Simply Type In Your Response After Each Short Answer Questio

Simply Type In Your Response After Each Short Answer Question For M

1. In some situations, there can be limited healthcare options and access specifically for individuals with Medicaid. Explain one of those reasons.

2. If you are caring for someone with dementia, it is important to know their life story. Explain what that means.

3. You are helping a resident and his son fill out paperwork for admission to the nursing home when they begin asking you questions about Advance Directives. In particular, they are asking questions about the Kentucky Living Will and the EMS Do Not Resuscitate (DNR) forms. Write below how you would explain each of these documents to the resident and his son. You must, at minimum, include their primary purpose, differences, and any similarities.

a. Primary purpose of each:

b. Differences:

c. Similarities:

4. Nursing facility care is typically “need” driven and not “want” driven. Explain what is meant by this.

5. What is the Medicaid case mix rate for St. Joseph’s Home for the Aged?

6. Mr. Wright was discharged from the hospital and admitted as a resident at McCreary Health and Rehabilitation Center. He has both Medicare and Medicaid. His stay is currently covered under Medicare Part A as a skilled resident because he is receiving occupational therapy 5 days a week for a total of 500 minutes per week (rehabilitation very high) plus tracheostomy care (an extensive service). He has an ADL score of 8. Fill in the following information for Mr. Wright’s current reimbursement:

a. RUG Category:

b. RUG IV:

c. Daily Rate:

7. Mr. Wright is no longer receiving any type of therapy but continues to receive tracheostomy care. His ADL score is the same. Fill in the following information for Mr. Wright’s new reimbursement:

a. RUG Category:

b. RUG IV:

c. Daily Rate:

8. Mr. Wright has exhausted his Medicare Part A benefits and will now have his nursing facility stay paid by Medicaid. What rate, per day, will the facility now receive for Mr. Wright’s stay? What is the difference in reimbursement rate for Mr. Wright, per day, from his first daily rate to today? What will be the loss/gain in revenue for the next 30 days?

9. Explain in detail what you have learned about Medicare and payment or coverage for long-term care services. Include at least five specific points such as eligibility, covered services, components of plans, funding sources, and oversight.

10. What is the difference between each of the following in Kentucky? Provide at least two correct differences for each:

a. Two differences between assisted living and nursing facility care:

b. Two differences between adult day care and assisted living:

Paper For Above instruction

Medicaid, a joint federal and state program, provides healthcare coverage to certain low-income individuals, including some populations with limited access to healthcare options. One primary reason for limited access is the variable availability of Medicaid services across different states and regions. Often, Medicaid offers limited provider networks, which can restrict individuals' choices in physicians and healthcare facilities. Additionally, Medicaid reimbursement rates are typically lower than those of Medicare or private insurance, discouraging some providers from accepting Medicaid patients, thus limiting options for enrollees. This creates disparities in access, especially in rural or underserved areas where healthcare providers may be scarce or unwilling to participate in Medicaid, leading to challenges in obtaining timely and comprehensive healthcare services.

For caregivers of individuals with dementia, knowing their life story is crucial as it provides insight into their personal history, values, preferences, and identity. This knowledge helps caregivers create a more personalized and respectful care plan, fostering trust and emotional connection. It allows caregivers to understand behaviors in context, manage symptoms more effectively, and promote meaningful activities based on the individual's past interests and experiences. Moreover, knowing the person's life story can be comforting and validating for the individual with dementia, helping maintain their sense of self amid cognitive decline.

Advance Directives are legal documents that specify an individual’s preferences regarding medical treatment if they become unable to communicate. The Kentucky Living Will is a type of advance directive that expresses a person's wishes regarding life-sustaining treatments and medical interventions, intending to guide healthcare providers and family members in respecting these wishes. Its primary purpose is to prevent unwanted medical procedures and ensure end-of-life care aligns with the individual’s values. The EMS Do Not Resuscitate (DNR) form, on the other hand, is a specific directive used by emergency medical services to avoid resuscitative efforts such as CPR in case of cardiac or respiratory arrest. While both documents address end-of-life decisions, the Living Will guides ongoing medical treatments in a healthcare setting, whereas the DNR form instructs emergency responders not to perform resuscitative measures. Both share the goal of honoring the individual's wishes concerning medical interventions, but they differ in scope and application, with the Living Will providing broader directives and the DNR being a specific, actionable request for emergencies.

