Frequently Asked Questions
A few things to consider as you transition from the hospital to a skilled nursing facility.
1. What is a skilled nursing facility
(sometimes called a "skilled care facility")?
Generally speaking, a skilled nursing facility is a clinical care provider of 24-hour licensed nursing. A "SNF," as they are often referred to, is primarily engaged in providing services for residents who require medical or nursing care and/or therapy services for the rehabilitation of injured, disabled, or sick persons.
Care typically includes: rehabilitation, intravenous therapy, post-surgical stabilization, pulmonary management, and wound care.
Additionally, our facility provides assistance with administration of medications, and aid in a variety of daily living needs, including dressing, bathing, walking, and eating.
2. Does a skilled nursing facility provide other services?
Following are the types of services available at Devon Gables Health Center:
- Psychiatric/psychological services
- Social services
- Housekeeping & laundry
- Life Enriching Activities
- Beauty, Barber Shop
3. Will my own doctor check on me in the facility?
- This depends on whether your doctor has privileges in the facility where you are admitted. If he or she is not credentialed for your facility, then your case will be referred to another doctor who is on staff there.
- While everyones medical condition varies, typically the facility physician will make rounds as needed.
- A nurse practitioner, who works under the physicians supervision, is typically in the facility 2-3 times per week, seeing various patients during each visit.
- Upon discharge, a facility will usually release information pertaining to your medical status to your personal physician at your request.
4. How do I know if I qualify for Medicare or Medicaid?
What’s the difference between the programs?
- Medicare is a federal health insurance program. It typically covers some expenses related to a stay in a skilled nursing facility, but only after an inpatient hospital stay covering a period of three midnights and only for a related illness or injury. Standard coverage includes up to 100 days in a benefit period.
- Generally, you may be eligible for Medicare if you or your spouse has paid into Social Security for at least 10 years.
- Additionally, you must be:
- age 65 or older and receiving social security retirement benefits,
- under age 65 with certain disabilities and have received social security disability benefits for 24-months,
- or be any age but diagnosed with End-Stage Renal Disease.
- Talk to a social worker at your hospital or visit www.medicare.gov for more information on eligibility requirements and to find out what services Medicare covers for skilled nursing facility stays.
- Medicaid is a federally-supported, state-operated Rehabilitation assistance program that pays for Rehabilitation services.
- Who is eligible? Certain individuals or families with substantially low incomes, who may have no medical insurance or inadequate medical insurance.
- Generally, eligibility is based on extreme financial need and medical necessity.
- Speak to a social worker at the hospital or visit www.cms.hhs.gov/medicaid/eligibility to learn more about eligibility and the criteria specific to each. Because each state operates its own Medicaid program, eligibility requirements and coverage vary from state to state.
Also, to find Medicare & Medicaid-certified skilled nursing facilities, go to www.medicare.gov/nhcompare.
5. What should I bring with me to the facility?
- First and foremost, bring all of your Medicare/Medicaid cards.
- Provide any and all insurance coverage cards to the admissions representative at the facility.
- Also, make sure to have drivers license and social security cards with you as they may be needed to complete the admission process.
Also, bring items that will make your stay more restful and easier on you, such as:
- Comfortable clothing, with your name clearly written on the label.
- A pair of non-skid, supportive shoes & socks
- Toothbrush/toothpaste, denture cups
- Comb, brush, personal lotions, deodorant & other essential toiletries
- Hearing aide, eyeglasses & eyeglass case
- Reading materials, family photos
6. What should I leave at home?
- Large amounts of money
- Electrical items, including extension cords, space heaters, and electric blankets
7. How do I know if I or a loved one can still live at home or should move into some kind of facility?
Look for some of the following signs to guide you as to whether you or a loved one needs help:
- Requiring daily assistance with eating, dressing, bathing, or using the toilet.
- Forgetting to take medications or perhaps taking too many.
- Behaving in ways that could be harmful (to yourself or to others).
- Wandering away from home or frequent signs of memory loss.
If you find you or a family member need help, here are some options, one of which may suit your specific situation:
- Find the right skilled nursing facility if you or a loved one has suffered an illness or injury and requires rehabilitation and/or continuous medical care, whether for the short or long-term. And, keep in mind that unfortunately there may be certain medical conditions that cause continued decline, regardless of the clinical solutions available.
- Move into an assisted living community, which offers independent living with assistance in the areas of housekeeping services, provision of meals, and personal care.
Following is a glossary of terms which may be helpful in your search for the right type of senior care.
Sources: U.S. Dept. of Health & Human Services; American Rehabilitation Association; Center for Medicare & Medicaid Services; seniorresources.com, 2007.
- A sudden and severe condition
- Activities of Daily Living (ADL)
- Physical functions that an individual performs each day, including bathing, dressing, eating, toileting, walking or wheeling, and transferring into and out of bed.
- Administration on Aging
- An agency of the U.S. Department of Health and Human Services. AOA is an advocate agency for older persons and their concerns at the federal level. AOA works closely with its nationwide network of State and Area Agencies on Aging (AAA).
- Advanced Directives
- A written statement of an individual’s preferences and directions regarding Rehabilitation. Advanced Directives protect a person’s rights even if he or she becomes mentally or physically unable to choose or communicate his or her wishes.
- Determination of a resident’s care needs, based upon a formal, structured evaluation of the resident’s physical and psychological condition and ability to perform activities of daily living.
