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Questions and Answers
What is required for Medicare Part A to cover a stay in a Skilled Nursing Facility (SNF) for short-term rehabilitation?
Which of the following statements about inpatient and outpatient care is true?
What coverage does Medicare Part A provide for the first 20 days of a Skilled Nursing Facility stay?
Which service is NOT covered under Medicare Part B?
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In which situation would a Skilled Nursing Facility stay NOT be covered by Medicare?
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Which of the following statements about Medicare Part D is accurate?
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What happens after Medicare has covered the first 20 days of skilled nursing care?
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Which of the following is a component of inpatient hospital care according to Medicare guidelines?
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What is the daily reimbursement rate for Long Term Care Medicaid?
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Which of the following is true regarding Medicare Advantage Plans?
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What is the cap amount for Medicare Part B coverage for outpatient PT/OT/Speech?
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Which dimension is NOT included in the Eight Dimensions of Wellness?
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What is the significant cost associated with falls among seniors according to the provided data?
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Which of the following factors does NOT increase fall risk?
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What describes the concept of Active Aging?
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What percentage of falls among seniors results in a head injury or broken bone?
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What is the role of Social Security payments for residents under Long Term Care Medicaid?
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What aspect is emphasized regarding chronic diseases in aging?
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Study Notes
Medicare Part A
- Covers inpatient hospital care, hospice services, skilled nursing facility care, and home health and DME.
- Premium-free
- Requires a 3-night inpatient hospital stay within 30 days of admission to a skilled nursing facility for short-term rehab.
- Covers 100% of costs for the first 20 days of skilled nursing facility care.
- Covers all costs except $204.00 per day for days 21-100.
- Residents must participate in daily physical therapy (PT) or occupational therapy (OT) for Medicare Part A to cover their stay.
- Weekly goals are set for residents during their stay.
- Medicare will issue a 5-day discharge notice when a resident meets all their goals and is ready for the next level of care.
Medicare Part B
- Covers outpatient hospital care, including outpatient rehabilitation (PT/OT) with a yearly cap.
- Covers physician services - monthly premium paid by beneficiary.
- Offers some home health care coverage.
- Covers preventative services and lab tests.
Medicare Part D
- Covers prescription drug plans.
Inpatient vs. Outpatient Care
- Inpatient care is generally appropriate when a patient is expected to need 2 or more midnights for hospital care.
- Inpatient admission requires a physician's order and formal hospital admission.
- Outpatient care includes services like emergency department visits, outpatient surgery, lab tests, and x-rays.
- A patient remains outpatient even if they spend the night in the hospital.
- A physician determines whether to admit an outpatient as an inpatient or discharge them.
Medicare Non Coverage for Skilled Nursing Facility Care
- If a resident does not have a 3-night inpatient qualifying stay, they will be responsible for room and board fees.
- Medicare Part B will cover PT/OT/ Speech as outpatient with a $1900 cap.
- Residents will be responsible for paying for room and board privately.
Medicare Advantage Plans
- Do not require a 3-night inpatient hospital stay.
- Require prior authorization for skilled nursing facility care.
- Require PT/OT evaluation, history and physical documentation, medication information, admission orders, and clinical updates throughout the SNF stay.
- Discharge dates are determined by the replacement plans.
Long-Term Care Medicaid
- Requires assets of $2,000 or less.
- Reimburses the facility $268.75 per day.
- The resident must receive a social security check, keeping $30 per month.
- Pays for vacation days per year for the resident.
- Requires a 5-year look back period.
Thrive Living Well at Twin Lakes
Wellness
- Defined as the quality or state of being healthy in body and mind, especially as the result of deliberate effort.
- Eight Dimensions of Wellness:
- Nutritional
- Intellectual
- Physical
- Spiritual
- Environmental
- Emotional
- Social
- Community
Subjective Evaluation
- Self-analysis assesses peak wellness and protected poor health leading to premature death vs. peak wellness and optimal well being leading to no illness.
Active Aging
- Living life as fully as possible within the eight dimensions of wellness.
- Described as "Engaged in life".
Successful Aging
- A choice, not a given.
- The Loss of Muscle & Strength With Age:
- Moderate strength training (2x per week minimum) helps mitigate losses.
- Sarcopenia, the age-related loss of muscle mass, accelerates after age 65-70.
- Loss of muscle leads to loss of function, impacting balance, mobility, and cognitive processes.
Falls
- One in four senior Americans fall every year.
- One in five falls results in a head injury or broken bone.
- A senior dies from a fall every 20 minutes in the US.
- Falls among adults 65 and older are the leading cause of injury death for that group.
- Lower body weakness, difficulty walking, medications, vision problems, fear of falling, and foot pain increase fall risk.
- Fall risk doubles if the single leg balance time is less than 10 seconds.
- To reduce fall risk:
- Talk to a doctor about medications, medical conditions, and be honest about fall experiences.
- Have regular eye exams.
- Make the home safe.
- Wear proper footwear.
- Focus on lower body strength and balance exercises.
- Use assistive devices if needed.
Aging is NOT a disease
- Chronic diseases, disabilities, and injuries were once thought to be inseparable from old age, but this view is changing.
- Many diseases can be prevented or controlled with awareness and lifestyle changes.
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