Search these blogs



Getting Medicare to Pay for Nursing Home Care -

Getting Medicare to Pay for Nursing Home Care - Getting Medicare to Pay for Nursing Home Care


don't let the nursing home business office tell you that Medicare can no longer cover room and board for your loved one because he or she isn't "improving."

 The Improvement Standard is not—and never has been—a valid reason for nursing homes to cut off Medicare nursing home days. Medicare's nursing home payment manual makes it clear that "[e]ven in situations where no improvement is expected, skilled care may nevertheless be needed." This manual was published in 2014, but some nursing homes haven't adapted to help chronic patients get access to the Medicare coverage they are eligible for. Many business offices rely on software programs to manage their billing, and those programs haven't caught up to the Jimmo v. Sebelius court decree that was issued on January 24, 2013.

 Articles About Skilled Nursing Care

    Who’s Who in Skilled Nursing: Staff Caregivers Should Get To Know

    When a loved one moves into a skilled nursing facility the flurry of new faces can be confusing for seniors and their family members. Who on the staff should you get to know? Who's responsible for which aspects of your loved one's care?

 Robin Maibach, Admissions and Social Services Director at Lourdes-Noreen McKeen, a retirement community in West Palm, FL, highlights the staff members that residents of skilled nursing facilities and their family members are most likely to interact with:

Charge nurse

    Other names: head nurse, staff nurse
    What they do: The charge nurse in a skilled nursing setting is there to oversee the nursing staff that helps senior residents with various health issues that may come up. These health care professionals generally work in eight-hour shifts to ensure that a senior has round-the-clock access to medical care. This means that, in any given 24-hour period, there may be three different people who take turns performing the role. Maibach advises caregivers to try and become familiar with the nurses assigned to the daytime shifts (generally 7:00 am-3:00 pm and 3:00 pm-11:00 pm)
    When to go to them: An elderly resident should contact the charge nurse when they have a health concern that they wish to seek treatment for. A senior who is not feeling well, or who has a cut, blister, or pain that needs treatment and they don't know what to do, should seek out the charge nurse on duty or contact an available CAN (see below for description).

Social worker

    Other names: case manager, gerontological social worker
    What they do: Skilled nursing facilities generally have one social worker assigned to each individual unit. These staff members exist to handle the non-nursing related issues that can crop up.
    When to go to them: If a senior is experiencing problems with unmet needs, or financial concerns, they should seek the help of their social worker to resolve the problem. Maibach says that a social worker can help an elderly resident with everything from getting broken hearing aid fixed, to helping a depressed resident gain access to a mental health professional. They also are trained to help residents navigate the complex processes underlying billing and financial aid.

Activities director

    Other names: recreation director, lifestyle coordinator, social director, life enrichment director, activity program coordinator
    What they do: An activities director is usually a full-time employee who is responsible for developing and implementing plans for various engagement activities and outings for senior residents.
    When to go to them: A senior (or family member) who has questions regarding a particular activity or program offered by the facility—or an idea for one—should consult the activities director.

Medical director

    Other names: N/A
    What they do: The medical director is responsible for reviewing the care that a resident is currently receiving from their personal doctor and make sure that their medical needs are being met by the medical professionals in the assisted living community. They are constantly in contact with the community's nursing staff as well as an individual resident's primary care physician.
    When to go to them: According to Maibach, medical directors don't often interact directly with seniors and their caregivers. Questions regarding an elder's health are generally fielded by either the community's nursing staff or their personal doctor, not the medical director.

Certified nursing assistant (CNA)

    Other names: nursing aide, care manager, licensed practical nurse
    What they do: According to Maibach, CNAs provide the bulk of hands-on care for seniors in skilled nursing facilities. They can assist an elder in performing activities of daily living, including: bathing, grooming, eating, toileting, etc.
    When to go to them: A senior should seek the services of a CNA if they require help with tasks relating to personal hygiene, eating or incontinence.

Dietary coordinator

    Other names: dietary assistant, food service coordinator, clinical nutrition manager
    What they do: Depending on the facility, a dietary professional may or may not be involved in the day-to-day preparation and serving of food to senior residents. Sometimes they will act in a strictly advisory capacity, helping design menus and meals to fit a senior resident's specific requirements.
    When to go to them: Typically, the family members of seniors living in skilled nursing facilities will play a significant role in helping a senior communicate their menu preferences to the dietary coordinator. If a senior has particular dietary restrictions or questions regarding the preparation or serving of food, they should solicit the help of the dietary coordinator or an available CNA.


    Other names: custodial service, maintenance staff
    What they do: Senior residents in a skilled nursing facility are not responsible for cleaning their own rooms or doing their own laundry. Room cleaning and linen changes are the daily responsibility of the housekeeping staff.
    When to go to them: A senior who has an accident or needs something in their room cleaned should contact the housekeeping staff for assistance.

    What’s the Difference Between Skilled Nursing and a Nursing Home?