- Certified Nursing Assistant (CNA)
- The CNA provides personal care to residents or patients, such as bathing, dressing, changing linens, transporting and other essential activities. CNAs are trained, tested, and certified and work under the supervision of an RN or LVN.
- Centers for Medicare and Medicaid Services (CMS)
- Formerly the U.S. Rehabilitation Financing Administration, CMS is an element of the Dept. of Health and Human Services, which finances and administers the Medicare and Medicaid programs. Among other responsibilities, CMS establishes standards for the operation of nursing facilities that receive funds under the Medicare or Medicaid programs.
- Continuing Care Retirement Communities (CCRC)
- Housing communities that provide different levels of care based on the needs of their residents – from independent living apartment to skilled nursing in an affiliated nursing facility. Residents move from one setting to another based on their needs, but continue to remain a part of their CCRC’s community. Typically CCRCs require a significant payment prior to admission, then charge monthly fees above that.
- Durable Power of Attorney (DPAHC)
- A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make Rehabilitation decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.
- Dual Eligibles
- Someone who is qualified for both Medicaid and Medicare.
- Rehabilitation Directive
- A written legal document which allows a person to appoint another person (agent) to make Rehabilitation decisions should he or she be unable to make or communicate decisions.
- Rehabilitation Power of Attorney
- The appointment of a Rehabilitation agent to make decisions when the principal becomes unable to make or communicate decisions.
- Hospice/palliative care is provided to enhance the life of the dying person. Often provided in the home by health professionals, today there are many nursing facilities and acute care settings that also offer hospice services. Hospice care, typically offered in the last six months of life, emphasizes comfort measures and counseling to provide social, spiritual, and physical support to the dying patient and his or her family.
- Hospice Care
- The provision of short-term inpatient services for pain control and management of symptoms related to terminal illness.
- Living Will
- A legal document in which a competent person directs in advance that artificial life-prolonging treatment not be used if he or she has or develops a terminal or irreversible condition and becomes incompetent to make Rehabilitation decisions.
- Long Term Care (LTC)
- The broad spectrum of medical and support services provided to persons who have lost some or all capacity to function on their own due to a chronic illness or condition, and who are expected to need such services over a prolonged period of time. Long term care can consist of care in the home by family members who are assisted with voluntary or employed help, adult day Rehabilitation, or care in assisted living or skilled nursing facilities.
- The federally supported, state operated public assistance program that pays for Rehabilitation services to people with a low income, including the elderly or disabled persons who qualify. Medicaid pays for long term nursing facility care, some limited home health services, and may pay for some assisted living services, depending upon the state.
- The federal program providing primarily skilled medical care and medical insurance for people aged 65 and older, some disabled persons and those with end-stage renal disease.
- Medicare Part A
- Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home Rehabilitation. Most people get Medicare Part A automatically when they turn 65.
- Medicare Part B
- Medical insurance that helps pay for doctor’s services, inpatient hospital care, and some medical services that Part A does not cover (like some home Rehabilitation). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.
- Nurse, Licensed Vocational (LVN)
- A graduate of a state-approved nursing education program, who has passed a state examination and been licensed to provide nursing and personal care under the supervision of a registered nurse or physician. An LVN administers medications and treatments and acts as a charge nurse in nursing facilities.
- Nurse, Registered (RN)
- Nurses who have graduated from a formal program of nursing education (two-year associate degree, three-year hospital diploma, or four-year baccalaureate) and passed a state-administered exam. RNs have completed more formal training than licensed practical nurses and have a wide scope of responsibility including all aspects of nursing care.
- Occupational Therapy
- Services provided to those individuals who are unable to cope with the tasks of everyday living and who are threatened or impaired by physical illness or injury, psychosocial disability, or development deficits. Occupational therapists work in hospitals, rehabilitation agencies, long-term care facilities, and other health-care organizations.
- The ombudsman program is a public/government/community-supported program that advocates for the rights of all residents in 24-hour long-term care facilities. Volunteers visit local facilities weekly, monitor conditions of care, and try to resolve problems involving meals, finances, medication, therapy, placements and communication with staff.
- Private Pay Patients
- Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).
- Physical Therapy
- Services provided by specially trained and licensed physical therapists in order to relieve pain, restore maximum function, and prevent disability or injury.
- Power of Attorney
- A legal document allowing one person to act in a legal manner on another’s behalf pursuant to financial or real-estate transactions.
- Pre-Admission Screening
- An assessment of a person’s functional, social, medical, and nursing needs, to determine if the person should be admitted to nursing facility or other community-based services available to eligible Medicaid recipients.
- Resident Care Plan
- A written plan of care for nursing facility residents developed by an interdisciplinary team which specifies measurable objectives and timetables for services to be provided to meet a resident’s medical, nursing, mental and psychosocial needs.
- Respite Care
- Scheduled short-term nursing facility care provided on a temporary basis to an individual who needs this level of care but who is normally cared for in the community. The goal of scheduled short-term care is to provide relief for the caregivers while providing nursing facility care for the individual. Short-term stay beds used for respite care must be distinct from general nursing facility beds.
- Skilled Nursing Care
- Nursing and rehabilitative care that can be performed only by, or under the supervision of, licensed and skilled medical personnel.
- Skilled Nursing Facility (SNF)
- Provides 24-hour nursing care for chronically-ill or short-term rehabilitative residents of all ages.
- Speech Therapy
- This type of service helps individuals overcome communication conditions such as aphasia, swallowing difficulties and voice disorders. Medicare may cover some of the costs of speech therapy after client meets certain requirements.