TOC/Disposition Urinary Incontinence and Foleys

Post-Acute Care Settings

• ALF: private pay, up to 2 ADL assist needs, 3 meals per day, medication administration may cost extra (typically lay person/med tech). No routine vitals, nursing assessments, labs, medical care on site
• 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 via face to face visit within 90 days before the start of care or 30 days after the start of care
  • Homebound: a person must rarely leave the home or require the assistance of another person, an assistive device, or special transportation to be able to leave the home. A homebound person may still leave the home for medical treatment or appointments, for religious services, or for brief, rare, nonmedical reasons. Under Medicare guidelines, individuals may be temporarily homebound (recovering from hospitalization) or permanently homebound.
  • Skilled need: care that can only be performed by, or under supervision of, a nurse, PT, or SLP. Once this need is established, additional skilled inhome services may be provided such as OT or SW
  • <8 hours per day and 28 or less hours each week
  • Medicare Part A and Medicare Part B full coverage for 30 day payment periods for 60 day plan of care.
• SNF: Medicare Part A (Traditional) pays 100 days (100% first 20 days, Day 21-100 requires additional co-pay [!$209.5004/day as of 20254] per benefit period)
  • Who qualifies?
    • Needs 3 qualifying midnights inpatient status (unless a part of an ACO, then waiver may be possible)
    • 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
      • Acute management of exacerbation of chronic disease
      • New use of oxygen or RT treatments
      • Examples of skilled therapy needs:
        • needs for/ability to do 1 hour therapy 5 days per week
        • Gait evaluation
        • Transfer training
        • ADL training
        • Speech/swallow restoration
        • Cognitive training
        • Therapeutic treatment to ensure patient safety
    • What should patients expect?
      • Will see MD *typically* within 72 business hours and 1-2 times/14 days
      • Physician on call 24/7 for emergencies
      • 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 7 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 minimum: 1 hour 5 times per week
      • Medications can take up to 12 hours to be delivered upon patient arrival to SNF at the med deliver portion
      • Medications are delivered once daily (often in pillpacks)
• Inpatient Rehab: 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 copay, 91+days daily copay for up to 60 lifetime reserve days)
  • Who Qualifies?
    • Does NOT need 3 qualifying midnights inpatient status
  • What should patients expect?
    • Will see PM&R physician daily
    • 24/7 nursing care
    • 3 hours of therapy 5 days a week (PT, OT, SLP, or a combination)
• LTAC: Medicare Part A covers 90 days (100% first 90 days but takes away from inpatient hospital days like IPR, can also use 60 lifetime reserve days)
  • 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