SNF who provides supplies?

toomuchbaloney · Mar 28, 2014

The typical hospice benefit does not pay for the room and board of a SNF. The payment for the room and board remains the responsibility of the family or insurer. In my experience, most people pay for this out of pocket. Back in the day that 5th level of coverage was a portion of the benefit package of those in the auto workers unions, but that is no longer true. Some people have paid for that level of coverage in private insurance plans, but again in my experience it is not terribly common. All of that, however, is separate from the hospice benefit which directs treatment plan and support, not room and board for daily living (other than as related to GIP or Respite levels of care).

If the incontinence supplies are needed and the need is related to the terminal condition the hospice provides them as a part of the benefit. If the hospice typically provides briefs and chux as a part of their care to a patient in their private home they should, similarly, provide that to patients residing within a facility. Most hospices will provide a set and limited amount of said supplies to the SNF pr patient.

It is unethical to make promises to facilities relative to supplies or HHA care and therefore prohibited. Hospice care is patient centered not facility centered. Too often hospices find themselves providing an unreasonable number of incontinence products to a facility based patient as staff "borrow" from that patient to accommodate the needs of a roommate or neighbor. To counter that the hospices will often engage the family in "protecting" the patient supplies, will keep very specific records in the facility to document delivery and quantity, and my actually place the pt name boldly on each and every item (yes, every brief and every under pad).

NC29mom, ASN, LPN, RN · Mar 29, 2014

Toomuchbalogny:

It makes perfect sense to provide supplies to snf pts. I've been in hospice for about 6-7y and I've always done it like that. However, the company I currently work for made us stop claiming it was bribery. I completely agree that providing an ABUNDANCE of supplies (more than standard) would be considered bribery.

I wish I could find it written somewhere in the Medicare guidelines. I feel very uncomfortable because I've always been under the impression we supply supplies....yet we aren't. Does anyone know if this responsibility is plainly written somewhere in the guidelines?

The same goes for DME. we used to supply for our snf pts, but have stoped for the same reasons ("it's bribery" & "it's included in room & room").

I'm a stickler for doing what is RIGHT. drives me crazy if I feel like I'm part of something dishonest.

toomuchbaloney · Mar 29, 2014

I can see that hospices might not provide supplies for those patients who already are paying for supplies through the room and board of the facility and cannot get a discount if the hospice contributes. In that situation it is understandable that the hospice would suggest to the family that those $$ saved in the hospice benefit can and will be applied in another fashion to benefit the patient. I suspect, however, that the savings is simply considered as potential profit making SNF patients that much more attractive.

Does this mean that your hospice likewise does not provide HHA visits because the SNF patients do not require them?

NC29mom, ASN, LPN, RN · Mar 29, 2014

Actually we still do provide aide services in our snf/ALFs. But several months back we went through a thing where we weren't supplying ALF's with aides or supplies if they were Medicaid bc supposedly the facilities were being compensated by Medicaid for each pt dependent upon amount of aide care required from ALF staff, meaning a duplication of services. That only lasted about a month. Seems like if Medicaid pays room and board for snf & alf's the rules would be the same......

Sometimes I'm so confused....even after working in hospice for years.

What does your hospice do? Provide supplies? DME? Aides? To snf? Or ALFs?

toomuchbaloney · Mar 30, 2014

It really varies dependent upon the hospice agency.

As a case manager, I preferred to have a hospice aide visit SNF patients at least once weekly to provide me with that naked skin assessment as well as the assessment of behavior during the process with the dementia patients. That saved me the long visits to undress and redress patients for routine assessments, I only had to do that then if there was a problem ID'd by my co-worker and reported to me.

TammyG · Mar 30, 2014

We always provide supplies to SNF patients. Hospice service includes the provision of "medical supplies" to patients regardless of location. Most of the SNFs have a separate charge (in addition to room and board) for "incontinence supplies", and that charge is not made to the family if we are providing those supplies instead.

There was a CMS release not long ago which I now can not find, saying that CMS had discovered the fact that long term care patients were using MORE HHA services on average than home patients, and there was a concern that these services should be provided as part of the room and board purchased by the facility. CMS said they would investigate further. I tried to find that release now and can't.

NC29mom, ASN, LPN, RN · Apr 13, 2014

We always provide supplies to SNF patients. Hospice service includes the provision of "medical supplies" to patients regardless of location. Most of the SNFs have a separate charge (in addition to room and board) for "incontinence supplies", and that charge is not made to the family if we are providing those supplies instead.
There was a CMS release not long ago which I now can not find, saying that CMS had discovered the fact that long term care patients were using MORE HHA services on average than home patients, and there was a concern that these services should be provided as part of the room and board purchased by the facility. CMS said they would investigate further. I tried to find that release now and can't.

I know exactly what article you are referring to when speaking about SNF's using HHA services more than home patients. I wish there was something more definitive in writing about incontinence supplies.

Our company sends our aides to our facility pts first, making the home pts visits in the afternoon. This practice is ridiculous in my opinion.

CapeCodMermaid, RN · Apr 14, 2014

Do I live on another planet?

Most room and board charges for someone on hospice are paid by Medicaid, not private pay. We don't charge separately for incontinence supplies. Our hospice providers are responsible for the medications related to the hospice diagnosis. They also pay for rental of specialty equipment such as low air loss matresses and Broda chairs.