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Frequently Asked Questions
What is skilled care?
Skilled care is health care provided 24 hours a day by nursing and/or rehabilitation staff to manage, observe, and evaluate your care. It is for residents who need help with more than just daily living activities.
Why would I need skilled nursing or rehabilitation care?
You receive skilled care to improve your condition, maintain your current condition, or prevent your condition from worsening. Skilled care helps you function as independently as possible and/or learn to take care of your health needs.
Does Medicare pay for a nursing home stay?
Absolutely! If you require skilled care and meet the criterion below, Medicare pays for your stay.
How do I qualify for skilled care under Medicare?
ALL of the following must be true:
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You have Medicare Part A (Hospital Insurance)
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You have a “qualifying” hospital stay- an inpatient hospital stay of three overnights, three midnights, or more.
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Your doctor has decided that you need daily skilled care and writes an order for such care.
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You need skilled services for a medical condition that was treated during the qualifying hospital stay -OR- you are admitted to a Medicare-certified skilled nursing facility within a set time period, usually within 30 days of your hospital discharge.
How long does Medicare cover my skilled nursing care?
Medicare uses a period of time called a “benefit period” to keep track of how many days of skilled benefits you use. A benefit period includes 100 days of skilled nursing care plus 60 days of wellness. There is no limit to the number of benefit periods you may have. Once a benefit period ends, however, you must have another three-day qualifying hospital stay and meet the Medicare needs as qualified above.
Is a DNR the same as a Living Will?
No. A Do Not Resuscitate (DNR) is a request from family and/or loved ones to the physician requesting that they do not start basic life support if the patient stops breathing and/or the heart stops beating. A Living Will is developed by the resident and specifies which measures to take or not to take to extend life.
What are Advance Directives?
Advance Directives are documents that state a patient’s choices about treatment; including decisions about refusing treatment, being placed on life support, and stopping treatment at a point the patient chooses. It also includes requesting life-sustaining treatment if that is what is wanted.
More About Advance Directives
The Patient Self-Determination Act
The Patient Self-Determination Act is a federal law that requires hospitals to “provide written information” to adult inpatients concerning “an individual’s right under state law…to make decisions concerning…medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate Advance Directives.” To help patients make these choices, Kansas law provides for Advance Directives. This write-up outlines what Advance directives are and what Kansas statues require. Kansas statues recognize both a living will and a durable power of attorney for healthcare.
Advance Directives
Advance directives are documents that state a patient’s choices about treatment including decisions like refusing treatment, being placed on life-support, and stopping treatment at a point the patient chooses. It also includes requesting life-sustaining treatment if that is wanted.
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There are several kinds of Advance Directives. There are two that are mentioned most often. One is called a living will and the other is called a durable power of attorney (SPOA) for healthcare. Through Advance Directives, patients can make legally valid decisions about their medical treatment.
The Living Will
The Kansas living will is found in a statute titled “The Natural Death Act.” The statute allows any adult to sign a form (related to themselves only) which states that life-sustaining procedures should be withheld or withdrawn when decision making capacity is lost and when such procedures would merely prolong death. Medical procedures deemed necessary to provide comfort or alleviate pain are not considered “life sustaining” under the act.
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For the living will or Natural Death Act Declaration to be effective, two physicians must personally examine the patient and determine that the patient and determine that the patient has a terminal illness. The physicians must agree that death will occur whether or not the medical procedure or intervention is done. The form is not effective if the patient is pregnant.
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The living will must be witnessed by two adults who are not related to, will not inherit from the person making the living will, and are not financially responsible for the patient.
The Durable Power of Attorney for Health Care
A durable power of attorney for health care is a document in which a person gives someone else the right to make decisions about health care for him/her. The person who would make the decisions is known as an “agent” and can be any adult except a physician or other health care provider (including people who work, own, or are directors for hospitals and other health institutions) unless the health care provider is related by blood or marriage to the person signing the document.
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The powers which can be granted include: the power to make decisions, give consent, refuse consent or withdraw consent for organ donation, autopsy or the treatment of any physical or mental condition. The agent may also make all necessary arrangements for hospitalization, physicians or other care, and to request and receive all information and records and to sign releases for records.
