Week 6 Flashcards
(43 cards)
Who has access to home health?
For Medicare:
- You are under the care of a doctor
- Intermittent skilled care (nursing, PT, OT, SLP)
- You are homebound:
> Can’t leave without help
> Leaving isn’t indicated due to medical condition
Home Health is also covered under Medi-Cal and private insurance
T/F: Home health is covered under Medi-Cal, Medicare, and private insurance
So T.
T/F: This is role of OT w/ PACE
- Ability to perform daily activities
- Home safety assessment and fall risk
- Reduce risk for additional injury or decline
- Management of chronic health conditions:
(Including medication, diabetes, heart failure, COPD, cognitive conditions, behavioral health)
Falso. This is role of home health OT.
In this setting, there are 3 facts of care provided: In home services, Community Services, and ____ Center
PACE
What does PACE stand for and who uses it?
Program of All-Inclusive Care for the Elderly.
- Be 55 or older
- Live in service area of PACE program
- Certified as needing nursing home-level of care
- Be able to live safely in community with PACE services
What setting involves Interdisciplinary team?
PACE
What are the 3 facts of PACE?
> Community services – caregiver come out to home 3-4x a week, home assessment, DME, specialist appointment, E care
In home services – caregiver
PACE center – provide transportation, primary care, meals, activities
T/F: These are the roles of home health OT.
- Perform assessments
- Home visits and home safety assessment
- Evaluate need for DME
- Skilled treatment
- Supervise maintenance exercises and groups
- Report progress, problems and recommendations to IDT
False. These are roles of PACE OT
What setting is this? Community-based program serving older adults and adults with chronic conditions and disabilities that might otherwise require a higher level of care.
Adult Day Health Care (ADHC)
What setting is this? Role of OT is…
- Restore or maintain optimal capacity for self-care to frail elderly persons or adults with disabilities
- Delay or prevent inappropriate or personally undesirable institutionalization
Adult Day Health Care (ADHC)
T/F: Continuing Care Retirement Communities (CCRCs) cover the full range of levels of care within senior living options (In home, independent living, assisted living, alzheimer’s care, nursing, and hospice care)…
False. CCRC’s do not cover “in home” as it is a more independent living situation
What are the 5 principles of a Patient-Centered Medical Home (PCMH)
Comprehensive Care, Patient-Centered (in the name), Coordinated Care, Accessible Services, Quality and Safety
You qualify for _____ if you meet at least one of the following:
- age 65 or older and eligible for SS
- permanently disabled and receive disability benefits for at least two years
- End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant)
Medicare
Also known as Hospital insurance... Inpatient Hospital Skilled Nursing Facility Rehab Skilled is medically necessary not custodial Hospice Home Health (skilled)
Medicare Part A.
Benefits start when the individual first enters a hospital and ends when there has been a break of at least 60 consecutive days since inpatient hospital or skilled nursing care was provided
How is Medicare funded?
Medicare is funded by the Social Security Administration, federally. (correct me if i am wrong) (I.E. Taxpayers lol)
Medicare has 4 parts
->Medicare Part A (hospital insurance) Inpatient Hospital Skilled Nursing Facility Rehab Skilled is medically necessary not custodial Hospice Home Health (skilled)
- Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, durable medical equipment, ambulance, yearly wellness visits, and some preventive services.
- Medicare Part C (Medicare Advantage) includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services. Private insurance that covers all Medicare services and may also offer extra coverage
- Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Provides a prescription drug plan coverage for individuals who have Medicare Part A and Part B
What Medicare Plan is this?
includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services. Private insurance that covers all Medicare services and may also offer extra coverage
C
What Medicare Plan is this? Provides a prescription drug plan coverage
D
What Medicare Plan is this? Inpatient Hospital
Skilled Nursing Facility Rehab
Skilled is medically necessary not custodial
Hospice
Home Health (skilled)
A
What is Medicare Plan B?
Out-patient MD Yearly wellness visit Therapy (PT/OT, etc.) DME ED HHS Labs Ambulance Ambulatory surgical centers Supplies and screening
How is medicare funded?
Part A
Mandatory payroll deduction (FICA tax) of 1.45% of taxable earnings (paid by each employee and the employer for each)
Part B
Premium payments deducted usually from monthly SS benefit checks for those who are voluntarily enrolled in the SMI plan (25%) and through contribution from the general revenue of the federal government (75%)
You are eligible for this type of health insurance if you are low income, mothers, children, older adults, disabilities, aged, blind, developmentally disabled, mentally ill, income varies by state
Medicaid
What kind of health insurance has state federal partnership ?
Medicaid
What does Medicaid provide?
Hospital Services Physician Services Nursing home care (including custodial) Home health care Laboratory and X-ray services Some optional programs also include services such as dental and vision care
