Reference no: EM133676610

Overview

In this lesson we covered financial aspects of the long-term care. The financial aspects of long-term care are complex, regulated by various state and federal governing bodies. Although, for educational purposes, we cover content in well-designed modules, it is important to recognize finance or the cost associated does not operate in a vacuum. Access, cost, and quality (the infamous "Iron Triangle") are interrelated with change or movement in one area impacting the other. To that end, this activity illustrates the interrelations of access, quality and cost (aspects we have covered) in delivering long-term care.

Procedure

Case Scenario

Your favorite seventy-two year old Uncle Bob recently slipped on the ice and broke his left hip. After surgery and a four-day hospital stay, the hospital is ready to discharge him. His physician believes Uncle Bob would benefit from a stay at a skilled nursing facility where he would receive skilled nursing, physical therapy and occupational therapy. The physician writes the order. Your Uncle Bob has Medicare A and Medicare B.

Questions

• Will Medicare cover his skilled nursing facility stay?
• Why or Why not? Be specific (meaning, why Uncle B is or is not eligible for Medicare AND what, if any portion would Medicare cover of the SNF stay)
• Because the social workers cannot recommend a facility, Uncle Bob asks you, the future healthcare administrator, for your advice. He wants to stay within 10 miles of the State College area so family and friends can visit during his stay.
• Using the data compiled in Nursing Home Compare
• which facility do you recommend and why? Please be sure to select Nursing Homes as your "provider type" and review facilities within a 10-mile radius of State College, PA. HINT: Speak to Uncle Bob's condition and the services he would need as well as the related quality indicators.
• Compare the selected facility information to state and national standards, speak specifically to (a) health inspections, (b) quality, and (c) staffing in your response. Again, comment on Uncle Bob's condition as and specific health inspection areas, quality indicators, and staffing.
• Based on your assessment of the facility data, is the Five-Star Quality Rating System helpful to potential residents and their families in making decisions about nursing home care?
• Why or why not?
• If a facility receives a five-star rating in one period and then is downgraded to a lower rating in a later period, does it impact facility operations? Explain why or why not.