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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.