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The person singing the DPOA for health care can choose which of the above powers the agent will have. Specific instructions can be given. For example, a specific treatment may be prohibited. Requests for treatment, including life-sustaining care, can also be included. The special instructions allow the DPOA for health care to be specific for each individual’s needs.
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The agent and the health care providers must follow the patient’s expressed wishes. This means that they must also respect any wishes that are stated in the living will. Unless limited, the DPOA for health care allows the agent to make decisions about withholding or withdrawing life-sustaining treatment in all types of illnesses (including comas or persistent vegetative states) and is not limited to terminal illness.
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To be effective, the document must be notarized or witnessed by two adults who are not related to and who will not inherit from the person signing the document.
Here’s How It Works...
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You have the right to information about your medical condition, diagnosis, prognosis and possible treatments. You also have the right to refuse any treatment including lifesaving medical treatment.
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A representative from Salem Home will talk with you about your rights outlined above and your right to make Advance Directives. You also have the right not to make Advance Directives. That is your choice.
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You may choose between DPOA for health care and a living will, or you may have both. The basic difference between the two is that the DPOA for health care designates a particular person to make decisions for you when you are not able to decide for yourself and can cover all health care decisions. A living will states your wishes about withholding or withdrawing life-sustaining care.
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If you choose to make Advance Directives, Salem Home may provide the necessary forms for making a living will or assigning a DPOA for health care. Forms are also available from other resources, such as your local extension office. You do not need a lawyer in order to make an Advance Directive. However, legal advice is certainly appropriate. There are options other than the forms provided in the Kansas statute that are legal and can be used.
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A living will must be witnessed by two adult people. A DPOA for health care may be witnessed or notarized. Although it is not necessary for the forms to be legal, it is recommended that the documents be both witnessed and notarized. This is in case you travel to another state that requires Advance Directives to be notarized.
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If you make Advance Directives, you should discuss them with your physician. You are responsible for making copies available to him/her and all other doctors you may deal with. You should also discuss and share copies of your Advance Directives with your family members. It is always a good idea to keep copies for yourself.
Not-For-Profit Aging Services…
There IS a difference!
When you are searching for an aging-services provider, what matters most is that the direct caregiver is competent and compassionate. This is hard to figure out from a short visit, but one way to help improve your chances of choosing a quality provider is to choose one that is non-for-profit. In nursing home care, numberous studies show that quality is better and staffing ratious are higher in non-for-profit organizations. In assisted living, home health, adult day and other aging services, non-for-profit providers offer a commitment to quality that stems from a mission of service and a history of compassion. Here’s what non-for-profit providers offer:
Values-Driven Management
Not-for-profit providers manage their margin to achieve the mission. Quality is the barometer for their work, not earnings. Many non-for-profits grew out of local religious and civic groups and their managers are part of those organizations. They are not driven by a desire to increase profits for owners or stock prices for shareholders. All proceeds are reinvested in rewarding staff, improving facilities and fulfilling their missions.
Community Oversight
All not-for-profit providers are accountable to a board of directors, whose members volunteer their time and talent, to assure quality services and management. Finances are open for inspection and volunteers help keep management aware of changing community needs and perceptions.
Committed Staffing & Commitment to Staff
We all want a compassionate, knowledgeable and committed person taking care of our loved one. And we want to know that our caregivers are receiving a decent wage and important benefits for the hard work they do. Not-for-profit organizations know that, and invest their resources to make that a reality for every person they serve. Research shows that these providers hire more direct workers, provide better benefits packages, offer them more educational opportunities and evaluate their satisfaction more than their counterparts. And that’s what makes for great care and great caring.
Stability
Long-term care involves creating lasting relationships. Many non-for-profit providers have been in their communities for decades and offer the stability that will give you peace of mind. The groups are less likely to sell or close because of economic fluctuations.
What is the Non-For-Profit Difference?
Our nation’s non-for-profit housing, community service and long-term care providers are on a mission. Their objective: to provide the highest quality and most compassionate care to those they serve. The good nuews for older people, persons with disabilities, their families and the entire aging-services profession is that they are succeeding.
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At a time when non-for-profit aging-services organizations are under intense government and media scrutiny, non-for-profits are showing by example that there is a difference when it comes to quality.
