A 66-year-old male, Mr. Longview, is admitted to the hospital in an
inpatient status for CHF exacerbation and chest pain. His medical
history includes, gout, pain, COPD, HTN, insulin dependent DM, renal
disease, irritable bowel, peptic ulcer disease, and A-fib, for which he
is on Coumadin therapy. He has medications for each diagnosis, and PRN
inhalation meds for respiratory issues. He has been out of his
medications, including Lasix, for two weeks due to financial reasons.
Mr. Longview owns his own home and lives at home alone and has a son
that lives out of state. There are no other family members and the
patient has recently retired. He has a Medicare replacement plan (ex.
Health Spring, BCBS, Aetna) and is advised by the hospitalist that he
needs to go to a skilled facility to participate in a cardiac rehab
program. A referral is made to the local skilled nursing facility. Mr.
Longview is expected to be discharged as soon as acceptance to facility
is secured. The business manager at the skilled nursing facility is out
of the office, and the Director of Nurses is to handle the authorization
and admission.
Please answer the following questions:
1. Based on your research, will this patient be authorized for Medicare covered skilled nursing care services? Why or why not?
2. What determines observation versus inpatient admission?
3. How can the hospital case manager and the skilled nursing facility provide care for this resident?
4. What services will be available based on your research of services covered for skilled nursing care?
5. If these services are not provided, what are some other options to explore for this patient?

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