Category Archives: healthcare consulting

healthcare consulting, healthcare management, NF, SNF

Home Health Compare Tools For Medicare Beneficiaries

Home Health Compare Tools For Medicare Beneficiaries as per the Medicare Website

Let me start by giving you some statistics. Do you know experts say that there are 10,000 people now enrolling in the Medicare program every day? As people are living healthier and longer now, this trend is expected to continue for the next fifteen (15) years.

At the White House Conference on Aging in 2015, the following statistics were presented: there were 44.7 million Americans 65 and over and 6 million aged 85 and over in 2013. Also noted was that in 2013, there were 75.9 million baby boomers (people born between 1946 and 1964) accounting for almost one-quarter of the population, per U.S. Census Bureau, Population Estimates. Baby boomers began turning 65 years old in 2011. The White House conference on Aging paper also noted that between 1980 and 2013, the centenarian population more than doubled from 32,194 in 1980 to 67,347 in 2013, per U.S. Census Bureau, Population Estimates.

For those baby boomers who may be new to the Medicare system and may have the need to hire home care agencies to provide Medicare skilled Services in their homes, or, if you have or relatives who may need Medicare skilled services at home, please take advantage of the Medicare website. It has very useful and beneficial information to help keep you informed of your benefits as well as provide you with tools to help guide you. Visit Home Health Compare at https://www.medicare.gov/homehealthcompare

I want to highlight two (2) home health care Tools here for Medicare Beneficiaries:

Tool # 1 is a Home Health Agency Checklist. You can use this tool to compare what you are looking for to meet your needs. This checklist has twelve questions. I am listing a few of the questions. Questions such as: Is the agency Medicare-certified? Is the agency Medicaid certified (if you have both Medicare and Medicaid insurance)? Does the agency offer skilled nursing services or skilled physical therapy? Please note that if the agency you hire is not Medicare-certified and you expect Medicare to pay for your care, Medicare does not pay for skilled care if the agency is not Medicare certified. As a Medicare beneficiary, there are certain specific requirements that the provider must meet in order for Medicare to pay for the services. If you have private insurance, then you see what is covered by your private insurance. Also if you plan to pay privately out of pocket for the whole care or service, then Medicare-certified may not apply. Other questions to ask include whether the agency will meet your language and cultural preferences; whether they offer personal care services like bathing, dressing, etc.; whether they offer support services like helping arrange for meals on wheels; or can they meet the services and hours based on your doctor’s orders; is staff available on nights and weekends for emergencies? You can download the Home Health Agency Checklist form the Medicare website.

Tool # 2 is the Quality of Patient Care Star System “Home Health Compare”- This is a comparison of listed Medicare-certified Home Health Agencies based on the agency’s performance on the Quality Measures on the Home Health Compare Medicare website. The data shows how each home agency used best practices when caring for its patients and patients improved in certain important areas of care.

As stated above people are living healthier and longer now, and some people prefer to have their care being provided at their homes, when the situation arises, as opposed to going to a skilled nursing facility. This obviously is a matter of choice for the patient based on discussion with the patient, the patient’s doctor and family member(s).

 

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healthcare consulting, healthcare management, NF, SNF

Long Term Care Final Rule – October 4, 2016 Federal Register

Did you read some of the preamble in the Federal Register, which included comments from the public, and the long term care community and other stakeholders, as well as Centers of Medicare and Medicaid (CMS)’s response? I downloaded the 185-page Federal Register / Vol. 81, No. 192/ Tuesday, October 4, 2016 / Rules and Regulations. It is interesting to read the comments and CMS responses.

This blog is based on one segment of the comments tom the proposed rule, published July 2015, listed in the preamble. I am assuming this comment was made by professionals from the LTC community.

 

Here goes:

Comment: “Some commenters also expressed concern that CMS may be unreasonably focused on regulating LTC facilities, to the point of not updating regulations and requirements for other types. Commenters also claimed that LTC facilities are “the most regulated industry in America” and that “the nuclear industry is less regulated” than the LTC facility industry.”

