Learning Goal: I’m working on a nursing multi-part question and need an explanation and answer to help me learn.
Respond to each classmate with educated feedback and your professional opinions with 200 words each.
CLASSMATE#1
One of the essential roles of a medical professional is to act as an advocate for their patients. They better understand what the patients need and which resources are likely to benefit them to get the care they deserve and require. In this case, fighting to ensure that the patient receives Medicaid coverage to be checked in to a nursing home for better care. As advocates, medical professionals play a key role in ensuring that their patients get the best care. By pushing for specific policy changes to ensure more coverage in this case due to the patient’s particular condition, who is categorized as a low-income earner and thus cannot afford to provide for herself while in the nursing home. The first step in helping the patient get Medicaid coverage is by highlighting the fundamental purpose of Medicaid. It was mainly developed to help low-income earners get better coverage to meet the specific needs they require, as in the case of the elderly lady. Secondly, one would highlight why Medicaid is the only option for their patient. Third, share with other stakeholders the importance of Medicaid for patients and why it would help improve their overall care and that for other low-income earners (Kaiser Family Foundation, 2016). In presenting these arguments, one might also highlight why an acute care setting does not meet the necessary needs of the patient.
To help the patient get her Medicaid coverage, one would have to collaborate with other professionals to assist patients in getting such coverage. One of the main stakeholders that will have to collaborate with includes local government officials in the healthcare sector. They can only help ensure that the patient gets her coverage. The local government officials are presented with the qualification documents for the patients (Nickitas et al., 2019). The second set of stakeholders to engage with would-be healthcare leaders in this setting as they have a better understanding of the needs of the patients and are closer to the patient and thus understand why the patient needs the coverage and how beneficial the coverage will become for the patient.
Medicaid is the most significant source of financing that cares for long-term care by providing care for the elderly and the disabled. Medicaid is ideal since it helps cover the coverage of elderly and disabled people who have limited funds to seek private care of medicare. Medicaid pays for the cost of skilled labor, such as custodial care that is provided in skilled nursing homes. This is an ideal set-up for the elderly and the disabled as they are guaranteed access to long-term care since it would otherwise be expensive for this group of patients. Medicaid has been instrumental in ensuring that more low-income elderly and disabled patients have access to quality care for the long term as it pays 100% of the daily rates (Amadeo, 2019). Financing is the leading way Medicaid offers a better chance for the elderly and the disabled to receive adequate care.
References
Amadeo, K. (2019) Federal poverty level guidelines and chart.
Kaiser Family Foundation. (2016). Medicaid’s role in meeting seniors’ long-term services and supports needs.
Nickitas, D. M., Middaugh, D. J., & Feeg, M. D. (2019). Policy and politics for nurses and other health professionals: Advocacy and action. (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers. Read Chapters 11 & 12.
CLASSMATE#2 Medicare & Medicaid
Medicare is a federal health insurance plan that aims at increasing healthcare accessibility and affordability. It focuses on older adults 65 years and above. The plan also covers disabled people below 65 years who receive disability benefits from Social Security or Railroad Retirement Board. Additionally, people with certain chronic diseases such as End-Stage Renal Disease (ESRD) or ACL are eligible for Medicare(Bunis, 2021). Medicare is offered in parts A, B, C, and D. Part A pays for hospital stays, some skilled nursing care after being hospitalized, and hospice care. For patients in long-term care facilities, Medicare covers healthcare services in the first 100 days. The first 20 days are paid wholly, but from the twenty-first day, the patient receives a co-pay of $164.50 every day until the hundredth day. Medicare part B covers doctor and outpatient services, while part C covers Medicare advantage. Part D covers prescription medicines.
In the given case study, the patient needs to be placed in a nursing home since she cannot take care of herself independently. The Medicare plan paid by the patient cannot cover services at a nursing home. However, she qualifies for Institutional Medicaid benefits which cover nursing homes or long-term care (“Medicaid eligibility for Medicare beneficiaries who need long-term care in a nursing home,” 2018). This plan covers personal care, nursing care, and therapy services in a nursing home. As a nurse, I would advocate for the patient so that she can obtain the services required for improved health and wellbeing.
I would apply specific strategies to ensure that the required assistance is obtained quickly. The first step that I would take is assisting the patient in applying for financial aid from the healthcare facility’s charity kit. Many healthcare facilities bring together financial resources and put them in charity kits to assist patients with limited financial abilities to cover for required healthcare services sought from the facility. Getting such help would enable the patient to obtain the primary specialized and personal care that she would need (“Medicaid eligibility for Medicare beneficiaries who need long-term care in a nursing home,” 2018). The second step is to search for health insurance coverage that is appropriate for the patient to be admitted to a nursing home. Since she has limited income and pays for Medicare part B, the patient might be eligible for Medicaid benefits for long-term care. I would gather all information about the patient and inform the appropriate insurance provider selected to start the paperwork required for the patient to receive all the benefits. These steps would ensure the satisfaction of the patient’s health needs.
Patient advocacy requires the collaboration of nurses and other stakeholders involved with the patient’s health and wellbeing. In this case, I would collaborate with various healthcare professionals and stakeholders to ensure that the patient is satisfied with the assistance and care offered. I would engage the primary care provider and the physician to give detailed information about the patient’s health status and needs that makes her eligible for the financial aid from the charity kit. Besides, collaborating with the eligibility officer from the healthcare organization would facilitate approval of the patient’s request for financial aid. Of course, the process will follow the outlined steps to enforce fairness and justice. Lastly, I would collaborate with the health insurance provider selected to make sure that the patient gets all her benefits to cater to the care provided in the nursing home. Indeed, this would boost her health and wellbeing.
References
Bunis, D. (2021, January 1). Understanding Medicare part a, part B, part C and part D. AARP. https://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_the_plans.html
Medicaid eligibility for Medicare beneficiaries who need long-term care in a nursing home. (2018, March 1). Medicare Interactive. https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/medicare-and-medicaid/medicaid-eligibility-for-medicare-beneficiaries-who-need-long-term-care-in-a-nursing-home
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