Nursing Home Industry

• The nursing home industry is dominated by the for-profit sector.

• Nationally, the average nursing home had 107.6 beds with an occupancy rate of 86%.

• Most nursing homes operate in chains, the 10 largest chains have at least 90 homes.

Nursing Homes Stats

• 90% of all residents that live in nursing homes are 65 years of age or older.

• 80% of residents are dependent for their mobility, 66% are incontinent, 47% require assistance when eating and 37% are dependent in all three areas.

Nursing Home Services

• Nursing homes provide a variety of services such as:

• Restorative care.

• Treatment of skin wounds.

• Dementia care.

• These are the most commonly available services offered at nursing homes.

Patient Conditions

• The three most common conditions nursing home patients suffer from are:

• Bladder incontinence 54%.

• Alzheimer’s disease 46%.

• Bowel incontinence 43%.

• Also weight variation, pressure sores and skin rashes.

Nursing Home Finances

• National expenditures for nursing home care have been much lower than those in other sectors of health care delivery.

• Most of the expenses are financed through Medicaid, but private sources like private insurance and out of pocket cover a sizeable portion.

Medicare

• Medicare is known for being the primary payer for elderly medical services.

• In 2004, Medicare only covered 13.9% of the costs of nursing homes.

• Medicare only covers limited benefits for nursing home care.

Medicaid

• Of the 52 million Medicaid beneficiaries, only 3.3% received services in nursing home facilities.

• These facilities consumed 22% of total Medicaid expenditures, which is far more than what it spent for any other service.

Private Pay

• Private pay is out of pocket financing for LTC (long-term care insurance).

• Many patients are initially admitted to a facility through private funds.

• Once the funds are exhausted, then the patient may qualify for Medicaid.

• The term step down refers to exhausting ones assets and income to the medically needy levels to qualify for Medicaid.

Prospective Payment

• In 1998, Medicare implemented the PPS program to replace cost based reimbursement for SNFs.

• Prospective payment is based on case mix.

• Patients who are more seriously ill incur more costs so depending on the case mix will determine how much the SNF is reimbursed.

Prospective Payment

• Patient assessment plays a big role in prospective reimbursement because it is used to determine the case mix.

• A trained RN oversees the assessment process using a minimum data sheet (MDS) which contains over 100 assessment items that provide extensive information about the patient.

Federal Certification

• In order for SNFs and NFs to qualify for federal certification which allows them to admit Medicare and Medicaid patients they must meet 17 major categories.

• 1. Residents Rights. Choose a physician.

• 2. Admission, transfer, and discharge rights.

• 3. Resident behavior and facility practices.

Federal Certification

• 4. Quality of Life.

• 5. Resident assessment.

• 6. Quality of care.

• 7. Nursing services.

• 8. Dietary services.

• 9. Physician services.

• 10. Rehabilitation services.

Federal Certification

• 11. Dental services.• 12. Pharmacy services.• 13. Infection control.• 14. Physical environment.• 15. Administration.• 16. Laboratory services.• 17. Other services. Maintenance of clinical

records.

Conclusion

• Nursing facilities play a very key role in our society. They offer families and people who are unable to care for themselves or loved ones an opportunity of assisted living.