OT 504 week 1 SS Services and Settings

What is Long-Term Care (LTC)?

an overarching term for services that assist people with daily occupations and ongoing care needs.

Where can LTC services be provided?

Home health programs, community programs, or facility-based settings.

What occupations may LTC support?

Activities ranging from meal preparation to dressing.

Who commonly uses LTC services?

Individuals managing chronic conditions, progressive diseases, cognitive disorders, or increased health risk factors.

What factors increase the likelihood of needing LTC?

Age, sex, family history, and lifestyle choices.

What are the three types of Adult Day Services?

Social, Medical, and Special Purpose.

What is Social Adult Day Care?

Programs focused on recreation, nutrition, socialization, and functional maintenance.

what type of people are used in social adult day care?

for people who don’t have a lot of medical issues but may need assistance with daily activities and social interaction.

What is Medical Adult Day Care called in California?

Community-Based Adult Services (CBAS).

What does Medical Adult Day Care provide?

Health monitoring, rehabilitation, and healthcare services.

what type of person uses medical adult day care?

Individuals with medical conditions like chronic illnesses or disabilities who require health services and assistance.

What is a Special Purpose Adult Day Program?

Programs designed for anyone with cognitive impairment such as individuals with Alzheimer's disease or dementia.

what is an OT role in adult day care services?

it depends on the type of daycare setting and the needs of the participants, which may include providing therapeutic interventions, assessing clients' abilities, and facilitating engagement in meaningful activities.

why can an OT do in adult day care services?

reduce risk for additional injury or decline, management of chronic health conditions, participant and caregiver/family education, exercise programs, fall prevention, activity/leisure skills training, social participation

What are examples of Senior Centers mentioned in the lecture?

City of Glendale Adult Recreation Center and Pasadena Senior Center.

What is an example of an Adult Day Healthcare/Community-Based Adult Services (CBAS) program?

ONEgeneration Adult Day Healthcare Program.

What are examples of Adult Day Programs listed in the lecture?

Conejo Valley Senior Concerns, Easterseals Adult Services Brea, OPICA, WISE & Healthy Aging, and St. Barnabas Senior Services.

What is an example of a Community Center with Senior Programming?

YMCA.

what does PACE stand for ?

Programs of All-Inclusive Care for the Elderly

What is the purpose of PACE?

Medicare or medicaid program that help individuals receive healthcare services in the community instead of a nursing home or healthcare facility.

What three major service areas are included in PACE?

In-home services, community services, and PACE center services.

Is PACE available in every state?

No. PACE is only available in some states that offer PACE under Medicaid.

Can someone enroll in PACE without Medicare or Medicaid?

Yes, if they meet eligibility requirements and pay privately.

What are the eligibility requirements for PACE?

Age 55+, live in the service area, require nursing home-level care, and be able to live safely in the community with PACE support.

What is the minimum age requirement for PACE?

Participants must be at least 55 years old.

What geographic requirement must be met to enroll in PACE?

The individual must live in the service area of a PACE organization.

What level of care must a person need to qualify for PACE?

A nursing home-level of care, as certified by the state.

Can a person who qualifies for nursing home care still live at home while enrolled in PACE?

Yes, if they can live safely in the community with help from PACE services.

What are the four eligibility requirements for PACE?

1. At least 55 years old

2. Live in a PACE service area

3. Need nursing home-level care (state certified)

4. Be able to live safely in the community with PACE support

If a person has Medicaid and enrolls in PACE, do they pay a monthly premium for the long-term care portion of PACE?

No. Individuals with Medicaid do not pay a monthly premium for the long-term care portion of the PACE benefit.

What costs may a person with Medicare but without Medicaid pay in PACE?

A monthly premium for the long-term care portion of PACE. A premium for Medicare Part D prescription drug coverage

What is Medicare Part D?

Medicare's prescription drug coverage program.

Are there deductibles or copayments for approved PACE services, drugs, or care?

No. There are no deductibles or copayments for services, drugs, or care approved by the PACE healthcare team

Who determines which services and care are covered under PACE?

The PACE interdisciplinary healthcare team.

What happens if a person does not have Medicare or Medicaid but wants PACE services?

They can pay privately for PACE services.

Which group generally has the lowest out-of-pocket costs in PACE

Individuals who qualify for Medicaid.

True or False: PACE participants pay copayments for approved healthcare services.

False. Approved services do not have copayments.

True or False: A person without Medicare or Medicaid can still enroll in PACE if they pay privately.

True.

What professionals are commonly on the PACE interdisciplinary team?

Physician, OT, PT, nurse, social worker, dietitian, recreational therapist, personal care attendants, and others.

What are OT responsibilities in PACE?

Assessments, home safety evaluations, DME recommendations, skilled treatment, maintenance programs, and communication with the interdisciplinary team.