The response to this comment is that CMS “recognize that the proposed rule and this final rule are large, detailed documents, and that many individuals relied on summaries to learn about the proposed requirements. We understand that working professionals and family caregivers be very busy, but we are concerned by some of these misinterpretations. Most of the misconceptions fell into three categories: Unfamiliarity with the old requirements, misunderstanding of the proposed requirements, or confusion about which facilities must the LTC requirements. The comments displaying unfamiliarity with the existing requirements are troubling to us…..”

CMS pointed a few of the areas where they said that they are concerned about the confusion based on comments received.

 

These include:

  1.  The resident’s right to choose his or her physician – CMS said that this has been a long standing part of the regulation or requirement
  2. The requirement that a RN be part of the interdisciplinary team – CMS said that this also has been long standing part of the old regulation or requirement
  3. The requirement that a plan of care be established within 48 hours of the resident’s admission – CMS said that this is intended to be a baseline plan of care not a full plan of care.

As long term care professionals we can argue the pros and cons of CMS’ response, but I believe that the points raised should be taken to heart, if concern is expressed about staffs unfamiliarity with the old regulations, and that we do not give detailed attention to the requirements or regulations. Facilities have their staff development directors. Facilities have general orientation when incoming staff are taught policies and procedures, and there are semi-annual or annual mandatory in-services to cover competencies, regulations, policies and procedures. Also there are seminars that staffs attend externally for continuing education that cover other aspects of the regulations. One of CMS observation is that people are busy, and yes we do get very busy in long term care facilities. With our busy work days, I am not sure how often we, as key personnel reference the LTC regulations during our tour of duty? The LTC Regulations Binder sits on the bookcases in our offices.

When regulatory issues or questions do come up during our busy days at our facilities, how do we balance getting to the immediacy of the situation and making sure we are in compliance with what the regulation states? For me during my time as administrator at my facilities, I usually add regulatory compliance to my agenda items for my monthly general staff meetings, and I would have the department director present or the staff development director present.

For the direct caregivers, staffing is sometimes problematic for some facilities, so when there is high turnover, or vacancies, or call-ins, then regularly scheduled in-services are negatively impacted.

Please note that CMS did take comments from provider community into consideration and made some modifications and changes to some proposals for the Final Rule.

 

healthcare consulting, healthcare management, NF, SNF

Seniors and Consumers of Long Term Care – How to Access Information on Long Term Care:

Do you know that the Centers for Medicare & Medicaid Services (CMS) has a wealth or I can say a ton of information on their website (http://www.Medicare.gov) to help consumers know about different aspects of the post-acute and long term healthcare delivery system in the U.S.? This includes skilled home health care, skilled nursing care, nursing care (nursing home care).

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES

Do you know that the U. S. Department of Health &  Human Services (HHS) also has a ton of information on their website (http://www.hhs.gov) for consumers or potential consumers about programs and services for seniors?

ADMINISTRATION ON AGING

Do you know that the Administration on Aging (AOA) also has very useful information on Planning for Long Term Care their website (http://longtermcare.gov) about long term care? I am sure that as a consumer, you have a sense of what you want, you have a sense of what you need, and you have a sense of what questions you want answered; so how do you navigate the system(s) to get the right information to meet your specific needs at a point in time?

Situations change, and needs change at different stages of your life as you grow older gracefully. The good news is that the information is there for you, lots and lots of information. The three website highlighted above are just three of several websites you will access to find the information you are looking for. The not so good news is navigating the websites sometimes becomes a challenge because of the volume of information. Also lots of people procrastinate in accessing long term care information and data until the last minute when they have an immediate need or long-term care.

We are all practicing healthy lifestyles, so we justify the habit to procrastinate in planning for our later years. It is actually so wonderful and beneficial to spend time at the gym, or go for long walks, or exercise at home, eat healthy food, and work hard to maintain our healthy lifestyle. So why else do we procrastinate? People procrastinate for a variety of reasons, some procrastinate for cultural reasons, some for religious reasons, some for financial reasons, some for superstitious reasons, some for their own personal reasons. Whatever the reason, it is advisable to start accessing the information on the long-term care websites, particularly when you don’t need to make an immediate decision right now. Accessing the information helps you understand what your options are, and what paths you may want to take when you get ready to plan for your golden years and for long-term care.

Out of the three websites referenced above, I will recommend that you access the 3 rd website,  http://longtermcare.gov first.

