource use, and other measures.

Measure domains to be standardized across post-acute care settings

  • Community discharge
  • Functional status
  • Cognitive function
  • Skin integrity
  • Major Falls
  • Medication reconciliation
  • Potentially preventable hospital readmissions

Adulthood and Aging Midterm Prep (5 decks)

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