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What You Need To Know About Skilled Nursing

What You Need To Know About Skilled Nursing

Danielle Batdorff
Director of Admissions
The GRAND of Dublin

What is skilled nursing?

Skilled nursing is a type of intermediate care in which the patient or resident needs more assistance than usual. This setting is designated for physical, occupational, and speech therapies, to aide in strengthening the patient who has a goal of returning to their home at baseline. Skilled nursing services are offered to patients who need IV medications administered, who may have wound care needs, or who may need teaching on medication management, an example of this would be newly diagnosed diabetics.

What is the difference between short-term care and long-term care?

Short term care is a temporary solution that may last from a few days to a few months and is typically provided for rehabilitation and allow for recovery outside of a hospital. Long term care is typically utilized for in-house placement for the duration of the patient’s life, providing permanent custodial assistance.

What social activities are offered?

The GRAND Skilled Nursing ActivitiesSkilled nursing facilities offer a full calendar of social events and activities. Residents are encouraged to join in as many activities and social events as they like. Some examples include; art classes, ice cream socials, bingo and cards, game and movie night, quest performers and church services.

In addition, they offer wellness programs, exercise classes, beauty salons, small dining areas, café and restaurant style dining rooms, and outdoor sitting and walking areas.

 What should I bring with me?

It is recommended that you bring comfortable clothing for working out in therapy along with well-fitting shoes. Personal hygiene items (all labeled with your name), photo ID, insurance cards, advanced directive paperwork (Power of Attorney and Living Will paperwork).

What are the rooms like?

The GRAND of Dublin Skilled Nursing RoomSome facilities offer both single and double occupancy rooms. Each facility has its own characteristics which make it unique and sets it apart from the other down the street. An example; The GRAND offers single occupancy rooms with walk-in showers, individual heating/cooling units, refrigerators, Wi-Fi and cable. Patient’s medications are locked securely in each patient room and we strive to provide a home like atmosphere.

What does Medicare cover?

Medicare part A covers skilled nursing care under certain conditions for a limited time.

* You must have a qualifying hospital stay. This means you meet the minimum 3 night inpatient hospitalization requirement.

* You have part A and days left in your benefit period.

* Your doctor has ordered skilled services due to a medical condition which requires the need for 24/7 nursing care and therapy services offered 5 to 6 days a week.

Medicare covered services include:

  • A semi-private room
  • Meals
  • Skilled nursing care
  • Physical and Occupational Therapy
  • Speech-Language Pathology Services
  • Medical Social Services
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers ones health) to the nearest supplier of needed services that aren’t available at the SNF
  • Dietary Counseling

Medicare part A will pay as follows:

  • Days 1-20 – pays at 100% with no patient responsibility  (Remains $0 co-insurance for 2019)
  • Days 21-100 – patient responsibility of $167.50 per day co-insurance  (2019 co-insurance will be $170.50)

Additional information can be obtained through

How do I find out what my insurance will cover?

Insurance benefits and eligibility will be checked prior to admission to the building, but you may also call the member services number on your card and a customer service representative will provide you with details of your coverage options.

What is the next step and what can I expect once I select a facility?

Once you have selected a facility you will notify your hospital social worker and he/she will send the referral to the building for review. You may choose to tour the building. Your clinical is then reviewed by the admissions and nursing team to make ensure the facility can clinically manage your stay, and then the hospital liaison will visit you in the hospital to answer any questions you may have. If you need an authorization from your insurance to admit, the facility will then start that process. Once authorization has been received the facility will communicate with the hospital social worker.

What are your staffing ratios?

At The GRAND skilled setting, our ratio is 1:12 or 1:13, with an STNA on each hall. Our staffing ratios are significantly above average.

How often is therapy provided and will I have a schedule?

The GRAND of Dublin TherapyTherapy is provided at the discretion of your ordering physician, the therapy team, and your needs. You can ask for a specific schedule if that works better for you. At The GRAND, the therapy team will meet with you either the day of your arrival or the next day.  An example, some prefer mornings, some prefer afternoons and some prefer to have their therapies separated. Meaning occupational therapy may be planned for the afternoon and physical therapy planned for the mornings.

What sets your facility apart from the others?

The GRAND offers several amenities that set us apart from our competitor’s. We have Digger and Finch pub, our ice cream parlor, Movie Theater, beauty salon, pharmacy, chapel, licensed in-house therapy team and team of dedicated nurses and STNA’s and low patient/staff ratios, we offer outstanding service to our residents.

The GRAND of DublinWhat are your visitation hours and/or restrictions?

Each facility will have set hours of operation. The most common hours of operation most facilities follow are 8am to 8pm, 7 days per week. The GRAND’s hours are 8:30am to 8pm, Monday through Friday and 9am to 8pm, Saturday and Sunday. There may or may not be restrictions on when visitors can be with their loved one. The GRAND does not have such restrictions and provides security 7 nights per week.

