Acute Rehab - POGOe
Levels of Care Pocket Card
| Post-Acute Care Settings |
| |LTAC |Acute Rehab (IRF) |Subacute |SNF |Home health care (HHC) |Hospice |
|Which patients |Technology dependent: trach, vent, |Mostly CNS or |Complex med or surg |Med or Surg |Homebound. |MD referral for life expectancy ~ 25d |1-4 wks |Aggregate < 2wk |Avg 30d |Usually 1-8 wks per episode |Varies by diagnosis |
|Medicare Part A |100% |100% |100% d1-20, |No co-pay |100% (up to a cap amount) for team |
| | |(if show progress) |then 80% d21 – 100 plus copay | |services, meds, DME |
|Physician Visits |Daily |Daily |Within 30 days; or as required by facility |As outpatient, |Can keep PCP. Office or home visits. |
| |(hospitalists, pulmonologists) |(mainly PM&R physicians) |(usually 2-3 days) |Face-to-face encounter w/in 90d|Hospice MD also available. |
| | | |(primary care clinicians) |prior to or 30d after start HHC| |
|Usually Excludes | |Complex wounds |In-house dialysis, TPN, Vent, PCAs, continuous |Unsafe environment. |Not terminally ill |
| | | |infusions | | |
|Approx cost range |$1500-3000/d |$1000-2000/d |$600-700/d |$150-400/d |$100-300/d |$100-800/d |
|Comment |Can have complex wounds | |Unusual: |Medicaid can provide |HHA 6 hr/wk. Can add SW, ST. |Team approach; pain and symptom |
| | | |Medicaid |co-pay |Can have SN daily. |control. Does not cover facility room |
| | | | | | |and board |
Definitions:
CNS - central nervous system
DME – Durable Medical Equipment
HHA - home health aide
HHC - home health care
IRF – inpatient rehab facility Medicare
LTAC - long term acute care Part A: H (hospital, hospice,
SNF - Skilled nursing facility post-hospital acute care, home care)
OT - occupational therapy
PCA - patient controlled analgesic Part B: O (office visits, outpatient
PM&R – physical medicine and rehabilitation rehab and other therapies
PT - physical therapy
TPN - total parental nutrition
|Long-term Care (LTC) Settings |
| |PASSPORT |Adult Day Care (ADC)|PACE |ILF |Group Home |ALF |NF |
| |(Ohio) | | | | | | |
|Residence |Home |Above listed facility |
|Which patients |Impaired 2+ ADL. |Impaired 2+ ADL. |Impaired 2+ ADL. |Independent. |Young: psych. |Impaired 1+ ADL. A |Impaired 2+ ADL |
| |Could be in NF but |Could be in NF but |Could be in NF but | |Older: frail |few may be driving.| |
| |has some care at home|has some care at |has some care at | | | | |
| | |home |home | | | | |
|Payer |Medicaid |Medicaid or private |Medicaid / Medicare|Private Pay |Private pay or |Private pay. LTC |Private pay. |
| | |pay |Usually 65+ but | |Medicaid |insurance. Medicaid|Medicaid. LTC |
| | | |take 55-64 yo psych| | |(uncommon) |insurance. |
|Care |Up to 20 hours/week |Supervision and |Adult day care 1-5 |No 24 x 7 nursing.|VS monthly. |VS q1-3 months. |24 x 7 nsg. |
| |HHA; Lifeline; ADC; |assistance with |d/week; some HHA; | |May/may not have |May/may not have |VS monthly. |
| |transportation. Can |ADLs, 1-5 d/week, |medical care; |VS q1-3 mos. |some on-site |nurse 24 x 7. Pt | |
| |enroll in hospice if |medication |Lifeline; |May have 1-2 |nursing |may opt to | |
| |appropriate |administration, |transportation |meal/d. Self-admin| |self-admin meds | |
| | |transportation, | |meds | | | |
| | |stimulating | | | | | |
| | |activities | | | | | |
|Docs |Private |Private |Assigned at the ADC|Private |Private |Occasionally |Doc with care |
| | | |facility | | |in-house. Mainly |privileges at |
| | | | | | |private |facility, |
| | | | | | | |Q30d x 3, |
| | | | | | | |then q60d |
|Exclude |If needs 24 x 7 care |If needs 24 x 7 care|If needs 24 x 7 |Usually excludes |Wandering; cannot|Usually excludes |Aggressive behavior|
| |and doesn’t have it |and doesn’t have it |care and doesn’t |dementia |give PRN meds |incontinence. If |unless dementia |
| |at home, not eligible|at home, not |have it, not | |unless pt asks |wanders, need |unit |
| | |eligible |eligible | | |locked unit | |
|Approx cost range |$18-21/hr |$50-60/d for ADC in | |$700+/month |$600-2000/month |$2000-7000/month |$150-320/d |
|(OH) |for HHA in Ohio |Ohio | | | | |(4500-10,00 /month)|
|Comment | |Some ADC offer |Must give up care |Residents may be | |Medical care |Medical care |
| | |intensive services |with non-PACE docs|driving, working. | |responsibility- |responsibility- |
| | |(therapy, skilled |and hospitals. Get |Can hire private | |family. Typically |facility. |
| | |nursing, health |PT, OT, dental, |duty HHA and/or | |impaired 1-3 ADL |Typically impaired |
| | |monitoring) at |Podiatry, meds, |purchase other | | |4-5 ADL |
| | |additional cost |primary care |services | | | |
| | | |on-site | | | | |
Definitions:
NF = nursing facility
PACE - Program for All-inclusive Care for the Elderly
ALF - assisted living facility Resources:
VS = vital signs nhcompare
ADL = activities of daily living
HHA = home health aide
ADC = Adult day care
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