    When it comes to senior living, many terms get thrown around: skilled nursing and nursing homes are two examples. Oftentimes, the terms are used interchangeably. The confusion leaves many caregivers asking, “is there a difference?"

    Tracking Alzheimer's or Dementia in Senior Living Communities
    Staff at assisted living and skilled nursing facilities is prepared to monitor your parents' well-being as dementia progresses. You should expect them to track your parent's condition in a variety of ways.


Dying from Dementia -- Dementia Suffering Often Unnecessary | Alzheimer's Reading Room

Original content +Bob DeMarco , the Alzheimer's Reading Room
Posted by Bob DeMarco at Wednesday, February 11, 2015

Dying from Dementia -- Dementia Suffering Often Unnecessary | Alzheimer's Reading Room: The "Choices, Attitudes and Strategies for Care of Advanced Dementia at the End-of-Life," or CASCADE, study prospectively followed the clinical course of 323 nursing home residents with advanced dementia living in 22 Boston-area nursing homes for up to 18 months.

At the final stage of the disease, patients had profound memory deficits such that they could not recognize close family members, spoke fewer than six words, and were non-ambulatory and incontinent.

Over the course of the study, 177 patients died.

The researchers found that the most common complications were pneumonia, fevers and eating problems, and that these complications were associated with high six-month mortality rates. Uncomfortable symptoms, including pain, pressure ulcers, shortness of breath, and aspiration, were also common and increased as the end of life approached.

Dr. Mitchell, an Associate Professor of Medicine at Harvard Medical School, said that she and her team found that while 96 percent of the patients' health-care proxies believed that comfort care was the primary goal of care for their loved one, nearly 41 percent of patients who died during the study underwent at least one intervention, including hospitalization, an emergency room visit, intravenous therapy, or tube feeding, in the last three months of life. However, patients whose health-care proxies understood the clinical course of the disease were less likely to receive aggressive treatment near the end of life.

"Many of the patients in our study underwent interventions of questionable benefit in the last three months of life," says Dr. Mitchell. "However, when their health-care proxies were aware of the poor prognosis and expected clinical complications in advanced dementia, patients were less likely to undergo these interventions and more likely to receive palliative care in their final days of life."

At the beginning of the study, 81 percent of the proxies felt they understood which clinical complications to expect in advanced dementia, yet only one third said that a physician had counseled them about these complications.

Currently, more than 5 million Americans suffer from dementia, a number that is expected to increase by almost three-fold in the next 40 years. A recent study by Alzheimer's Disease International estimates that the number of people with dementia worldwide will exceed 35 million by 2050. Dementia is a group of symptoms severe enough to interfere with daily functioning, including memory loss, difficulty communicating, personality change, and an inability to reason. Alzheimer's disease is the most common form of dementia.

"A better understanding of the clinical trajectory of end-stage dementia is a critical step toward improving the care of patients with this condition," says Dr. Mitchell. "This knowledge will help to give health-care providers, patients and families more realistic expectations about what they will confront as the disease progresses and the end of life approaches."

The CASCADE study was funded by the National Institutes of Health.

Scientists at the Institute for Aging Research conduct rigorous medical and social studies, leading the way in developing strategies for maximizing individuals' strength, vigor and physical well-being, as well as their cognitive and functional independence, in late life. Hebrew SeniorLife, an affiliate of Harvard Medical School, is a 106-year-old organization committed to maximizing the quality of life of seniors through an integrated network of research and teaching, housing and health care.

How Alzheimer's Spreads Throughout the Brain | Alzheimer's Reading Room

How Alzheimer's Spreads Throughout the Brain | Alzheimer's Reading Room:
                 Title: How Alzheimer's Spreads Throughout the Brain

What is the Difference Between Alzheimer's and Dementia?


Certified Nursing Assistant (CNA): End-of-Life Care in Long-Term Care (Research, Video 1:51)

Hospice and Nursing Homes Blog Frances Shani Parker, writes this blog. Research on the CNA preparedness role included in-person interviews with 140 CNAs about their experiences regarding residents' deaths. These experiences included characteristics such as care preferences, status perceptions of residents, and the caregiving context with emotional and informational preparedness.

These were the results:

 1) CNAs who reported that residents were "aware of dying" or "in pain" expressed higher levels of both emotional and informational preparedness.

2) CNAs who endorsed an end-of-life care preference of wanting all possible treatments regardless of chances for recovery were likely to report lower emotional preparedness.

3) More senior CNAs, both in regard to age and tenure, reported higher preparedness levels.

4) Greater support from coworkers and hospice involvement were associated with higher levels of both facets of preparedness, the latter in particular when hospice care was viewed positively by the CNAs.

This research concludes that more information about the status of residents and more exchange opportunities within the care team around end-of-life care-related challenges may help CNAs feel more prepared for residents' deaths and strengthen their ability to provide good end-of-life care. Creating this kind of context requires ongoing commitment, implementation, and monitoring.