Involuntary Discharges and Transfers to Face Scrutiny

Involuntary Discharges and Transfers to Face Scrutiny

Corey J. Ohalek
Associate General Counsel
Vrable Healthcare, Inc.

Recently, the Office of Inspector General (OIG) announced it would increase federal oversight regarding involuntary discharges and transfers issued by SNF’s. Specifically, the OIG will be focusing on “whether State agencies have effectively investigated and enforced proper transfer and discharge procedures.” The OIG noted that “discharge/eviction was the most common complaint to the Long-Term Care Ombudsman Program.” Also, the OIG indicated that, due to the quantity, it is worth investigating involuntary discharges and transfers. CMS has estimated that “as many as one-third of all residents in long-term care facilities are involuntarily discharged.”

Involuntary discharge

One of the main areas of review for the OIG is the “lax or ineffective State enforcement.” The OIG plans to review how the State LTC Ombudsman address involuntary transfers and discharges and “the extent to which State survey agencies investigated and took enforcement actions against nursing homes for inappropriate involuntary transfers and discharges.” The State LTC Ombudsman is not the only entity that the OIG is focused on in its review and it will also review the” extent to which nursing homes meet CMS requirements for involuntary transfers and discharges.”

Although the OIG’s main focus will be the actions and/or inactions of State agencies, the OIG’s actions should place all SNF’s on notice to review and adhere to the state and federal regulations regarding involuntary transfers and discharges. “State ombudsman and enforcement agencies may strengthen their involuntary discharge and transfer enforcement activities to ensure that they are not perceived as being lax or ineffective.”

Find more information here.

December 2018 Activity Calendars

December 2018 Activity Calendars

Skilled Nursing Activity Calendar

Grand of Dublin December 2018 Activity Calendar





















Assisted Living Calendar

GRAND of Dublin December 2018 Assisted Living Activity Calendar





















Memory Care Activity Calendar 

GRAND of Dublin December 2018 Memory Care Activity Calendar


Executive Functions

Executive Functions

Jeanne R. Seliskar, MA, CCC-CLP
Corporate Director of Rehabilitation
Vrable Healthcare, Inc.

Executive FunctionsIf you have ever had a hospitalization, the whole process can make you feel “a little off”.  Most of us can fairly quickly return to our normal selves, but for many others something has changed with the ability to think clearly, concentrate or remember.  Speech Pathologists at The GRAND of Dublin have been focusing on helping patients with Executive Functioning skills.  These are skills which involve high level thinking, allowing individuals to function independently with all the specifics and decisions of daily living.  Executive functions include:  attention, concentration, memory, problem solving, sequencing, organizational skills and judgment.  These areas can be easily affected by multiple medical situations, such as strokes, head injuries, poor oxygen levels, chemical imbalances in the body or anesthesia.

At The GRAND on of the challenging ways, to improve these high level thinking skills is through multi-tasking and bilateral integration.  Patients are asked to complete exercises that combine cognitive-verbal and motoric tasks in alternating physical and verbal patterns while crossing over the midline of their bodies.  These tasks stimulate the brain to integrate movement and thoughts from both the left and right sides of the brain.  When this takes place, gains are made across the board in all executive function areas, impacting the improved ability to think insightfully, problem solve complex tasks, improve memory and concentration and make sound judgments.  These are the components necessary for an independent and safe return to the patient’s home environment.  That is the goal for patients and families in Rehab at The GRAND of Dublin, and addressed by our expert, experienced Speech Pathologists are trained in the specifics of remediating these impairments.

To learn more please contact the therapy department at The GRAND of Dublin by calling 614-889-8585 today.

The Flu: From 1918 to 2018

The Flu: From 1918 to 2018

Andrea Hartley CPhT
Pharmacy Technician / Central Supply Manager
The GRAND of Dublin

fluWe all know the flu virus can be deadly to vulnerable populations, but did you know that in 1918 a worldwide flu outbreak caused illness and deaths in many young and healthy people, as well as those at high risk? This particular strain of the flu became known as the Spanish flu because it was well known that Spain was hit particularly hard, but before the end of the 1918 flu season the virus had spread to every corner of the globe and killed up to 50 million people. The particular strain that caused the 1918 pandemic was of avian origin, as were many of the most deadly flu outbreaks.

The first flu vaccine in America was released in 1940, so at the time of the Spanish flu there was nothing to stop its spread except good hygiene disinfectants and isolation those who fell ill.  Today we not only have a vaccine for the flu, we have diagnostic tests and we have prescription medications to help treat the virus, as well as lessen the symptoms and duration of the illness; some can even be taken to prevent the flu in people who have been exposed to the virus: we have Tamiflu (Oseltamivir) oral capsules and liquid, Relenza (zanamivir) inhalation powder and Rapivab (peravimir) injection.

