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By Tim Lane, Director of Rehab, PAHCS Staff members at Koronis Manor and Hilltop Care Center are dedicated to returningpatients to their previous level of functioning and going home. A common misconception heard from people is "I don't want to go to a nursing home. You go there if you're going to die." In fact, 50% of patients admitted to the nursing home are discharged in less than 90 days. A majority of those return home.
Tim Lane (right) and Sarah Scepaniak (second from left) assist a patient with therapy. In order to remain in the hospital, a patient's condition must be followed daily by a physician. This forced hospitals to become cost-efficient since no matter how expensive tests and treatment were, the reimbursement was a fixed amount. The net effect was to decrease the number of days a patient is in the hospital. The Center for Disease Control and Prevention (CDC) recently reported that for elderly patients, hospital stays in 2001 averaged 5.8 days versus 12.6 days 31 years ago in 1970. Even though a patient is medically stable, they are sometimes not functionally stable. They may not be ready to resume the same level of activity as they had prior to an illness or surgery. As a result, they aren't quite ready to return home. The government recognized that it would be creating significant medical problems by discharging patients home before they were ready. Instead, they concluded, it would be less costly to pay for temporary nursing home care as a place to heal and recover. Then patients could continue to receive the same therapies they had started during their hospital stay. Under the present Medicare program, a patient needing skilled care could receive up to 100 days of government assistance in paying for nursing home care. In fact, for the first twenty days, all room, board, and therapy services are covered at 100% of the cost. There is a $105 per day copay after twenty days, then Medicare pays the remaining allowable charges. In most cases, a secondary insurance policy or Medicaid will pay the copay amount.
Included in skilled care are: When patients are admitted to the hospital, the social worker is involved in an assessment to determine whether the patient is eligible for daily skilled services - for example, Medicare Part A. After a patient is transferred to Koronis Manor or Hilltop Care Center, therapists complete an assessment to decide if he or she has good potential to improve their level of functioning. Therapists then attempt to stimulate the same routines the patient has at home. Patients and therapists then work together to regain skills required to return home safely. The therapy team welcomes input from the resident's family to assure that the return to home is a success. In most cases the physical and/or occupational therapist will make a home visit with the resident to confirm that the unique layout of a patient's home can be managed safely. The therapist consults with nursing staff, social worker, and physician for any support services that will be helpful once the patient returns home. The changes in Medicare can work to benefit patients in their desire and motivation to return home. Knowing that going to the nursing home after an illness, injury, or surgery can mean safe recovery, patients can feel better about this transitional stop before returning home. Feel welcome to contact PAHCS Social Worker Lois Roback, or Tim Lane, Director of Rehab Services, for any specific questions or concerns at 320-243-3779.
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This trend began with the advent of the Diagnosis Related Groups (DRGs) in 1984. The federal government set up 483 different diagnosis groups and based payment to hospitals on what they determined to be medically necessary to treat a patient with a particular diagnosis. Today we have about 510 DRGs.