Disposition

Post Acute Care Settings

Assisted Living Facility: private pay, up to 2 ADL assist needs, 3 meals per day, medication administration may cost extra. No routine medical care 

Home Health: Medicare beneficiaries qualify for skilled home health services (nursing, PT, speech/language therapy) if they are homebound, have a skilled need, and are certified by a clinician. 

  • Homebound: must rarely leave the home or require the assistance of another person, an assistive device, or special transportation to be able to leave. A homebound person may still leave the home for medical treatment or appointments, for religious services, or for brief, rare, non-medical reasons. This can be permanent or temporary (i.e after hospitalization/surgery)
  • Skilled need: care that can only be performed by, or under supervision of, a nurse, PT, or SLP. 
  • Medicare Part A and Medicare Part B have full coverage for 30-day payment periods for a 60- day plan of care. 

Skilled Nursing Facility (SNF): Medicare Part A (Traditional) pays 100 days (100% first 20 days, Day 21-100 requires additional co-pay [$209.50/day as of 2025] per benefit period) 

  • Typically, need 3 qualifying midnights inpatient status 
  • Examples of medical/skilled nursing needs: IV meds at least daily, Wound care at least daily, Any TPN/enteral feeds, Ostomy care, Device/drain management 
  • Examples of skilled therapy needs: Gait evaluation, Transfer training, Speech/swallow restoration
  • What should patients expect? 
    • Will see Provider *typically* within 72 business hours and minimum once/30 days 
    • Physician on call 24/7 for emergencies GERIATRICS 159 
    • Day-to-day care provided by nurses and APRN 
    • Nurse patient ratio up to 1:20, CNA ratio up to 1:8 
    • RN in building for 8 hours 5 days per week (LPNs providing around the clock care), nurse ratios are regulated otherwise based on “nursing hours per resident day” and acuity) 
    • RT only in house 24/7 in facilities with patients on vent/trach 
    • Therapy provided Is usually 45-90 minutes daily 

Inpatient Rehab (IPR): Medicare Part A covers 90 days of hospitalization—IPR days count as inpatient hospital days (100% first 60 days, Day 61-90 covered by daily co-pay, 91+days daily copay for up to 60 lifetime reserve days) 

  • Does NOT need 3 qualifying midnights inpatient status 
  • What should patients expect? 
    • See PM&R physician daily 
    • 24/7 nursing care 
    • 3 hours of therapy 5 days a week (PT, OT, SLP, or a combination) 

Long Term Acute Care (LTAC): Medicare Part A covers in the same manner as IPR 

  • Functions like a hospital for patients who no longer need inpatient diagnostics 
  • Commonly used for ventilator weaning, new trachs, complex wound care 
  • What should patients expect? 
    • Physician sees daily, RT, 24/7 nursing 

Discharge Considerations: 

  • Weight bearing restrictions/post-surgical precautions 
  • Wound-care instructions 
  • Date of placement of lines/catheters/drains/tubes 
  • Follow up labs VUMC “Transition of Care to Nursing Home” consult (no age restrictions!)

Geriatrics team NP calls and gives warm handoff to SNF provider (Available Monday-Friday 8am- 5pm; Pager 14009) 

Always be on the lookout for elderly adults at risk for abuse/neglect/exploitation: Legal obligation to notify APS (1-888-277-8366) or https://reportadultabuse.dhs.tn.gov

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