Posts tagged 'nursing homes'
Every day we hear more and more information about Bush tax cuts, Medicare and Medicaid cuts and all sorts of issues that will confront the most vulnerable individuals in the country.
There are members of Congress on both sides of the aisle who are not at all happy with the fact that Alzheimer’s patients and nursing home/long term care patients may lose their care, but now, let’s add physical therapy to the mix.
Members of Congress are not happy. Healthcare advocates are upset. Individuals with disabilities that need the services, and disability advocates are, well, almost livid.
To their credit, Congress is doing all they can to stop this situation from happening. What will happen if Congress is not successful is that after July 1st, a large number of patients will learn that they have exceeded their cap on their therapy benefits and will have to start paying – sometimes very high amounts – out of their own pockets or find hospitals that will treat them.
All courtesy of the Bush Administration’s Medicare plans for the future. The very near future. It is possible that over 650,000 beneficiaries could lose their therapy benefits by the end of this year. Congress is against this happening and both Democrats and Republicans have ideas on how to stop this. Regardless, both sides are trying to do what they can to prevent these regulations from going through, protecting those that need this care the most.
The Medicare Rights Center has stated that it will be perilous for beneficiaries if the deadline passes without Congressional action stopping this. Patents with these benefits can be in therapy for everything from broken bones to strokes to traumatic brain injury. Those with more minor issues can choose to wait, address their issues in a different way or, if possible, they can make arrangements (possibly by negotiating block or discount prices) to pay the costs themselves if they can.
However, those with severe issues may have a much more difficult time. For instance, when dealing with long term therapy, if the person needs to stop because of these provisions, their condition could digress and they could get worse, reversing progress they have made.
The catch is that current regulations allow about $1,800 for physical therapy for year in a doctor’s or therapist’s office; however there is no cap for receiving these services as an outpatient in a hospital. Though patients can choose to go to a hospital for treatment, there are not enough hospitals or therapists available at those hospitals to treat them.
This is a quandary for those who need these benefits. It is important and notable that Congress is trying to act in time to overcome the July 1st deadline to block the Bush Administration from allowing these services to be curtailed for people who truly need and depend on them.
It hasn’t been long since we have seen the overzealous use of restraints in nursing homes. In fact, restraints are still in use now – mostly legitimately – however; too many times they are used too much and for the wrong situations.
A Medicare initiative through Lumetra has helped reduce the use of restraints in nursing homes by an average of 26% during the past few years. This is a good sign, and it has taken a collaboration between the Centers for Medicare Services, working with nursing homes and their employees to make this work.
Even though nursing homes throughout California had limited their use of restraints since 2004, there were still a high number of incidents. However, the nursing homes that started working with Lumetra, a non-profit organization dedicated to improving the quality of healthcare, and beginning to focus on person centered planning, including the nursing homes previously considered the most “poor performing” reduced their use of restraints by 55%, working through Lumetra’s Quality Improvement Collaborative.
This is a great step forward to reach this much of a reduction in restraints. In addition to becoming a great step forward, it is a credit and a relief to the staff involved on such an important issue.
Lumetra worked with 138 California nursing homes for over 18 months, specifically trying to decrease – and eventually eliminate – restraint, as well as further establishing and sticking to person centered plans. Person centered plans are more successful in obtaining positive results and less resistance, mainly because the person has helped develop the plan for themselves and, as a result, this is more of an encouragement for them to set up their own goals and boundaries and work within them. The idea of person centered planning has moved forward rapidly, and has been a breakthrough.
When a person sets up their own goals, dreams and boundaries and is given the support and tools to work toward them, it becomes a “win-win” situation. For further information check: www.Medicare.gov.
Understanding how Skilled Nursing Rehab works and where Medicare fits in is extremely important. There are a lot of facts that can affect your situation and create some serious issues for you if you or someone in your family needs this type of care.
The way Medicare handles Skilled Nursing Rehab is that the original Medicare plan pays 100% of the first 20 days. Most of the time, if there is any improvement that the facility can say is enough improvement; Medicare will try to have you discharged within those first twenty days.
After the first 20 days, the Medicare beneficiary pays $128 and Medicare pays the remainder of the day’s bill for up to 100 days. Looking at these figures, this is where supplemental insurance becomes very important. This could be a Medigap/Medicare Supplement plan or it could be an employer retiree plan. This type of plan will pay most or all of the $128 per day out-of-pocket expenses that are your responsibility.
Because Medicare is a health insurance plan that provides medical benefits, in order to receive those benefits, they have to determine that there is a medical need. If you are in a medical facility or skilled nursing rehab center, Medicare has determined the need, they will pay their share, however, when your condition improves, they will not continue to pay.
Sometimes and individual or family does not agree with the decision that the person is ready to be released even though that person has improved. If that happens, it is important to very firmly and specifically relate your concerns to staff, the social worker, the doctor and the social worker. If the person has had a stroke and is still unable to get in and out of the house safely, still have severe balance issues or other barriers, specifically let the facility and all the individuals we mentioned know.
Regardless, it is very important to study the issue of Skilled Nursing Rehab and Long Term Care very carefully. Take the tie to do some research on the net, through your doctor and even at your local hospital and find out what good policies are available and how they work. Be prepared so that if you or your family is ever in the situation where you need this type of coverage, you will be ready.
Most of us think about Medicare in terms of types and amounts of plans and coverage. Sometimes we only think about it when we are feeling ill or having to visit the doctor or hospital.
This is not all that Medicare does. There are many types of information that Medicare collects and Medicare provides. One important type of information that Medicare tracks is information regarding nursing homes. Medicare has just released information and created a database that lists the lowest quality nursing homes in the country.
The Nursing Home Compare website now has a searchable database that gives the names the lowest 5% of nursing homes around the nation. In addition to the database, CMS provides a monthly update showing results of nursing home inspections.
CMS is working hard to provide Medicare recipients and others more access and easier access to information regarding nursing homes. There are senators and congressmen who are pushing for bills to disclose even more information regarding nursing homes and the nursing home community. This may take time, but it is an important issue and it is being looked at carefully and pushed forward.
Whether you are actually at the point where you are looking for a nursing home, or you are a relative, friend or caretaker of an individual looking for or needing one, the information that CMS/Medicare has released is essential.
There is much more information at www.medicare.com, including frequently asked questions with answers and links to other sites and further information.
If you are approaching retirement, already retired and on Medicare or just looking for answers about Medicare or nursing homes, take the time to explore the subject in advance. It could certainly keep you from ending up in the wrong place in a bad situation later on.