Nursing facility care being “need-driven” means that the services provided are based on the individual's healthcare requirements rather than personal desires or preferences. It emphasizes that admission and the level of care are determined by medical necessity, such as assistance with activities of daily living or management of chronic conditions. Conversely, “want-driven” care would cater to personal preferences that are not medically necessary. For example, a person may wish to receive certain recreational activities or specific amenities, but these are considered supplementary in need-based care models. This distinction ensures resources are allocated efficiently, prioritizing those with genuine health needs over those seeking non-essential services.

The Medicaid case mix rate for St. Joseph’s Home for the Aged is a specific reimbursement figure determined by the facility's resident acuity and resource utilization, usually provided in the supplemental documents. According to the provided data, the rate is ____________. (Insert Rate)

Mr. Wright's current reimbursement details, when receiving extensive therapy, place him in a RUG (Resource Utilization Group) Category of ________________, with a corresponding RUG IV code of ________, and a daily rate of _____. When therapy services are discontinued, his RUG Category shifts to ________________, with appropriate RUG IV and daily rate adjustments reflecting his decreased intensity of care. These classifications are used to determine the reimbursement based on the level of services provided.

Since Mr. Wright has exhausted Medicare Part A benefits, the facility receives a Medicaid rate, which, based on current Medicaid reimbursements in the facility's region, is typically ________ per day. The difference between his initial daily rate (when he first entered the facility) and the Medicaid rate is approximately _________. Over the next 30 days, the total revenue loss or gain can be calculated by multiplying the daily rate difference by 30 days, accounting for any change in services and care level. This financial shift impacts the facility’s budgeting and resource allocation, emphasizing the importance of understanding reimbursement mechanisms.

Medicare provides coverage primarily for short-term, post-acute care services, with eligibility typically requiring a prior hospital stay of at least three days and the need for skilled nursing or therapy services. The program covers services such as skilled nursing, physical, occupational, and speech therapy, in both inpatient and outpatient settings. However, Medicare does not generally cover long-term custodial care, which includes assistance with daily activities over extended periods. The funding for Medicare comes from payroll taxes under the Federal Insurance Contributions Act (FICA), with oversight by the Centers for Medicare & Medicaid Services (CMS), which sets eligibility criteria, standards for providers, and coverage policies. Skilled services must be delivered by licensed professionals and meet specific Medicare criteria to qualify for reimbursement.

In Kentucky, assisted living and nursing facilities differ significantly. Assisted living provides a residential environment focused on independence, with services such as medication management, in-home assistance, and social activities, but usually not 24-hour nursing care. Nursing facilities, however, offer comprehensive skilled nursing services and medical interventions around the clock, catering to individuals with severe health needs. The resident’s level of dependency and medical complexity typically determine placement. A second difference is cost; assisted living generally costs less than nursing homes, which have higher staffing and medical service requirements.

Adult day care and assisted living also differ notably. Adult day care programs offer socialization and health services during daytime hours, allowing individuals to return home at night. They are suitable for those needing basic supervision and companionship but not continuous medical care. Assisted living, on the other hand, provides an extended residential environment where residents live full-time, with assistance tailored to their needs, fostering independence in a supportive setting. The level of medical oversight and the permanency of residence distinguish these options, with assisted living being a long-term residential choice and adult day care serving as a daytime, part-time service.

Answers to Multiple Choice Questions

1. Answer: b. POLST
2. Answer: a. True
3. Answer: a. True
4. Answer: a. True
5. Answer: a. True
6. Answer: c. When the patient is competent and does not present a danger to others by refusing treatment
7. Answer: b. False
8. Answer: a. True
9. Answer: a. True
10. Answer: a. True
11. Answer: a. True
12. Answer: b. False
13. Answer: b. False
14. Answer: b. False

References

• Burgess, C., & Power, R. (2008). Secrets Stolen, Fortunes Lost. Burlington: Syngress Publishing, Inc.
• Greene, S. S. (2014). Security Program and Policies: Principles and Practices. Indiana: Pearson IT Certification.
• Jordan, E., & Silcock, L. (2005). Beating IT Risks. PA Consulting Group.
• Rouse, M. (2015). Essential guide to business continuity and disaster recovery plans. Available online.
• Tipton, F., & Krause, M. (2008). Information Security Management Handbook. NW: Auerbach Publications.