Twin Lakes Community Continuing Care retirement Community (CCRC) ppt

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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?

A physician's order for outpatient therapy only

A 7-day outpatient observation

A 3-night inpatient hospital stay (correct)

A 5-day inpatient hospital stay

Which of the following statements about inpatient and outpatient care is true?

Patients remain outpatient after an overnight stay unless formally admitted. (correct)

Outpatient services require a physician’s order for admission.

Patients are classified as inpatient after only one night in the hospital.

Inpatient status requires at least two nights of medically necessary care.

What coverage does Medicare Part A provide for the first 20 days of a Skilled Nursing Facility stay?

Coverage with a $204.00 daily copayment

100% coverage (correct)

Coverage only if therapy sessions are completed

No coverage

Which service is NOT covered under Medicare Part B?

Prescription drug plan Signup and view all the answers

In which situation would a Skilled Nursing Facility stay NOT be covered by Medicare?

A patient spent 3 days as an inpatient but did not have therapy participation. Signup and view all the answers

Which of the following statements about Medicare Part D is accurate?

It provides coverage for prescription medications. Signup and view all the answers

What happens after Medicare has covered the first 20 days of skilled nursing care?

Care continues at a reduced rate of $204.00 per day. Signup and view all the answers

Which of the following is a component of inpatient hospital care according to Medicare guidelines?

Complex medical decision making Signup and view all the answers

What is the daily reimbursement rate for Long Term Care Medicaid?

$268.75 Signup and view all the answers

Which of the following is true regarding Medicare Advantage Plans?

They require clinical updates submitted throughout the stay. Signup and view all the answers

What is the cap amount for Medicare Part B coverage for outpatient PT/OT/Speech?

$1900 Signup and view all the answers

Which dimension is NOT included in the Eight Dimensions of Wellness?

Economic Signup and view all the answers

What is the significant cost associated with falls among seniors according to the provided data?

Over 50 million in medical costs in 2015 Signup and view all the answers

Which of the following factors does NOT increase fall risk?

Proper footwear Signup and view all the answers

What describes the concept of Active Aging?

Living life fully within the eight dimensions of wellness. Signup and view all the answers

What percentage of falls among seniors results in a head injury or broken bone?

1 in 5 Signup and view all the answers

What is the role of Social Security payments for residents under Long Term Care Medicaid?

Residents can keep $30 per month. Signup and view all the answers

What aspect is emphasized regarding chronic diseases in aging?

They can often be prevented or controlled. Signup and view all the answers

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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