THE ADMISSIONS PROCESS

Residents are admitted to the nursing home while utilizing several different levels
of care and payor sources. Approximately 98% of our residents are admitted to the skilled nursing unit for a qualified level of care. Admission diagnoses vary greatly and can include post fractures, strokes, falls, and progression of chronic conditions. Admission to skilled care means that the resident has met Medicare, hospice, or private insurance guidelines for skilled care, which normally require a higher level of care than intermediate care residents. 
   
Under Skilled Medicare requirements these residents must meet eligibility criteria as defined by CMS
(Center for Medicare and Medicaid Services). These requirements include:

1. The resident is enrolled in Medicare Part A and has days for use;
2. The resident  has had a 3-day prior qualifying hospital stay; and
3. The admission for skilled care is within 30 days of discharge from
    the acute care (hospital) stay.

The resident must also meet requirements that demonstrate "a need for medically necessary skilled care on a daily basis, which is provided by or under the direct supervision of skilled nursing or rehabilitation professionals, and, as a practical matter, these skilled services can only be provided in a skilled nursing facility, and the services must be provided for the condition for which the resident was treated during the qualifying hospital stay."

Some examples of skilled services include daily dressing changes, intravenous fluids or medications, physical/speech/occupational therapy, or terminal care. The services vary depending on the needs of the individual resident. Medicare residents receive benefits for up to 100 days, as long as they continue to meet the requirements. A physician must also certify the need for admission and then periodically re-certify the need for extended care services. Private payor patients, such as hospice or private insurance, can waive the qualifying 3-day hospital stay required by Medicare. 
 
Residents may also be admitted to an intermediate level of care. Intermediate care must:

1. Be ordered by a physician;
2. Be provided 24 hours a day; and
3. Consist of a minimum of eight hours of licensed nurse coverage daily.

Residents that have available funds can pay privately for this level of care or they can be qualified for the Medicaid system. The goal of intermediate care is to maintain residents at their maximum level or self-care, prevent regression, and return them to a previous level of independence. Approximately 50% of residents transition to an intermediate level of care due to the need for continued care needs.