Q&A: Alternatives to skilled care facilities

November 7, 2018
Medicare Web

Q: If a long-term acute hospital or a skilled-nursing facility isn’t necessary for a patient, but staying at home isn’t a plausible or healthy situation, where are some other options for patients to go after a hospital discharge?

A: Long-term care at alternative non-skilled care facilities does not require a skilled provider and therefore is not covered by commercial insurance or Medicare. In some states, Medicaid is offering some coverage for assisted living and residential care. Be sure to check the coverage in the state where the patient resides.

Although this care does not require a skilled, licensed individual, these facilities offer quality and safety for patients who cannot safely live alone or in their home.

Assisted living centers provide the following resources:

  • Housing and support with activities of daily living (ADL) and instrumental activities of daily living (IADL)
  • Meals
  • Medication management
  • Housekeeping
  • Transportation
  • Laundry
  • 24-hour staff
  • Personal assistance with ADLs

Case managers are often available at this level to support the patient in managing their healthcare needs and accessing the healthcare delivery system. Many assisted living centers are staffed by social workers who also offer adjustment-to-illness counseling, emotional support, and help with finances and transportation.

Group homes are typically small (usually eight or fewer patients), and patients share common spaces. Group homes provide the following resources:

  • Services for children or adults who have chronic disabilities and require continual assisting to complete ADLs and IADLs
  • Assistance with behavioral issues

Residential treatment facilities provide therapy for patients with drug and alcohol addictions, behavioral problems, or mental health issues. Patients seen at these facilities are not appropriate for inpatient psychiatric care.

Case managers and social workers are integral to this setting, ensuring that patients are managing their care plan and, if applicable, their behavioral plan. Additionally, case managers tend to serve as the connection point between the residential center and the hospital, should the patient be readmitted. As in the context of assisted living, case managers and social workers can also help with finances and transportation needs.

For more information, see Care Transitions in Case Management. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.