Need info re Medicare and visiting patients in ICF facility.

[NRSKarenRN, BSN, RN]

Had a query from an Intermediate care facility that care for clients who are in Intermediate Care Facility (ICF) due to blindness with profound to severe MR who also have other health issues: new/unstable diabetic, gait dysfunction, uncontrolled HTN.

ICF provides only 8 hrs MAX/day of RN care under MA wavier program and administer insulin on day shift only. The personal care assistants are not always following the patients care plan and do not currently do glucometer testing. They are requesting our homecare agency visit facility to teach caregivers how to individually care for each diabetic client, instruct diet and teach glucometer testing and eval compliance with diabetic management.

PT to visit those clients with worsening ambulation.

Under Medicare, I know we can visit patients "in their own home" in assisted living and boarding home, but unable to find regs about ICF facilities. Can anyone help me with links to regs?

[renerian, BSN, RN]

Karen in Ohio in ICF facilities I have only done psyc nursing if the facility does not have a program for that skill. Good question. I don't know about PA only Ohio. Do you have a PA council for home care in your state?

ren

[NRSKarenRN, BSN, RN]

Our VP of Nursing conctacted state Dept of Health. Since services in ICF are under Medicaid, and ICF is patients "HOME", appropriate for homecare to come in under Medicare provide instruction to caregivers for new health conditions unrelated to reason for living in ICF.

Changing the "culture of caregiving" that performing glucometer testing is done by personal care workers in assisted living facilites and by patients family members is an appro[riate task for them to perform is another story. But we are trying. PT has been beneficial in teaching new techniques too for those with ambulation issues and ordering new equipment.