If you or an elder you know are interested in getting into a Skilled Nursing Facilities (SNF), it is likely because of the wide range of services SNFs provide that exceed what regular nursing homes or intermediate care facilities can offer. However, admissions into SNFs is a multi-step process that can be confusing and frustrating. Below is an outline that will hopefully aid you in qualifying, identifying, and being accepted into an SNF.
Step 1: Qualifying for Medi-Cal Long-Term Services in a Skilled Nursing Facility
Before you begin on your search for a Skilled Nursing Facility (SNF), it is important to understand the criteria California utilizes for determining admission into SNFs. The criteria for admission is set forth in state regulations and are applied on a statewide basis. Essentially, the question is: Does the condition necessitate skilled medical attention, like that found in a hospital? Examples would include, but are not limited to:
• Skilled Nursing Services – e.g., wound care, tracheostomy care, tube feeding, ventilator;
• Continuous skilled nursing observation needed at frequent intervals – e.g., blood pressure, pulse, respirations, observation of skin conditions, input & output;
• Medications which cannot be self-administered; or
• A physical or mental function limitation.
Step 2: Obtain All Consents
If you are a representative for an elder who is seeking admission into a SNF, your first step will be to obtain consent from your elder to release confidential information. After you have consent from the elder, or their representative, to release confidential information, you will of course, have to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and obtain a release of protected health information. With these consents in hand, you will be able to obtain a doctor’s order to transfer the elder or patient to a SNF. This simply requires a phone call to the elder’s doctor’s office and asking if the doctor agrees that the patient should be transferred to a SNF. If so, request an order, and that’s it.
Step 3: Tuberculosis Screen
All SNFs require a tuberculosis screening. While you are on the phone with the doctor’s office under “Step 2,” you should also ask if a tuberculosis screening is needed, either a PPD test or chest xray. If so, you may request an order for a home care Registered Nurse (RN) to evaluate the patient and administer a PPD test. The RN must check the PPD in person. PPD results usually take 3 days to come in, and a transfer cannot take place until they are in.
Step 4: Identify Possible Facilities
In order to focus your search, ask your doctor if they make patient visits to any SNFs. If so, ask which ones, and let that serve as your list of SNFs to explore. You may also use online resources to search for SNFs in your area:
• Medicare.gov
o Nursing Home Compare
o www.medicare.gove/nursinghomecompare/search.html
• CalQualityCare
o www.calqualitycare.org/
Step 5: Call Facilities
Once you have identified which SNFs you and your elder would like to pursue, you will need to call the admissions coordinator for each facility to inquire about the availability of beds. Aim for 3 facilities with available beds for you and the elder to choose from.
If the patient’s current doctor does not make SNF visits, ask the admissions coordinator if the attending physician will accept your patient. If not, you will need to find a doctor that will attend to the patient in the SNF.
If the admissions coordinator states that there are no more available Medi-Cal beds, do not believe them. If a facility accepts Medi-Cal, then all of the beds at the facility are Medi-Cal approved beds. Make sure to clarify if they mean all beds are full, or just Medi-Call beds.
Step 6: Request Medical Records
As part of the admissions process, you will need to request the patient’s doctor’s office to transfer the medical record, history and physical, recent discharge summary (if any), insurance info, and order to transfer to the SNFs for their review.
Step 7: Choosing a Facility
Once accepted, a family member or the patient’s representative must visit each facility to choose which facility the patient will be transferred to. It is of course encouraged that the patient, if possible, visit the facilities too. It may be useful to take a “Nursing Home Checklist” to help evaluate each facility. For example: • Medicare – www.medicare.gov/NursingHomeCompare/checklist.pdf Once a SNF has been chosen, complete all of the admission paperwork at the SNF in order for the facility to approve the transfer. From there, request a day and time for the SNF to accept the patient.
Step 8: Transporting Patient to SNF
Once a date and time are established, all that will be left is transporting the patient to the SNF. Options include a personal vehicle or Medivan or ambulance. It is important to note that Medicare will likely not pay for transporting the patient to the SNF, unless the patient is unable to take regular means of public or private transportation. While you are calling the doctor under “Step 2” you can also ask if the doctor will provide a written order stating such. The transport company may also require forms for the doctor to fill out. It is important to note, that ambulance companies usually cannot guarantee that Medi-Cal will pay for the transportation, so be prepared to pay a bill if you choose to use an ambulance.
After informing the transportation company, the SNF, and the patient on the time and date of the transfer, it will be wise to prepare a transportation packet to follow the patient to the facility. A transportation packet includes the following:
• Transfer Order from Doctor
• Medical Records
• Doctor Notes
• RN Notes
• History and Physical and/or discharge summary from a recent hospital admission, if available
• Medication List
• Insurance Information
And that’s it. You have successfully transferred your elder into a SNF where they will receive skilled nursing care. If you have any questions about qualifying for Medi-Cal coverage, the Santaella Legal Group, APC serving San Ramon, Dublin, Pleasanton and the entire bay area, specializes in Medi-Cal planning and ensuring that elders receive all the coverage they are entitled to and qualify for. Please Ivette M. Santaella at (925)831-4840.