Effective Management of Long-Term Care
Facilities (3rd ed.), Ch. 6
5. Mabel Brown resides in an assisted living facility and is admitted to the hospital following a stroke. After a hospital stay of 8 days, Ms. Brown returned to her apartment at the assisted living center, but she needs assistance with personal care and some speech therapy. Will Medicare pay for the personal care services and speech therapy? Explain.
6. Hilda Smith, who had osteoporosis, sustained a hip fracture because of a fall in her home. After 5 nights in an acute care hospital, she is admitted to a SNF where she spends 16 days for rehabilitation, nursing care, and assistance with ADLs. The patient is then discharged to her own home where a physical therapist from a home health agency comes in to train her to use a walker and build strength. After being at home for 25 days, Mrs. Smith develops deep venous thrombosis (blood clot in a vein) in her thigh (related to her fall) and is admitted to the hospital, from where she is transferred to a SNF after spending 2 nights in the hospital. Assuming that Mrs. Smith meets Medicare criteria for the services described here, how many days of SNF care is Mrs. Smith entitled to during her most recent stay (assume that she qualifies for the full 100 days)? How much in deductibles and copayments does Mrs. Smith have to pay (use 2014 figures given in the text)?
7. Under HIPAA, any felony conviction for fraud, theft, embezzlement, or other financial misconduct by a health care provider must also result in the provider’s expulsion from Medicare and Medicaid programs.
8. A patient’s family visits a skilled nursing facility that is dually certified. The patient’s daughter meets with the administrator and inquires, “My mom, Josephine, has Medicare coverage. I am a nurse and have been taking care of her at home, but my family and a new job are putting more and more demands on my time and I cannot take care of my mom anymore. She requires tube feeding and has an indwelling urinary catheter. She is in a wheelchair because of limited mobility. She may need some physical therapy. I have heard good things about your nursing home and would like to bring her here.” What should be the administrator’s response?
1 Fraud Target: Senior Citizens
https://www.fbi.gov/scams-and-safety/common-fraud-schemes/seniors
2. “Top 10 Financial Scams Targeting Seniors”
3. National Center on Elder Abuse
4. What is Elder Abuse?
http://www.aoa.gov/AoA_programs/elder_rights/EA_prevention/whatisEA.aspx
Aging Care's guide on Elder Abuse:
http://www.aginginplace.org/guide-to-recognizing-elder-abuse/
