Kaiser Health News reports on a ghastly phenomenon that appears all too common for people with Medicare in some nursing homes. To increase their revenues, nursing homes create conditions that lead residents to be rehospitalized.
NOTE:
Medicare is now changing its nursing home payment policies to
try to align nursing home financial incentives to deter poor care.
What is Skilled Nursing?
A skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. Skilled nursing facilities provide round-the-clock assistance with healthcare and activities of daily living. There are numerous federal regulations regarding what skilled nursing facilities must and must not do.
Nursing homes, now more commonly known as skilled nursing facilities (SNFs), serve as licensed healthcare residences for individuals who require a higher level of medical care than can be provided in an assisted living facility. ... Skilled nursing facilities are commonly used for short-term rehabilitative stays.
Skilled nursing is a term that refers to a patient's need of care or treatment that can only be done by licensed nurses. Get the facts on skilled nursing with this review of this branch of medical care and the patients served by it. A number of patients may have a health status that changes quickly.
Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Medicare-covered services include, but aren't limited to: Semi-private room (a room you share with other patients)
When you no longer need the amount of
care provided in the hospital, the hospital will begin the process
to discharge you. Most people hope to go straight home from
the hospital after surgery or being ill. But even if you and your
doctor planned for you to go home, your recovery may be slower than
expected. So, you may need to go to a skilled nursing care or
rehabilitation facility.
Licensed by the state's Department of
Health Services, skilled nursing care facilities have regulation
and inspection requirements. Skilled nursing facilities provide
care for patients who require intense skilled medical care.
Patients remain under skilled nurses and doctors care; who
specialize in the care of the elderly.
Some nursing homes have special care units for people with serious memory problems such as Alzheimer's disease. Some will let couples live together. Nursing homes are not only for the elderly, but for anyone who requires 24-hour care
.Texas Nursing Home Licensing Requirements
In order to become a nursing facility provider you must first apply for a license from the Texas Health and Human Services (HHS). Facilities may wish to be private pay (facility with no certification) or Medicaid- and/or Medicare-certified.
As a prerequisite for participating in the Title XIX Medicaid Nursing Facility Program and receiving reimbursement for eligible Medicaid residents, a provider must have an allocation of Medicaid beds or have entered into a lease agreement with a nursing facility owner that has an allocation of Medicaid beds. In order to become a Medicaid nursing facility provider, a nursing facility owner must be licensed and have an allocation of Medicaid beds.
Credentialing Requirements for Texas Nursing Homes
Nurse Aide Registry - The state maintains a registry of all nurse aides who are certified to provide services in nursing facilities and skilled nursing facilities licensed by DADS. This includes registration for nurse aides and candidates through the Nurse Aide Testing Credential Management System and the Employability Status Check Search (link is external).
Nurse Aide Training and Competency Evaluation Program - DADS reviews and approves or disapproves nurse aide training and competency evaluation programs and nurse aide competency evaluation programs.
Nursing Facility Administrators - DADS licenses nursing facility administrators and enforces professional standards. Licensing functions are completed through the NFA Licensing System (link is external).
Medication Aide - DADS conducts permitting activities to include issue and renewing permits as well as imposing and monitoring sanctions on medication aides.
Surveys and Investigations of Complaints and Incidents
HHS surveys nursing facilities annually to ensure that they are in compliance with state licensure and federal certification regulations. HHS also investigates self-reported incidents from facilities and complaints from residents, family members, friends and others.
Surveyors initiate investigation of complaints and incidents in facilities within 24 hours, 14 days, 30 days or 45 days, depending on the priority assigned by the intake program specialist who receives the complaint or incident report. The priority is based on the immediacy and seriousness of the allegation.
Did you know that original Medicare generally DOES NOT cover long-term care stays in a nursing home? Watch this video from the Centers of Medicare and Medicaid Services to learn more.
How to Choose a Nursing Home
Choosing a nursing home is a difficult task for most. In Texas
alone, there are currently 1,207 certified nursing facilities.
Determining which nursing home will provide the best possible care
for your loved one should always be the most important when making
your decision. Always remember, things aren't always as they
appear.
There are many things to consider
when choosing a nursing home for your loved one.
- How you will pay for nursing home care is a major consideration.
- Asking if the facility Medicare and Medicaid approved?
- Reviewing their nursing home inspection report.
- Making sure they have a current state license. It should be prominently displayed.
If you get the run-around or if the report contains any unexplained health, safety, or quality of life deficiencies, consider dropping that facility from your consideration.
Also, it's important to compare Medicare and Medicaid-certified nursing homes and to view the quality of care provided to patients. Medicare.gov offers the best, most reliable Texas Nursing Home Compare tool around.
Tips When Choosing a Nursing Home
- If Medicaid or Medicare are paying for the nursing home care make sure the facility is a certified Medicare and or Medicaid provider...or both.
- Talk with your physician about the level of care and any specific services that are needed and make sure the facility can meet those needs. Find out what medical, therapeutic, and other specialty services are available.
- What services are included in the basic daily rate? Ask for a complete list of specific services and benefits not covered in the basic rate.
- Make a worksheet for evaluating each facility you are considering. Select the criteria you feel are important and "weight" the different criteria based on what is most important to you and what is less important.
- When evaluating a nursing home it's important that you get answers to whatever questions you may have, that you not feel intimidated, and that you have a tour of the entire facility. Spend plenty of time at each of the facilities. Make unexpected return visits to the facilities that look promising at different times of the day and evening and around meal time.
- Talk with everyone from the administrator to the director of admissions, nurses, visitors, volunteers, family members of residents at the facility. Notice the interaction between staff and residents, interaction among the staff, and the activity level of residents. Is family involvement encouraged and, if so, how?
- When trying to decide on which homes to visit talk to your physician, friends who have had experiences with local facilities, hospital social workers and religious organizations. Referrals from someone you know and trust are often your best source.
Both the Texas Health Care Association and Leading Age Texas have checklists for helping select a quality nursing home that best meets your needs. Keep in mind that in home care and community-based services may be options that can allow a person to remain in their own home or in the community as long as possible.
Consider checking out some of these
options too such as home health care, personal assistance
services, homemaker/chore services, adult day care and respite
care.
Aging
in place home automation technology is making it possible for older adults
to remain at home longer, and safely.
If you have a problem involving a nursing home contact the State
Long-Term Care Ombudsman at (512) 444-2727. An Ombudsman is a
advocate (supporter) who works to solve problems between residents
and nursing homes, as well as assisted living facilities.
Medicare.gov Nursing Home Compare - Detailed information about every Medicare and Medicaid-certified nursing home in the country.
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DISCLAIMER: Links to other websites or references to products, services or publications do not imply the endorsement or approval of such websites, products, services or publications by Elder Options of Texas. The determination of the need for senior care services and the choice of a facility is an extremely important decision. Please make your own independent investigation.