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Crash Course in Nursing Homes: Summary of 11 Lessons Learned

[fa icon="calendar'] Feb 5, 2019 8:04:00 AM / by Kim Mcilnay, BCPA posted in self-advocacy, elderly illness, Medicare, medi-cal, Nursing Home/Skilled Nursing Facility

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In the preceding blogs titled Crash Course in Nursing Homes, Part 1, Part 2 and Part 3, I shared Susan's experiences with illegal nursing home practices and lessons learned. This post summarized the lessons learned for easy reference.

Lesson 1: Rehab/nursing home stays are only covered by Medicare if a patient is first admitted to a hospital for 3 midnights.  You may think you're admitted to the hospital but you may actually only be on observation status. Observation status does not qualify you for medicare coverage for a skilled nursing facility. Ask your nurse, doctor, or the admissions team if you are "admitted" or on "observation status." 

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Crash Course in Nursing Homes Part 3: Final Lessons

[fa icon="calendar'] Feb 4, 2019 9:51:00 AM / by Kim Mcilnay, BCPA posted in self-advocacy, medi-cal, Nursing Home/Skilled Nursing Facility

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In Part 1, I shared Susan's story and shared Lessons 1-3. Susan was staying in a Skilled Nursing Facility (SNF) for rehab and was unsafe for discharge to home. The SNF threatened eviction once Susan's Medicare approved stay was completed. In Part 2, I shared the steps we took to fight Susan's illegal eviction and share Lessons 4-8. Today's post will cover final lessons learned, including resident rights when transferred to the hospital. 

Glossary of Terms
SNF = Skilled Nursing Facility. Commonly called a "nursing home." Offers skilled nursing, lodging, food, and medication therapy. May offer rehab services like physical therapy, occupational therapy, and speech therapy.
ALF = Assisted Living Facility. Offer long-term housing to residents who may need assistance with Activities of Daily Living (ADLs) such as bathing, dressing, eating and toileting, but do not require the level of medical or nursing care available in a SNF.
RCFE = Residential Care Facility for the Elderly.  These are a type of ALF, but tend to be in homes. Also known as "board and care."
Room and Board= Frequently confused with "board and care" in discussions. These are group homes with multiple residents but they do NOT provide any assistance and are unsupervised. They may offer a food plan, but are otherwise just homes with multiple residents.
Medi-Cal = Name of California's medicaid program. Helps provide basic insurance for those below a specific income. Medi-cal will cover long term SNF placement for residents who have specific medical needs. They will also cover "custodial" (not needing medical care) if specific criteria are met.
Medicare = Medical insurance for those over 65 years old or those who qualify for Social Security Disability.  Medicare does not cover long-term custodial care. Specific criteria must be met in order for Medicare to cover care in a long-term care facility. 

Susan lived comfortably in the nursing home for several months under Medi-Cal custodial care payment when an illness required transfer to the hospital. Lesson 9: Skilled Nursing Facilities are  required to readmit residents within 30 days of transfer to the hospital and they are required to hold the resident's same bed if transferred to the hospital for less than 7 days.  I was aware of these regulations already. We requested to sign a bed hold form at the facility. This bed hold meant that Susan's exact bed would be available to her for the next 7 days.

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Crash Course in Nursing Homes Part 2: Fighting Illegal Nursing Home Practices.

[fa icon="calendar'] Jan 7, 2019 1:36:00 PM / by Kim Mcilnay, BCPA posted in self-advocacy, medi-cal, Nursing Home/Skilled Nursing Facility

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In Part 1, I shared Susan's story and shared Lessons 1-3. Susan was staying in a Skilled Nursing Facility (SNF) for rehab and was unsafe for discharge to home. The SNF threatened eviction once Susan's Medicare approved stay was completed. This post will review the steps we took to fight Susan's illegal eviction and share Lessons 4-8. Part 3 will cover final lessons learned, including resident rights when transferred to the hospital.

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Crash Course in Nursing Homes Part 1: When You Can't Pay

[fa icon="calendar'] Dec 3, 2018 11:33:00 AM / by Kim Mcilnay, BCPA posted in self-advocacy, Medicare, medi-cal

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Who pays for a nursing home stay when a patient isn't able to pay for it themselves?  I went through a crash course recently while helping a friend who needed a nursing home. I'll share a few insights with you from that experience.

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