Sub-acute/rehab floors

[CapeCodMermaid]

Can any of you tell me what staffing is like on your sub-acute units?

[FROGGYLEGS, LPN]

It can get a bit confusing as some of the terms overlap.

ICF- intermediate care--- This would be your average LTC resident.

Rehab residents are usually short term for therapy.

They can be "skilled" for nursing care or therapy. These have a lower resident to staff ratio and require more care.

[CapeCodMermaid, RN]

Rehab-what it sounds like....new knees, hips, fractures....Physical and Occupational therapy is their main focus and then they go home. (of course some long term residents are on rehab services if they have had a decline)

Sub-Acute....picture a really busy med-surg floor, but with fewer nurses and you have a picture of today's sub-acute patient...pneumonia, CHF, COPD exacerbation...or a fractured hip in a 89 yo who also has pneumonia...wound vacs, IV's, you name it. People this sick used to be in the hospital

LTC--long term care....most are too feeble or frail or demented to take care of themselves anymore, so we do it.

Skilled nursing..covers the gamut. anyone can have a skilled need....it's something that requires an MD order and needs the, well, SKILL, of a nurse or therapist...wound care, insulin with a sliding scale, lung sounds s/p nebs.....

[mattsmom81]

Thanks guys for the clarification...one more question and I'll back off...LOL!

Are these classifications important as far as billable services and reimbursement or just used to describe the patients?

[CapeCodMermaid, RN]

To be on Medicare in a SNF, one must have had a 3 day qualifying hospital stay. In order to stay on Medicare, one must have a skill. There are all sorts of different levels of payment for Medicare patients depending on how much rehab they are getting and how much nursing care.

So...the long answer is....if you have skills and are getting alot of rehab, then the facility will be reimbursed at a high level of payment....the fewer the skills and rehab needs, the less reimbursement.

People on Medicaid also called Mass Health in Massachusetts get paid for by a different score.

In my facility. all the beds are "skilled" which means we are certified by Medicare to provide care for 142 residents. However, not all 142 have Medicare. We have Medicare, Medicaid, private pay patients, and all sorts of different Managed Care patients. The business office classifies them. The rehab staff does to a certain extent. The nurses on the other hand, don't care who pays for what.

Are you thouroughly confused now?

[mattsmom81]

To be on Medicare in a SNF, one must have had a 3 day qualifying hospital stay. In order to stay on Medicare, one must have a skill. There are all sorts of different levels of payment for Medicare patients depending on how much rehab they are getting and how much nursing care.

So...the long answer is....if you have skills and are getting alot of rehab, then the facility will be reimbursed at a high level of payment....the fewer the skills and rehab needs, the less reimbursement.

People on Medicaid also called Mass Health in Massachusetts get paid for by a different score.

In my facility. all the beds are "skilled" which means we are certified by Medicare to provide care for 142 residents. However, not all 142 have Medicare. We have Medicare, Medicaid, private pay patients, and all sorts of different Managed Care patients. The business office classifies them. The rehab staff does to a certain extent. The nurses on the other hand, don't care who pays for what.

Are you thouroughly confused now?[/QUOTE]

:flowersfo :chuckle

Thanks for answering...I can grasp most of it. I imagine the different payor sources demand different charting, documentation and billing. There's a lot to all this in LTC...and I know the MDS process can make or break a facility if its not being done correctly.