Twin Lakes Community Continuing Care retirement Community (CCRC) ppt

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.