Resident's Handbook by yaofenji

VIEWS: 3 PAGES: 26

									   508 West Pearl • Afton, Iowa 50830
  Phone 641.347.8416 • FAX 641.347.5497
afton@mddc.com •   www.aftoncarecenter.com




Resident’s
Handbook
                     i
     Afton Care Center’s
         Resident’s
         Handbook




ii            iii
       Our Care
     Brightens Lives

iv         v
                                                                Contents     Contents


                               Contents                                         Section 5 .............................................................17
Section 1 .............................................................. 1        Services Provided...............................................17
  Admission Needs................................................. 1              Activity Program ................................................17
  Important Papers Needed..................................... 2                  Beauticians .......................................................17
  Necessities to Bring ............................................. 2            Dental, Optical and Hearing Services ....................17
  Special Equipment (if needed) .............................. 3                  Dietary Services ................................................17
  Items Not to Bring .............................................. 3             Laundry Services ...............................................17
  Furniture ........................................................... 3         Housekeeping ....................................................18
Section 2 .............................................................. 5        Maintenance ......................................................18
  Admissions, Transfers, ......................................... 5              Medications and Pharmaceutical Services ..............18
  And Discharges ................................................... 5            Nursing Services ................................................19
  Admission Policy ................................................. 5            Medical Director .................................................19
  Admission Requirements ...................................... 5                 Physician Services ..............................................19
  Transfer Policy .................................................... 6          Religious Services ..............................................20
  Discharge Policy.................................................. 6            Social Services ..................................................20
Section 3 .............................................................. 9        Therapy Services ...............................................20
  Financial Matters................................................. 9            Survey Results ..................................................20
  Business Office ................................................... 9           Volunteer Services .............................................21
  Medicare and Insurance ....................................... 9              Section 6 .............................................................23
  Resident Trust Fund............................................. 9              Rehabilitation Services ........................................23
  Rates ...............................................................10         Physical Therapy ................................................23
Section 4 .............................................................11         Occupational Therapy .........................................23
  Important Information ........................................11                Speech Therapy .................................................24
  Clothing and Personal Items ................................11                Section 7 .............................................................25
  Confidentiality ...................................................11           Resident Council, Records, and Self-Determination .25
  Electrical Appliances ...........................................11             Resident Council ................................................25
  Gratuities ..........................................................11         Resident Records ...............................................25
  Newspapers ......................................................12             Resident Self-Determination ................................26
  Food ................................................................12       Section 8 .............................................................27
  Personal Mail .....................................................12           Advocates For Residents .....................................27
  Smoking and Alcohol ..........................................12                Iowa Department Of Inspections and Appeals ........27
  Transportation ...................................................13            Long-Term Care Ombudsman...............................27
  Room Changes ..................................................13               Operation Restore Trust ......................................28
  Room Decorations ..............................................13               Iowa Protection and Advocacy .............................28
  Safety Precautions .............................................14            Section 9 .............................................................29
  Televisions ........................................................14          Medicare Coverage .............................................29
  Visitors and Out-of-Facility Visits ..........................14                SNF Care in 2008 ...............................................36




                                  vi                                                                               vii
                 Afton Care center
                                                   508 W. Pearl, Afton, Iowa 50830




       Welcome to Afton Care center.

       We are grateful for the opportunity to serve
       you and welcome you to our care center.

       We offer a wide range of services and activities
       that we hope will bring comfort and variety
       to your life. To help acquaint you with these
       services, we have prepared this handbook
       for you and your family. Please keep this
       handbook and refer to it anytime you may
       have a question or want to share information
       with a visitor, your family, or a special friend.
       If you have any questions, please feel free to
       talk with me, the director of nursing services,
       or the social worker. Our doors are always
       open to you and your family.



       Again welcome,




       Administrator
       Afton Care center




viii                           ix
                                                         Section 1


                              Section 1

                      Admission Needs
    You will need to bring the following cards or copies of the
      following:

       • Social Security Card
       • Medicare Card
       • Medicaid Card
       • Any private insurance cards you may have

    We will need to verify your pay source

       • If you are going to pay privately we will collect
         payment for the first month on the day of
         admission. If you move on the 15th of the month,
         you will pay from that day until the end of the
         month. We will pre-bill so you will receive the bill
         for the next month at the end of the first month
         you are here. The resident will initially pay the
         rate for the minimum level of care. Residents
         are assessed by their 21 stday in the facility. The
         assessment may result in a rate increase to the
         moderate or maximum level of care. Assessments
         will be completed on a quarterly basis, and when/
         if a resident experiences a significant change in
         their condition. A significant change assessment
         could also result in a change in the resident’s
         rate.
       • If you are going to receive skilled care (Medicare
         Part A) we will need to verify the number of skilled
         days that you have. If you qualify for skilled care,
         Medicare will pay 100% for days 1 through 20;
         for days 21 through 100, you will pay a daily
         co-payment. If you have supplemental health


x                                  1
Section 1                                                                                                          Section 1


      insurance, it may pay the co-payment. (See              Special Equipment (if needed)
      addendum regarding current co-pay amount).                  • Walker or cane
    • It is important that you inform us at the time of           • Glasses
      admission what your pay source will be when you             • Hearing aids
      are discharged from skilled care.                           • Dentures
    • If you will be utilizing Medicaid as your pay source,
      we will need to call Union County Department of         Items Not to Bring
      Human Services and speak to the case manager                • Electric heating pads
      to verify that you have the Medicaid that pays for          • Extension cords
      your stay at the care center.                               • Spray cans
    • If you have long-term insurance, you will be                • Candles
      responsible to file your claim as needed.                   • Existing medications from home or hospital,
                                                                    including      over-the-counter   medications
Important Papers Needed                                             (this includes: Tums, aspirin, eye drops or
   • Do Not Resusitate status                                       analgesics).
   • Living will (if you have one)
   • Durable power of attorney for health care (DPOA;         Furniture
     if you have appointed someone for health care)               • We provide a bed, chair and a wardrobe closet.
   • Power of attorney for finances (POA; if you have               We encourage you to bring items that make you
     appointed someone)                                             feel at home. If you are in a semi-private (shared)
   • Guardianship papers (if you have appointed                     room, your belongings must fit on your side of
     someone)                                                       the room.
   • A recent history and physical
   • Correct name, address, and phone number of
     contact person

