Frequently Asked Questions Concerning Skilled Care/Traditional Medicare Services and Discharge
Traditional Medicare guidelines change periodically.
Please check with Grand River Health – Care Center social services, administration and/or billing staff to clarify any questions you may have.
Medicare Part A (Hospital Insurance) covers skilled nursing care in a skilled nursing facility (SNF) under certain conditions for a limited time. Medicare covered services include, but are not limited to: room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical & social services, medications, medical supplies and equipment used in the facility, ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the Skilled Nursing Facility and dietary counseling.
All persons under Traditional Medicare are entitled to 100 skilled days; however, the number of days provided or covered will be determined by your functional/medical status. Traditional Medicare will only cover your stay if you are showing progress in your plan of care or have a medical condition that warrants skilled nursing. You will be given at least a two (2) day notice before coverage ends. Please note that often you and your responsible party will be aware of your progress and will have more than two days notice.
Shortly after admission, a therapist(s) will greet you and complete an assessment. Therapists will discuss with you the frequency and duration of services, what to expect from therapy and your individual therapy goals.
Traditional Medicare guidelines set criteria to determine if a therapy service is skilled. “The deciding factor in determining if a therapy service is skilled is whether the service can be safely and effectively carried out by a non-skilled person. Other points in determining skilled therapy include therapy services when the skills of a therapist are necessary to safely and effectively furnish recognized therapy services, whose goal is improvement of an impairment or functional limitation. If at any point in the treatment of an illness or injury, it is determined that the treatment is not rehabilitative, or does not require the services of a qualified professional for management or a maintenance programs, the services will no longer be considered reasonable and necessary.” Many other insurance companies defer to the Medicare guidelines for coverage criteria. For further explanation, please consult Rehab Director, at 625-7454.
Yes, you will be notified of your care conference by letter. You and family or friends are encouraged to attend.
Yes, if the doctor agrees that you are able to and your family or friends can manage your needs. However, please remember that a leave of absence cannot be an overnight stay (you must be physically in the facility at midnight). Please coordinate any excursions with your therapists as early as possible in order to not miss a therapy session. Also, training with family members may be needed in advance.
Yes, you may return to the same room. Please, also refer to the bed hold policy you signed upon admission.
The social services department will meet with you shortly after your admission to begin discussing your discharge.
Yes, if rehab/nursing recommend continued services at home, in-home services will be coordinated.
The social worker, will ask you if you prefer a specific home health agency. If you are not familiar with one, then the social worker will provide several reputable agencies for you to choose from. The social worker will obtain orders from your physician and make the referral to your chosen agency.
If you have Traditional Medicare or another type of insurance plan that covers this service, then this service will be covered.
Physical, occupational, and speech therapies, nurse, nurse’s aide and social worker. The interdisciplinary team will recommend the disciplines to cover your needs.
Your therapists will make recommendations about what equipment or services you will need after leaving Grand River Health – Care Center. Equipment is usually provided by a durable medical equipment (DME) company. The social worker will ask you if you prefer a specific durable medical equipment company. If you are not familiar with one, then the social worker will provide several reputable companies for you to choose from. The social worker will obtain orders from your physician and make the referral to your chosen company.
Yes, you will likely need to meet with your physician prior to discharge as home health and some equipment items require a face to face assessment. Grand River Health – Care Center will arrange this for you.
Set up an appointment to speak with a Care Center representative to review your options.