Medicare Archives - THE GRAND

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 Medicare.gov

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.

New Medicare Cards to Debut in April 2018

New Medicare Cards to Debut in April 2018

by Corey Ohalek
Associate General Counsel
Vrable Healthcare, Inc.

MedicareAs the technology world expands, so does the risk of fraud and identify theft. In order to combat “fraud, fight identity theft, and keep taxpayer dollars safe,” the Centers for Medicare and Medicaid Services (CMS) will be issuing new Medicare cards to Medicare enrollees beginning in April 2018. The previously enacted Medicare Access and CHIP Reauthorization Act of 2015 mandates CMS to remove Social Security numbers (SSN) from all Medicare cards by April 2019. SSN-based Health Insurance Claim Numbers (HICN) will be replaced with “a new, unique, randomly assigned number called a Medicare Beneficiary Identifier (MBI).” Congress’s belief is that the change from the SSN-based HICN will “better protect private healthcare and financial information, as well as federal healthcare benefit and service payments, from fraud.” Beneficiaries will not see a change in the “enrollees’ benefits, and the effective date of the new cards remains the date that each beneficiary was or is eligible for Medicare.”

April 2018

In April 2018, new cards will be issued through the mail with mailings occurring in phases based on geographic location dictated by CMS. CMS will provide additional details on the timing of the new cards as the mailing progresses. Providers, such as Vrable Healthcare, Inc., have been preparing their facilities for the upcoming change to ensure a smooth transition to the new cards. Lastly, as an effort to provide more protection to enrollees, CMS has made it clear that it will “never ask enrollees for personal or private information or charge a fee to obtain the new card. In fact, enrollees need not take any action to obtain these new Medicare cards.”

For more information on the upcoming changes to the Medicare cards, click here.

What You Need to Know about Skilled Nursing

by Jada Palm
Hospital Liaison
Danielle Batdorff, BSHA/HIS
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. (Newly diagnosed diabetics, for example)

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. Long term care is typically utilized for in-house placement for the duration of the patient’s life.

What social activities are offered?

Skilled 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, 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.

Here at The GRAND, we offer weekly ice cream socials, wine and cheese nights, and happy hour to our social calendar.

What should I bring with me?

It is recommended that you bring comfortable clothing for working out in therapy along with good fitting shoes. Personal hygiene items (all labeled with your name), photo ID, insurance cards, advanced directive paperwork (Power of Attorney and Living Will paperwork). You may bring snacks to keep in your personal mini fridge.

What are the rooms like?

Some 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 2018)
  • Days 21-100 – patient responsibility of $164.50 per day co-insurance
    • (2018 co-insurance will be $167.50)

Additional information can be obtained through Medicare.gov

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 sure we 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, our corporate case manager will start that process.

What are your staffing ratios?

In our skilled setting, our ration is 1:12 or 1:13, with an STNA on each hall. Our staffing ratios are significantly below average.

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

Therapy 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. Our therapy team will meet with you upon admission and plan your schedule based on the recommended physicians order.

What sets your facility apart from the others?

The GRAND offers several amenities that set us apart from competitors. From the 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 services to our residents.

What 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.