What is Home Health?

Skilled healthcare services provided in a person's home.

What skilled services are included in Home Health?

Nursing, OT, PT, and speech-language pathology.

What dependent services may be included in Home Health?

Home health aide services and medical social services.

What is required to receive Home Health services?

Physician orders for skilled intermittent home health services.

What does "homebound" mean?

The person cannot leave home without assistance due to illness, injury, or medical recommendations.

Can homebound individuals leave their homes?

Yes, for infrequent outings, medical appointments, religious services, adult day care, chemotherapy, or dialysis.

What payment model is currently used in Home Health?

Patient-Driven Payment Model (PDPM), which replaced the Resource Utilization Group (RUG) system.

what does PDPM stand for?

patient driven payment model

what does RUG stand for?

resources utilization group

What was the main goal of switching from RUG to PDPM?

focus payment on patient characteristics and clinical needs rather than the volume of therapy services provided.

What are implications of PDPM?

Shorter rehabilitation periods and prioritization of medically complex clients.

Which parts of Medicare commonly fund Home Health services?

Medicare Part A and/or Medicare Part B.

Are Medicare co-pays or deductibles typically required for Home Health services?

No, there are generally no co-pays or deductibles for covered Home Health services.

How much of Medicare-approved rates for Durable Medical Equipment (DME) may clients have to pay?

Up to 20% of Medicare-approved rates.

What does DME stand for?

Durable Medical Equipment.

Besides Medicare, what insurance program may fund Home Health services?

Medicaid/Medi-Cal.

What type of Medicaid services may support individuals receiving Home Health care?

Home and Community-Based Services (HCBS).

What does HCBS stand for?

Home and Community-Based Services.

Who may use Home and Community-Based Services (HCBS)?

Individuals who need support to remain living in their homes and communities rather than institutions.

What other payment source can fund Home Health services?

Private insurance.

What does "out-of-pocket payer" mean?

The client pays for services directly without insurance coverage.

What are the four major payment sources for Home Health services?

Medicare, Medicaid/Medi-Cal (including HCBS), private insurance, and out-of-pocket payment.

What are key OT roles in Home Health?

Home safety assessment, fall prevention, ADL/IADL retraining, chronic disease management, caregiver education, and home exercise programs.

What major Home Health policy change occurred in 2021?

OTs can open Home Health cases and complete initial and comprehensive assessments under Medicare.

What telehealth flexibility exists in Home Health?

One telehealth supervisory visit per 60-day period if in-person visits are not possible.

fieldwork in home health is classified as what?

adult physical rehabilitation

why is the fieldwork in home health setting reclassified as adult rehab?

not all individual receiving home health are older adults, individuals are usually rehabbing after a physical injury or illness, frame of reference, assessments and interventions utilized are rehab specific

You may be exposed to home health in what setting?

CCRcC or community based program

What does SNF stand for?

Skilled Nursing Facility.

What type of care does a SNF provide?

High-level skilled care for medically complex individuals.

Who typically qualifies for a SNF?

Individuals who have been hospitalized, require daily skilled nursing or therapy, are medically unstable, or need medication management.

What Medicare requirement must be met for SNF coverage?

A hospital stay of at least 3 days.

How many days of SNF coverage may Medicare provide?

Up to 100 days.

What happens after 100 days of SNF coverage?

The individual is generally responsible for paying out of pocket.

What are traditional OT roles in a SNF?

ADL training, adaptive equipment training, compensatory strategies, environmental modifications, and behavioral/mental health interventions.

According to Rafeedie, Metzler, & Lamb (2018), what additional areas should OT address in SNFs?

IADLs, quality of life interventions, dignity, freedom of choice, and individuality.

How are SNF fieldwork experiences classified?

Adult Physical Rehabilitation.

what does CCRC stand for?

Continuing Care Retirement Community

What is a CCRC?

A Continuing Care Retirement Community that provides multiple levels of care within one community.

What is the primary goal of a CCRC?

To support aging in place.

what type of care is CCRC?

a form of long term care

What does a tiered approach to aging mean?

Residents can transition between care levels as needs change.

why are CCRCs often expensive?

They typically require entrance fees and ongoing monthly charges.

What levels of care may be available in a CCRC?

Independent living, assisted living, memory care, nursing home care, and hospice care.

SNF = ?.

High-level post-hospital skilled care.

LTC = ?

Umbrella term for long-term support services.

Home Health = ?

Skilled healthcare provided in the home.

PACE = ?

Community-based alternative to nursing home placement.

Adult Day Services = ?

Social, Medical (CBAS), and Special Purpose programs.

CCRC = ?

Aging-in-place community with multiple levels of care.

Most important theme across all settings?

Supporting participation, independence, safety, and quality of life through occupation-based care.