In 1960 the U.S. Public Health Service first recommended annual flu vaccination for high risk groups. This year the Centers for Disease Control recommend flu vaccination for everyone 6 months or older who do not have contraindications.

So much has changed in the prevention and treatment of the flu in the last 100 years!  At The GRAND of Dublin we offer flu vaccines to all of our employees and residents every autumn, and we still have plenty left this year if you need one during your stay with us.

For more information on the 2018 / 2019 flu season Centers for Disease Control and Prevention website.

Commercial and Managed Medicare Coverage

Commercial and Managed Medicare Coverage

Stefanie Villasante
Business Office Coordinator
The GRAND of Dublin

What does your Commercial or Managed Medicare insurance mean for your rehabilitation stay? It important that you understand how your coverage effects a variety of areas of your stay in a short term rehab facility, from admission, to type of room, to amount of therapy you receive to per day/week, how much it will cost you out of pocket, up to your prospective discharge date.  If you are looking for Skilled Rehab for yourself or a loved one it is important that you educate yourself on what coverage you have.  A lot of times the Business Office at your prospective Facility has access to this information and can help you understand your coverage.

Most Insurance providers require precertification for you to even come to a Skilled Nursing Facility.  This is done by the facility, with the paperwork provided to them from the hospital.  Some insurance companies will only authorize a Semi-Private room (you’re bunking up with a stranger for your rehabilitation stay).  A request is submitted to the insurance company and they generally take 24-48 hours to respond (they don’t always say yes).  You cannot transfer to the facility until the service is authorized.  Once the hospital and facility are notified of authorization, the hospital will then arrange transportation to the rehab center.

Medicaid CoverageMany Insurance companies cover 100% for the first twenty days, following a more Medicare-like guideline. The will have a set amount or percentage due per days for days twenty one on.  Other insurance plans have a deductible due up front and a daily coinsurance starting on day one of admission.  Almost all Insurances have an amount that you have to reach paying privately before they pay your services at 100% with no Out of Pocket cost.  This is known as your annual Out of Pocket Max.

Some Insurance companies have a “Level” that they assess your rehab need at.  This level dictates the amount of nursing care and therapy the facility will provide to you on a daily/weekly basis.  (Example: Anthem Level 2 covers 90 minutes of Therapy no less than 3 days per week, where Anthem Level 3 states 90 minutes of Therapy no less than 5 days per week).  So you might come into your Rehab stay thinking that you will have therapy 5-7 days per week, and might only be seen 3 times a week because that is all your insurance has authorized the facility to treat.

On a regular basis your Insurance Company will ask for updates from the facility.  These updates include nursing and therapy notes documenting your progress (or sometimes lack of progress).  At any point that insurance company can decide that you are ready to go home, or no longer meet skilled criteria and are in need of Long Term Care which is not covered by the insurance.  Managed Medicare Insurance plans will issue a “Notice of Medicare Non-Coverage” giving you AT LEAST a two day notice.  They are not required to give you any more notice than 2 days that you will no longer be covered your skilled stay.  If you have a commercial insurance plan, they do not have to follow Medicare guidelines and do not need to give you any notice.  A commercial plan might review your update, and say we are going to stop paying effect the previous day.  It is on you to discharge or pay privately at the facility if you stay.

With all of the different types of Insurances and Plans out there it is important to do your research before selecting one for yourself.  If you do find yourself in a situation where you don’t know your coverage or have questions, call your insurance company, talk to your hospital social worker, or the Business Office at the Rehab facility.  We all have a plan in mind of how everything will work out perfectly.  Unfortunately your insurance company (and life) doesn’t always follow that perfect plan.  Make sure you are doing your homework, so things don’t come up and leave you so shaken that is sets you back in your progression to home.



Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin


This SSS (Social Services Series) will be the continuation and completion of Ohio & Federal Nursing Home Residents’ Bill of Rights. During our last series we looked at the first five resident rights. We will resume summarizing the resident rights continuing with number twenty-five.

25. Residents have the right to be informed in writing of the basic rate charged by the center, services available and any additional charges related to such services. The basic rate of the center shall not be changed unless a 30 day notice is provided to the resident and/or the resident’s responsible party.

26. Residents have the right to receive their bill on a monthly basis for any charges not included in the basic rate.

27. Residents have the right to be free from financial exploitation. Residents have the right to manage their own financial affairs and/or the right to quarterly accounting statements if the center is delegated this responsibility. Residents have the right to review a complete record of their funds, transactions, bills, etc.

28. Residents have the right to access their valuables/property that are on deposit at the center at reasonable hours.

29. Residents have the right to receive notice prior to a room change and/or having a roommate as well as an explanation to the fact. The Grand has all private rooms.

