In my never-ending quest to discover all available options to seniors, I had the privilege of sitting down with Kris Thompson, the Executive Director at Peak Resources. We spoke briefly about the services that Peak Resources offers, what families and seniors should look for when choosing a nursing home, and the many benefits awarded to individuals who become a part of this incredible system.
See the full video interview here:
What are your responsibilities as Executive Director at Peak Resources?
I’m pretty much responsible for everything that goes on at the facility. The financial part, the business part, making sure we meet at the rules and regulations, which in healthcare and with nursing homes, there is an awful lot. I’m also involved in the healthcare part of it. There is a director of nursing in the department of nursing that oversees her staff and makes sure that the healthcare aspects of the nursing home are met.
What should a senior look for when choosing a nursing facility? What should the family of the senior look for?
Location. Everyone talks about real estate, which is very important. It’s crucial that you’re going to feel comfortable visiting, so you want to be close. If you have to drive across town and deal with a lot of traffic, that’s probably going to be burden and a factor that keeps you from visiting. Individuals who enter nursing homes shouldn’t lose contact with their family members. I would also recommend that you go through the facility and tour, just do a walk-through. Most facilities would be glad to do that and have a representative walk through with you to answer questions and point out things that the facility offers. As you’re walking around, look for common sense things such as this:
- Are there any pervasive odors that you notice throughout the facility?
- Are the residents of the facility happy? Are they socializing and doing different activities?
- Are the staff members happy? If they are happy with their job, that is going to be reflected in their performance and how they interact with residents.
Positive communication is one of the most crucial components that a nursing home resident can have. Is it a warm and welcoming environment? That’s always a good thing.
All facilities are also required to have their 25/67, which is their annual survey where the state comes in with nurses, pharmacists, and dietitians. It is state required to make sure that the employees are doing their job. You won’t see a federal survey every year, but you’re guaranteed that each year the state one will be conducted. They come in and look at all of those rules and regulations, they are making sure that the residents are getting the treatment that they need. They ensure that they are not being taken advantage of and that they can have access to their money right there.
Most facilities have the shopping aspect. On Fridays, we take everyone to the Wal-Mart to go out shopping, and if the resident doesn’t feel like going out, he/she can give the list to an employee who is managing the funds to go pick up personal items that the resident needs.
Not all nursing homes are health and rehab facilities, is that correct?
Right, and that’s usually part of the Medicare benefits. Most people have Medicaid Part A or Part B. That’s going to cover if they’re coming in from the hospital. For most people right now, unless it’s coming through a bundle payment part of Medicare, you’re required to have a three-day hospital stay. You want to make sure that if you are in the hospital, that it is a stay and not an observation because then you are qualified to use your Medicaid Part A benefits. If you meet that criteria – of which therapy or wound care is a part – you can use your Medicaid Part A benefits.
So if you’re going to be there at the facility 100 days, that first 20 is covered at 100%. The next 80 days is paid 80%, so there is a 20% co-pay. The supplement would pay that 80% if you have the supplement. Now, if you have long-term care insurance, it would pick up for that deficit and pay.
Does the supplement stop paying if the prognosis of the patient worsens?
Yes. When it comes to the Medicare criteria, the therapist will set up goals, such as, “I want him to be able to walk 10 feet in 5 days”. So if the patient is not increasing and making progress – and there’s a little bit of leeway there. Some people might have other stuff going on. They say you can refuse three times, but after that the therapy is going to be required, which is going to drop the Medicare Aid benefits and the supplement, as well.
Say if it’s a 10-bed facility, maybe 50% to 80% of the beds are certified, and that can also be with Part A, too. You can have them duly certified with Medicaid and Medicare, or one of each. Of course, if you have Medicare and you’re not in the certified bed, Medicare is not going to pay, so the home would advise you of that.
You meet with families from time to time, and you have folks at the facility who are trained to meet with the families to ensure that they have their affairs in order and can find a way to pay for the services and qualify them for the process. Is that right?
Yes, one of the federal regulations is that you have to have a social worker, and with that they do set up systems. You have to have a business manager that takes care of the billing. The social worker will deal with community resources, and there are options there as far as to help pay or help get them set up in the system. For some families, this is the first time that they are going through the process. Their parents have aged and they have reached that threshold where they need to enter the system. For many, it is a new and unfamiliar process. It can be very complicated, and considering those rules and regulations, they need to know when they meet the qualifications and how to determine eligibility.
Do you find that most families have planned ahead for this type of situation?
No, and I think people tend to put it off and not think that this is going to happen to them. If you look at statistics, you have a one in three chance of being in a skilled nursing facility. A lot has changed now because we do have 20-22% of our residents that are short-term that may come for that Medicare Part A, they get the rehabilitation, and then they’re able to go back home to live with their family. Others that return home with receive some type of home health care and sitter. There are a lot of good supports out there.
However, if someone at the facility feels that there is going to be what is known as an unsafe discharge, meaning the individual is well enough to go back home, but perhaps will not be taken care of the way he/she should in the home, then we are required to notify Adult Protective Services (APS). They would come in and do a home assessment to make sure that it is a safe environment for the senior citizen. Someone has to be home to take care of the senior, administer medication, etc. APS checks all of that out, and if they do not like what they see in the assessment, they’ll step in. That’s not meant to be a big brother system; this is meant to protect the seniors and get their needs met.
If you would like to know more about Peak Resources or speak to one of their employees, you can contact them by phone at 704-482-5396. They are located at 1101 N. Morgan Street in Shelby.
Call me if you have any questions:
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby