Skilled Nursing Facility and Medicare’s and Management of Care Plan

Skilled Nursing Facility and Medicare: Management of Care Plan

Management of Care Plan as per Medicare means “Constitute skilled services when, because of the patient’s physical or mental condition, those activities require the involvement of technical or professional personnel in order to meet the patient’s needs, promote recovery and ensure medical safety.”

Daily skilled services to meet the patient’s needs, promote recovery and ensure medical safety. It's Medicare terminology in addition to the fact that it clearly states what you are doing for that patient. So management of care plan states that there is a licensed person is necessary to coordinate the care of a patient because they would understand the relationship between the services patient is receiving and be able to evaluate each service’s effect on each other and how they're going to impact the patient.

And determine if this patient has a high potential for complications or not, the management care plan states that the licensed professional is managing the total care of the patient. And they are going to be evaluating that patient and determining if they need to intervene because the services are having an impact on each other.

Long Term care Training Example: A medication change and the person is attending therapies and the person also has a diabetic diagnosis or have a respiratory condition. Those are several different areas where they need to be coordinated. And nursing is doing that all the time but there are times when therapies will discontinue. So the person is post therapies so you're monitoring for complications or a decline – potential decline in function being post therapies.

You're looking at a respiratory status, you're looking at management of medications and you're trying to determine is their medical regime essentially stabilized? Well, that's management of care plan. That's looking at many different areas, many different services and the ultimate effect of each service on the other for the patient and being able to ensure that the patient is you're continuing to promote the recovery and ensure medical safety of that patient of management care plan.

Observation and Assessment

So in addition to that, Medicare talks about observation and assessment. And the reason why we focus on these is because these are advantageous to understand for those patients who are not your slam dunk skilled patients. But your patients were in that gray area of are they skilled, are they not skilled.

How do we figure that out? So observation and assessment talks about the licensed professional who is assessing the patient, observing the patient for potential complications, for areas that are high risk for that person.

So you're looking to determine if you need to intervene with the patient, if you need to change their medical regime, contact the physician or if you need to continue as the person appears to be stable at that moment.

What's interesting to understand about observation and assessment is just because you've observed the patient or you've done, neuro signs or you've done a cardiac assessment on the patient, even basic vitals for a patient does not negate the value if that patient does not show that they're having an adverse reaction because you are – that's your goal is to promote stability of the patient.

So documentation that the patient did not have an adverse reaction status post therapies or a change in medication, that is still skilled because you are still looking at multiple different areas of that patient’s functioning and you have determined that the patient is not at risk and the patient continues to function at a safe level.

So observation and assessment is important especially sometimes skilled care facilities will get in patients who have a psyche diagnosis. And they may have some medical issues but then those have resolved. And so now they just have some psychological symptoms.

Long Term Care Training Tip: Well, observation and assessment is critical because you're looking for hostile behaviors, you're looking for behaviors that put the patients or other patients or staff at risk. Suicidal or hostile behavior also is important to understand with psychiatric patient. And you need to look at what are your problem solving measures for that patient.

So not just “Oh, they had behavior, they had behavior, they had behavior” and documenting each time. But what did the skilled nursing facility – what did the staff do to intervene? What are our problem solving methods? And even if your method doesn’t work, even if you've trialed four different things for that patient, it's still the clinical process, it's still your reasoning behind well we thought that this would be appropriate for this patient. This is how we were going to manage their behaviors to allow them to be safer in this environment.

So the documentation of the process and the outcome. Outcomes are very important especially for anybody specifically to Massachusetts for our Medicaid system is based on many times payment and based on outcome. So it's great practice to make sure that you're documenting outcomes. Whether they're positive or negative, both are supportive.

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