30. Residents have the right not to be discharged or transferred from the center unless for the following reasons: for the safety of other residents in the center, the health of residents in center would be endangered, the resident’s health has improved and he/she no longer meets the criteria for services provided in the center, and/or the welfare/needs of the resident cannot be met in the home. Other reasons may be that the resident has failed to pay for the services provided in the home, the center’s license has been revoked and/or the home is being closed, the resident receives Medicaid and the center is terminating the Medicaid program w/in the center, the resident receives Medicare and the center is terminating the Medicare program w/in the center.

31. Residents have the right to voice grievances and recommend changes to the center’s employees, to The Department of Health, or to any other person not associated with the center (Ombudsman, Legal Rights, family, friends, etc.). Residents are able to do this per their choice, free from restraint, interference, coercion, discrimination or reprisal.

32. Residents have the right to be informed of any significant change in their health status as well as their responsible party/emergency contact. The center shall make every reasonable effort to notify the resident and/or their responsible party/emergency contact as soon as the significant change is noted.

Hiring Therapy Tech/Scheduler

Hiring Therapy Tech/Scheduler

Monday – Friday 9:00am – 5:30pm

We are currently looking for an experienced Therapy Tech/Scheduler to join our team at The Grand, located at 4500 John Shields Parkway, Dublin, OH 43017.

The Grand has 143 beds consisting of Skilled Nursing, Assisted Living and Independent Living.  You will be working at a one of a kind, state of the art facility in Central Ohio.

Our Mission:

Our every action must advance our mission: To improve the Quality of Life & Health of those we serve.

Company Overview

Vrable Healthcare is a growing Ohio company privately and locally owned with the vision of providing exceptional care across Ohio. We believe our first responsibility is to the patients we serve. We respect the physical, emotional and spiritual needs of our patients and find that compassion is essential to fostering healing and wholeness. Teaching and learning are fundamental in our efforts. We believe our employees are the source of our success.


  • Degree in exercise physiology
  • Experience with scheduling
  • Excellent organizational skills
  • Solid computer knowledge – excel, word, power point
  • Background in skilled rehab
  • Excellent communication skills

Vrable Healthcare is a trusted name providing skilled nursing and rehabilitation services throughout Ohio.  We offer competitive wages and benefits including 401k, tuition assistance, and paid vacations.

Interested in joining our team?  Qualified candidates should apply online at and visit us online at

Main Street: Created for Life and Designed for Living

Sara Katula
Activities Director
The GRAND of Dublin

Main Street: Created for Life and Designed for Living

Main Street at The GRAND offers many attractions that we are able to incorporate with our daily activities including our This and That Sundries gift shop, Main Street Chapel, seasonal courtyards, Digger and Finch Pub, What’s The Scoop? Ice cream parlor, activity center, and The GRAND Theater.  When you first enter Main Street you will see our Cool Beans Café.  It is open daily offering everything from a cup of coffee, deli sandwiches, daily soup specials, snacks, variety of drinks and a community newspaper is available to catch up on the daily news. Across from the Café is our This and That Sundries gift shop.  Our gift shop offers anything from daily necessities, seasonal décor, Ohio State gear to flower arrangements or trinkets.  Open daily for our residents and guest to shop at their convenience.

The next two attractions along Main Street are our chapel and the GRAND Theater.  The Main Street Chapel is designed for multi-denominational services to be held throughout the week with support from our local churches.  We have various church events throughout the week including memorial services, private ceremonies, or wedding renewals. Hospice companies may also use our chapel for coping, support and counseling.  The GRAND Theater plays daily movies posted outside the theater from 10am to 11pm. Our movie selection changes monthly playing both current and classic movies. Sporting events are shown in our theater especially the World Series, Super Bowl, and Ohio State Football.

Main StreetA few of our residents favorite attraction includes our What’s The Scoop? Ice cream parlor and Digger and Finch Pub. Our ice cream parlor is open Wednesdays and Saturdays at 3:00pm to satisfy any sweet tooth.  Many residents enjoy their ice cream in our seasonal courtyard that is decorated for harvest days, Thanksgiving, Christmas, and Easter. Families or guests may also use our ice cream parlor for hosting birthday parties, social events, and special occasions. The Digger and Finch Pub are open on Thursday evenings for Bingo night and Fridays at 3:00pm for Happy Hour. During Happy hour you can enjoy entertainment and appetizers along with your drink of choice.

At the end of Main Street there is our activity center that is designed for many of our traditional activities provided by our activity staff. We offer a variety of activities that will accommodate all of our guests to keep them busy and social.  Our activity staff passes out a daily activity schedule along with a monthly calendar posted in all the rooms to invite all residents, family, and guests. Main Street offers many activities and events for our residents and families to enjoy during their stay at The GRAND of Dublin Senior living community.