HCA-DQ8-Reply

Please reply to Dolores Mahoney– Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.

As a Case Manager, hospital discharge planning begins at the time of admission.  The Hospital Case Manager will interview the patient to determine the patient’s current living situation, support system, current services, available resources, and goal for discharge.  Discharge options are discussed, and plans are made.   If it is determined that a patient will need to be placed in a long-term care facility upon discharge, several steps must be taken.  The first step is it determine if the patient will meet Medicaid criteria for long-term care.  The next step is to determine what facility the patient would like to live in, schedule onsite visits for family, schedule a preadmission screening, and determine if the facility has Medicaid beds available. 

General qualifications for Medicaid include residing in the state in which you are applying for the benefits, meeting financial qualifications, being age 65 or greater, being permanently disabled, or blind, and having a functional need for long-term care. 

In Oklahoma, Medicaid is called SoonerCare and is administered by the Oklahoma Department of Human Services.  To qualify for immediate Nursing Home Medicaid eligibility, a single person has an income limit of $2,523 a month, and a $2,000 asset limit which includes cash, stocks, bonds, investments, IRAs, savings, checking accounts, and second homes.  One’s home is not included in the asset limit unless the value in equity exceeds $636,000.  A married couple has an income limit of $5,046 per month and a $4,000 asset limit.  A married couple with one spouse applying has an income limit of $2,523 per month for the applicant, and an asset limit of $2,000 for the applicant, and $137,400 for the non-applicant (American Council on Aging, 2022). 

        Oklahoma has a look-back period of 60 months immediately preceding the date of the Medicaid application to ensure no assets were sold or given away under fair market value.  For those individuals who do not meet the eligibility requirements due to being over the income limits, there are other ways to qualify.  These include Income trusts and asset spend down (American Council on Aging, 2022).

If this patient is hospitalized in acute care for three days, upon discharge she could be transferred under her Medicare to a long-term care facility that accepts Medicaid pending patients.  Medicare will pay for a skilled care facility at 100% for the first 20 days and then at 80% on days 21 to 100 when a skilled need has been identified.  This would provide her with 100 additional days of skilled nursing, physical, occupational, and speech therapy services before she transitioned to a Medicaid long-term bed.

Many individuals and their families who have loved ones in long-term care facilities are unaware of the Medicaid estate recovery program.   This program attempts to seek reimbursement of care costs for long-term Medicaid beneficiary patients by seizing the estate when their loved one passes.  This is important if their loved one has a home that they plan on inheriting. 

References

American Council on Aging. (2022, January 25).  Oklahoma Medicaid eligibility: 2022 income & asset limits. MedicaidPlanningAssistance.org.  https://www.medicaidplanningassistance.org/medicaid-eligibility-oklahoma/

Please reply to Josiah Nicholas– Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.

Probably the most important aspect of advocating for patients is ensuring that they are aware of all of their rights. This is more than just the usual patient’s rights that every hospital posts for patients to read. Part of the nuance of patient’s rights is being able to receive timely and understandable information on their disease process as well as treatment options that the team is either considering or has already made. Many patients in the acute care setting may feel rushed or like they do not have enough time with their doctors; nurses need to advocate for patients by ensuring that the patient is being given opportunities to both talk with and follow up with their doctors should questions or confusion arise. This is especially important when it comes to the elderly population. With the added stress of financial burdens an elderly person does not need to suffer due to having poor communication with their medical team. If possible I would make sure that I was present for physician rounding to assess the level of understanding of the patient and the quality of the communication being given by the team. I would also help the patient get in touch with loved ones if they wanted them to be involved with communication with the medical team; if the patient wanted a family member to listen in on team rounding along with the nurse then this could help enhance the level of communication as well as being able to help organize aftercare. In addition, I would reach out to the medical team if the patient thought of any questions after meeting with them; I would make sure that I delivered messages to the physicians in a timely manner. I would also make sure that the patient was being made fully aware of her treatment options by providing information on different long term care facilities that are close to her friends and family. In order to make sure that the patient gets the coverage she needs I would reach out the utilization nurse manager as well as the hospital social worker. This is important because they will have extensive information on what the patient’s insurance covers as well as what resources are available in order to supplement her insurance.

According to the Centers for Medicare and Medicaid Services (n.d.) Medicaid covers room, board and medical services for elderly or disabled that are of low income; the service is bundled and facilities that receive Medicaid funding need to pass certain standards of care. In theory it is good that the government both funds and regulates institutions that provide long term care to disabled/elderly persons. Weech-Maldonado et al. (2019) report that nursing homes that have a high amount of Medicaid covered residents are sometimes likely to suffer due to cutting costs with things like nursing staffing levels. It is no secret that the prospect of putting a loved one in a nursing home or even living there oneself is a scary thought.

Rojas et al. (2022) claim that many long term care facilities are driven primarily to make money and often find ways to bypass certain financial and policy constraints. So far, I do not think that the problem of elder abuse and providing poor care in nursing homes has been solved yet. Working in a nursing home is always something that am glad that I did to get perspective on the varying levels of quality of care that elderly and disabled patients receive. I think that it is common knowledge that nurses prefer not to work in nursing homes. This seems like a dilemma that needs to be solved one day.

Centers for Medicare & Medicaid Services. (n.d.).  Institutional Long Term Care. Medicaid.gov.  https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/index.html

Rojas, H. F., Ma, L., Sun, S., Steele, R., M.S., & Coffin, Janis, DO,F.A.A.F.P., F.A.C.M.P.E. (2022). Should Long-Term Care Facilities be Considered Cost-Efficient in Future Medicare and Medicaid Financial Policies?  The Journal of Medical Practice Management : MPM, 37(6), 273-277. https://aspenuniversity.idm.oclc.org/login?url=https://www-proquest-com.aspenuniversity.idm.oclc.org/scholarly-journals/should-long-term-care-facilities-be-considered/docview/2702260842/se-2

Weech-Maldonado, R., Lord, J., Pradhan, R., Davlyatov, G., Dayama, N., Gupta, S., & Hearld, L. (2019). High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance: The Journal of Health Care Organization, Provision, and Financing.  Inquiry, 56 https://doi.org/10.1177/0046958018825061