Services and Settings

Skilled Nursing Facility (SNF)

provides high level care

for people who have just been hospitalized

require daily skilled care from skilled nursing or therapy

more medically unstable

requires assistance with medication management

identified as adult physical rehabilitation

Skilled Nursing Facility (SNF) Eligibility

hospital stay for 3+ days

has a medical condition treated during 3 day hospital stay or started while getting care in a SNF for a hospital related condition

may get to 100 days of coverage (after → pay out of pocket)

Long Term Care (LTC)

provides assistance in daily occupations and covers a range of individual needs

provided in home health programs, community programs or facility based care

large range of methods of reimbursement

Long Term Care (LTC) Eligibility

individual who need assistance with:

managing chronic or progressive health conditions

managing cognitive disorders

people with increased risk factors (age, sex, family history, lifestyle choices)

Home Health

skilled (nursing, OT, PT, SLP) or dependent (aide, medical social services) health care services provided in the home environment

Home Health Eligibility

requires physician orders for skilled, intermittent home health services

Medicare approved home health agencies

home bound

Home Health Payment

patient driven payment model

Medicare part A or B

Medicaid/Medical (home and community based services)

private insurance

out of pocket

Patient Driven Payment Model (PDPM)

shorter period of rehabilitation

priority to complex clients discharged from hospital or inpatient rehabilitation units

Medicare Part A or B

no co-pays or deductibles

clients cover up to 20% of approved rates for durable medical equipment

Program of All Inclusive Care for the Elderly (PACE)

medicare and medicaid program that helps people meet their health care needs in their community instead of going to a nursing home or other care facility

Program of All Inclusive Care for the Elderly (PACE) Eligibility

only available in some sites that offer, under medicaid

at least 55 years old

lives in the service area

need a nursing home level of care (as certified by the state)

are able to live safely in the community with the help of PACE

Program of All Inclusive Care for the Elderly (PACE) Payment

medicaid: no monthly premium

medicare: monthly premium to cover long term care, premium for medicare part d drugs, no deductible or copayment for any drug, service or care your health care team approves

put of pocket if you don’t qualify

Adult Day Services

social

medical

special purpose (common diagnoses groups, that have some medical aspects too)

Continuing Care Retirement Communities (CCRC)

tiered approach to aging

supports aging in place

can be expensive (have to pay out of pocket)