Medicare Snapshot

SKILLED NURSING FACILITIES

SKILLED NURSING DEFINITIONS

SKILLED NURSING FACILITIY

(SNF): This level of care is typically found in a nursing center or a transitional care unit in a hospital.

Skilled Nursing commonly off ers two types of care within the community, short-term rehabilitation and long-term care. Short-term rehabilitation is typically paid for by Medicare or Insurance Plans and includes but is not limited to therapies and nursing care. Physical, occupational, speech and respiratory therapies are commonly off ered within a SNF. Health monitoring, 24 hour personal care (activities of daily living), trach care and more are provided within a SNF. Rooms are typically furnished and depending on the community may off er both provate and shared accomodations. Other services include meals, activities, transportation, phone service, cable television and all personal care. Depending on the facility, payor sources accepted are Medicare, Medicaid, VA, insurance plans & private sources.

PHYSICAL THERAPY (PT): Refers to assessing and treating large motor function, utilizing rehabilitative techniques of exercise, gait training, prosthetics, and heat to restore the client to his/ her highest functional level of strength, range of motion and mobility. SPEECH THERAPY (ST): Assesses and treats speech and swallowing disorders. Provides individually designed treatment programs to maximize communicative eff ectiveness for the client, such as stroke, head injury, laryngectomy, voice disorders, as well as cognitive defi cits.

OCCUPATIONAL THERAPY (OT):

Assesses and treats small motor function. Utilizes rehabilitative techniques of exercise, splinting and assistive devices to increase the client’s ability to carry out normal daily activity such as feeding, dressing, grooming, and performing household tasks. Guides client through specialized regimes and encourages sensory and muscle return. Exercises and activities are used to increase upper body extremity function.

TRACH CARE: Refers to care administered to patients who have undergone a tracheotomy. A tracheotomy is a surgical procedure in which a cut or opening is made in the windpipe (trachea). The surgeon inserts a tube into the opening to bypass an obstruction, allow air to get to the lungs, or remove secretions.

LONG TERM CARE: Skilled nursing communities can off er care to people

who cannot be cared for at home or in the community. They provide 24 hour care, nursing and rehabilitation services, meals, activities, help with daily living and supervision. Many communities also offer temporary or periodic care called Respite Care.

METHODS OF PAYMENT: Not all nursing homes accept all forms of payments. Furthermore, some nursing homes are limited in the number of beds available for a particular payment form.

INSURANCE, HMOS, AND OTHER

PAYERS: Some long-term care insurance, commercial insurance, commercial Health Maintenance Organization (HMO), Veteran’s Administration, Workers’ Compensation, and other programs cover nursing home stays. Plans vary.

SOCIAL WORKER: A clinical social worker whose purpose in health care is to enhance, promote, maintain, and restore the best possible social abilities of the patient or family. Services provided may be preventative, developmental, or remedial in nature.

MEDICARE: Medicare is a Federal program that serves people 65 and older and those with certain disabilities, regardless of income. Qualified individuals are automatically enrolled in Medicare Part A, but must apply to become eligible for Part B coverage. Medicare generally pays for the first twenty days in a nursing home following a hospital stay of at least three days. Medicare generally pays a portion of the nursing home bill (after the first 20 days) for up to 100 days per year.

MEDICAID: Medicaid is a stateadministered medical assistance program that serves low-income families, those 65 and older, people who are blind, and people who are disabled. You must apply and qualify for Medicaid before you are eligible for Medicaid coverage. Schedule an appointment with your local Department of Children and Family Services’ Medicaid Eligibility office to determine if you are financially eligible for Medicaid. Applicants must demonstrate that assets and income are below a maximum level, as well as other criteria in order to be eligible. Medicaid applicants must also meet medical eligibility for nursing home placement.

VETERAN’S BENEFITS - AID &

ATTENDANCE: A program available from the Department of Veterans Affairs for qualified veterans who have wartime service and are qualified to receive a VA Pension. Financial and medical qualifications apply.