A nursing-home-facility provides all of the personal care and services of an assisted living facility with the addition of 24-hour skilled nursing care twenty-four hours per day, seven days a week. Care provided in a nursing-home-facility is more complex medical care needed by residents who have had an injury, acute illness or a surgical procedure. This level of care requires the services of registered nurses and licensed practical nurses.
A nursing home that participates in the Medicare “A” program typically provides rehabilitation services with physical, occupational and speech therapists. Residents are admitted to the rehab program directly from an acute care hospital. Typically residents in these rehab units are recovering from a fractured hip and other orthopedic injuries, a stroke, or other debilitating conditions.
Many of these residents are discharged to home when they reach their maximum level of functioning. Some remain in the nursing home and continue therapy as needed in a Medicare “B” program and/or a restorative nursing program. Nursing homes provide additional follow-up with activities and wellness programs.
Medicare part “A” will pay charges for up to 100 days for Medicare eligible residents. The coverage is 100% for the first twenty days and is reduced by the resident co-pay for the 21st thru the hundredth day. Private Medicare supplemental insurance will cover the co-pay as long as there is Medicare coverage. If the resident has a Medicare replacement insurance policy, that insurance replaces Medicare and will pay for the first 100 days under the same guidelines as Medicare.
To be eligible for Medicare coverage the resident has to be enrolled in the program and have a 3-day qualifying stay in an acute care hospital. And he/she must have an admitting diagnosis that requires skilled care on a twenty-four hour a day basis with some potential for improvement. Medicare part “A” does not pay for the care of long term care residents.
The growth of “out-patient” departments or clinics within an acute care hospital can be a problem for the nursing home and the nursing home resident. If the clinic is not a part of the hospital then a stay in that unit may not meet the three day stay requirement and in that event the resident may not have Medicare “A” coverage in the skilled nursing home.
Residents in a nursing-home-facility with chronic, debilitating conditions need long term care that is more maintenance and preventive than restorative. Their care includes programs to protect the integrity of their skin and prevent development of wounds. Other care programs include nutrition, fall prevention, spiritual, activities, and safety. Typically the cost of care for such residents is paid out of private funds or Medicaid. Long term care insurance is increasing as an option to pay for nursing home care. Many policies also provide funding for home care and assisted living care.
Nursing home residents typically live in private or companion rooms. Some rooms and suites have a private shower and most have a central bath/shower room or “spa.” Many rehab nursing homes provide more upscale suites for their short term rehab clients.
Common areas in a nursing-home-facility may include:
Nursing Homes are licensed and regulated by state agencies such as the board of health. For example the Department of Health and the Agency for Health Care Administration regulate nursing homes in Indiana and Florida respectively. Medicare and Medicaid certification and regulation is performed by the states under contract by the federal government.
Future Medicare coverage is likely to be significantly impacted by the phase in of ObamaCare later in 2014. Big changes in the popular Medicare Advantage program are expected. Estimates of cuts in the amount of $455 billion were predicted in 2010. That number is now expected to top $716 between 2013 and 2022. Even greater cuts and/or restrictions in coverage can be anticipated when the Independent Payment Advisory Board provision is implemented. To say that Medicare coverage for the elderly is uncertain would be an understatement.
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