The website states that “Long-term care is a big topic. Use the PathFinder to get to the information most relevant and useful to you now.” At the Home Page, you are asked two questions – question (1) wants to know your age; question (2) wants to know whether you need long-term care now. Your name is not required. Submit your answers.

Finally, taking the steps to plan does not mean that you are planning to go live in an institution or a nursing home. Planning now means that you are participating in the communication, in the information flow, and in this very important decision-making process about your options as to where you prefer to live in your golden years, even if it is your home.

Nora Wellington, MBA, LNHA, Certified INTERACT Champion

CEO / Founder

N Wellington Associates LLC

Contact us for more information or to request a review of your current program: CLICK HERE

healthcare consulting, NF, SNF, Uncategorized

Long Term Care Industry Trend – SNFs & NFs

As we know the major drivers in our industry include:

  • Regulatory Compliance
  • Quality of Care, Quality of Life, and
  • Safe Environment

Knowing that our industry continues to be heavily regulated, I am sure that administrators and their teams continue to work hard on the upcoming changes and new Quality Initiatives mandated by Centers of Medicare and Medicaid (CMS) and other Long Term Care stakeholders. Long term care professionals and administrators continue to place a priority on providing quality care of our residents.

Just to highlight a few of the upcoming changes and Quality Initiatives that are mandated by CMS, and that facility administrators and their teams are preparing for. (1) Five Star Quality rating – there are additional Quality Measures that have been added to both the long stay residents and short stay residents; also Payroll-Base Journal; (2) Reduction in Hospital Readmission – some facilities are coming up with innovative ways to partner with hospitals for better outcomes in reducing transfers to the hospitals; (3) QAPI – Quality Assurance and Performance Improvement – at this time almost all facilities should have converted their QAA to QAPI.

So the question is are we prepared for these upcoming changes and additions to what we do?

Contact us for more information about the Long Term Care Industry Trend CLICK HERE

healthcare consulting, healthcare management, NF, SNF

Tools For Elderly Home Health Care

For the Baby Boomer children and their Elderly loved ones who may need skilled home health care services after hospitalization, I am sure we can all appreciate the tool on the Medicare website that helps us in our decision-making process. Tools For Elderly Home Health Care include This tool, “Home Health Compare”. It helps families and their loved ones compare quality of care in home health agencies.

This tool is found on the Medicare website, http://www.medicare.gov/homehealthcompare/search.aspx . For those who have accessed the main Medicare website (www.medicare.gov) you do know that there is a mountain of information on the site. I believe I can safely say that people need help sometimes, navigating the site for the precise information they are looking for. Also because of the nature of the information, they also need to be very careful in interpreting some of the information and/or data presented.

The tool, “Home Health Compare” is designed for the elderly and their families, for other consumers, and also for the home health care agencies themselves, to compare the quality of care provided to clients. Experts and professionals within both Medicare/Medicaid programs and within the home care industry, have stressed that this tool, Home Health Compare, should not be used as the only determining factor in the decision-making or selection process for consumers.

This site: http://www.medicare.gov/homehealthcompare/search.aspx has a compilation of all Medicare certified home health agencies in the U.S. If you are discharged from the hospital with doctors orders for skilled home care such as skilled nursing care, physical therapy, occupational therapy, Speech therapy, Medical Social Services, and Home Health Aide, this is for you.

Contact us for more information CLICK HERE

healthcare consulting, healthcare management, NF, SNF

CMS Updates for Home Health Care Agencies

CMS Updates Home Health for Health care agencies. Press Release Announcement from CMS on Home Health Quality Measure Per press release public comments will be due October 14, 2016 on a cross-setting post-acute care measure under the Improving Medicare Post-Acute care Transformation Act of 2014 (IMPACT Act) to meet the domain of incidence of major falls, for application in home health. If you are interested in commenting on this you can visit the Public Comment webpage of Centers of Medicare & Medicaid Services (CMS).

This site: http://www.medicare.gov/homehealthcompare/search.aspx has a compilation of all Medicare certified home health agencies in the U.S. If you are discharged from the hospital with doctors orders for skilled home care such as skilled nursing care, physical therapy, occupational therapy, Speech therapy, Medical Social Services, and Home Health Aide, this is for you.

To learn more about CMS Updates Home Health or to schedule a consultation for your organization, CLICK HERE