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Medicare Basics

Medicare Part A is the portion of Medicare that covers hospital insurance. This includes coverage for skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions, for a limited time.

To be eligible for Medicare Part A coverage for skilled nursing care in a SNF, the following conditions must be met:

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Managed Care 101 (Medicare Advantage, SCO, Managed Medicaid, HMO, PPO)

Please note that this is a very basic overview to get you started.

What is managed care?

Managed care is a health care delivery system organized to manage cost, utilization, and quality.

Individuals who have enrolled in Medicare Part A and Part B are eligible for coverage by an approved private insurer through Medicare Advantage (Medicare only) or SCO (Managing both Medicare and Medicaid).

Before the 2003 Medicare Modernization Act, seniors didn't have the option to enroll in Medicare Advantage.

Medicare Advantage is also known as Medicare Part C.

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yelling and screaming-Developing a care plan: Management of Behavioral Symptoms

  1. Assess for triggers: Determine if the yelling and screaming is a result of over-stimulation, boredom, or too little stimulation. Try to eliminate or lessen the cause as much as possible.

  2. Give the resident something to eat or drink, such as hard candy (if not contraindicated by dietary/dysphagia concerns). This can help to redirect the resident's attention and provide sensory stimulation.

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Catastrophic Reaction- Developing a care plan: Management of Behavioral Symptoms

When developing a care plan for managing catastrophic reactions or emotional outbursts in residents, it is important to keep in mind that these behaviors usually occur because the resident feels overwhelmed or is experiencing a sense of failure. Here are some interventions that can be included in the care plan:

  1. Person with the best relationship should respond: Identify the staff member who has the best relationship with the resident and ensure that they are the ones to respond to the behavior.

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