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By continuing a tradition of mission-driven, consumer-centered management and competnt, hands-on care, not-for-profits set the standard in the continuum of housing, care and services for the most vulnerable Americans.
Mission-Driven Values...
Not-for-profit organizations manage their financial resources in accordance with their missions. Many of these housing and service providers were founded by faith-based and civic groups of rich tradition, and their long-standing values are reflected in their governance and management.
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They are not driven by daily pressure to increase their “bottom line” for owners, investors or shareholders. The pressure to make a profit is felt the most by the consumer, due to an inevitable array of cost-cutting reductions in staffing, services, supplies and overall quality.
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Quality, not earnings, is the barometer of a not-for-profit organizations’ efforts, All proceeds in a not-for-profit are reinvested in improving the physical environment, serving more people, offering more and better accommodations and services and, ultimately, fulfilling the organization’s mission.
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Claire Gaudiani (Yale University), author of The Greater Good (2003), often speaks of generosity within the American culture. Translating our mission-driven, non-for-profit values into policies, procedures and daily operations is clearly and enduring example of generosity in action.
Accountability...
Not-for-profit organizations are accountable to voluntaqry boards of directors, who donate their time and talent to ensure that ethical management, financial integrity and quality services are maintained. Not-for-profit finances are always open for public inspection; with such information readily available on the Internet, the information is literally at our fingertips.
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Volunteer board members also have their fingers on the pulse of evolving local community needs, thereby bridging internal and external communities. Not-for-profits have a responsibility to be active, contributing members of their localities. Social accountability opportunities and measures continually help non-for-profits not only to identify but also to exercise leadership in meeting local community needs.
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We all desire compassionate, knowledgeable and dedicated staff overseeing the needs of our loved ones. Not-for-profit organizations recognize that staff satisfaction and commitment are related to having sufficient numbers of staff, fair wages and benefits, flexibility when needed, continuing education/growth opportunities and an environment of respect.
Articles/Research that Support our Assertion
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January 4, 2012: The New Your Times Old Age Blog: Happier Staffers at Nonprofit Nursing Homes
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November 30, 2011: McKnights Long-Term Care News: For Profit Nursing Homes Provided Poorer Quality Of Care, Study Asserts
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January 12, 1995: Making the Case for Nonprofit Healthcare. A speech by Cardinal Joseph Bernardin to the Harvard Business School of Chicago
A Sign of Excellence...
Salem Home has won the coveted PEAK Award, granted to only select retirement communities by the Kansas Department on Aging and Disability Services... Twice! Salem Home received the awards for offering excellent alternatives for residents.
Related Links
Refer to the links below for any questions you may have regarding long-term care services and aging.
The goals of KDADS are to continue to deliver quality Older Americans Act services; to keep older adults and persons with disabilities at home and independent as long as possible; to keep them safe by ensuring that those who provide their care are qualified and tested; to support an integrated and coordinated Medicaid system to help those the agency serves; and to provide Kansans who need behavioral health services with appropriate care so they can live productive and fulfilling lives.
The Kansas Foundation for Medical Care, Inc. is a not-for-profit organization focused on improving healthcare quality. They ensure that Medicare and Medicaid patients receive appropriate and quality healthcare. KFMC, Inc. also educates consumers so that they can make informed decisions about healthcare.
LeadingAge Kansas is an association of 160 not-for-profit and other mission-driven aging services providers dedicated to serving the needs of aging Kansans. We advance policies and promote practices and learning that empowers our members to help seniors live fully as they age. Our members serve nearly 25,000 seniors in Kansas each day.
Kansas Adult Care Executives (KACE) is the only professional association dedicated to serving the unique needs of the Adult Care Executive. KACE is the Association that examines the issues and challenges of the long-term care industry from the administrator’s perspective. KACE is dedicated to providing the education, skills, and information the professional administrator needs to stay ahead in our rapidly changing field.
Hillsboro Community Hospital is committed to providing high-quality medical care in a friendly hospital environment. Hillsboro Community Hospital is a 15-bed critical access hospital providing high-quality care distinguished by patient satisfaction. feedback/results.
The mission of Center for Medicare & Medicaid Services (CMS) is to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries.
The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.