Necessities to Bring
    • At a minimum, 7 changes of machine washable
      clothing (including socks, and undergarments)
      always mark your items clearly
    • Bathrobe
    • Sweater, coat, hat, mittens
    • Shoes
    • Electric razor (men)
    • Make-up, comb or brush


                               2                                                              3
                                                             Section 2


                                  Section 2

                     Admissions, Transfers,
                        And Discharges
    Admission Policy
    It is the policy of Afton Care Center to admit only those residents
    whose needs can be met by the facility or met in cooperation
    with community resources or other providers. It is our policy to
    provide equal access and services to all residents without regard
    to race, color, national origin, disability, or age. Admission is not
    denied to people with communicable disease including, but not
    limited to blood and body substance infections. Consultation
    with the State Department of Health will be conducted on a
    case-by-case basis with the welfare of inquiries, existing
    residents and staff considered. The facility will not admit
    persons in need of services greater than can be provided and
    will preclude provision of care for any resident whose needs are
    sustained by electrical-life support equipment by transferring
    any such resident to a facility with these capabilities. Afton Care
    Center will not conduct any procedures requiring surgery or the
    administering of anesthesia.

    Admission Requirements
    The resident must be admitted to the facility under the order of
    a physician licensed to practice in the state of Iowa. A physician
    must see a resident once a month for the first three months
    of nursing home care and once every sixty days thereafter.
    The attending physician must furnish the facility with a recent
    history and physical of the resident, diagnosis to admit, course
    of treatment and physician orders necessary concerning the
    safety of the resident.

    All residents have extensive rights in this facility, according to
    state and federal regulations. These rights will be discussed with
    you at the time of admission. Advanced directives will also be

4                                     5
Section 2                                                                                                                     Section 2


discussed with you upon admission, and assistance is available,            • If discharge or transfer is the result of a final,
if needed, to initiate these directives.                                     non-appealable decision by the Department of
                                                                             Social Services or the Professional Standards
Transfer Policy                                                              Review Organization.
If a resident requests a transfer to another facility or to return
home, a ten-day notice to the care center is requested. All            If a physician disapproves the discharge but the resident insists,
transfers shall be coordinated by the social worker and/or             the form “Release from Responsibility for Discharge” must be
designee to ensure that social services are provided so that           signed by the resident and two witnesses. It is the responsibility
adequate arrangements exist for meeting the resident’s needs.          of the resident or their family to remove all personal belongings
These procedures will be waived in cases of emergency such             from the room at the time of discharge. Any clothing left in the
as transfers to hospitals. When a resident is transferred to           laundry is the responsibility of the resident and should be taken
any facility, including hospitals, a summary of the course of          at the time of discharge or picked up within one week. In the
treatment followed here will be sent to the receiving facility. In     case of discharge by death, the responsible party is notified
cases of emergency, the resident will be watched carefully and         immediately and the remains will be prepared for transfer to the
transferred to the hospital on the orders of the physician.            mortuary of the resident’s choice. All discharges are coordinated
                                                                       by the social worker and/or designee to ensure that social
Discharge Policy                                                       services are provided so that adequate arrangements exist for
If the care center discharges a resident, the administrator will       meeting the resident’s needs. The social worker or director of
give at least a 30-day written notice to the resident or responsible   nursing may call a discharge planning meeting if the need is
party, attending physician, and any other responsible party. A         apparent.
30-day notice will be waived in the following circumstances:

    • An emergency transfer or discharge is required
      by the resident’s urgent health care needs
      and is in accord with orders of the attending
      physician.
    • An emergency transfer or discharge is required
      to protect the health, safety, or well-being,
      of other residents and staff from the resident
      being transferred.
    • The transfer or discharge is agreed to by the
      resident or the resident’s responsible party, and
      notification is given to the responsible party,
      physician, and the person or agency responsible
      for the resident’s placement, maintenance and
      care in the facility.

                                6                                                                       7
                                                           Section 3


                                 Section 3

                         Financial Matters

    Business Office
    The Business Office will be open from 8:00 a.m. to 4:30 p.m.,
    Monday through Friday. During this time, we will be happy to
    help residents with check cashing, acquiring postage stamps,
    purchasing writing material, handling trust account transactions,
    and answering questions about other business matters.

    Medicare and Insurance
    The Afton Care Center is a skilled facility. This means that we can
    admit residents who may qualify for Medicare for their source
    of payment for a period of time. In order to qualify for Medicare
    Part A, the resident must have spent three (3) midnights in
    the hospital prior to admission to the facility and require daily
    skilled care services. Medicare Part A will provide coverage for
    up to 100 days of skilled nursing care. Full coverage is provided
    for the first 20 days. After the 20th day, a co-payment is
    required.

    Medicare Part B may pay for some of the ancillary supplies
    and therapies provided. If you have any questions about your
    insurance policies, please contact your insurance agent or the
    social worker. If you feel you may qualify for Medicare benefits,
    please visit with the administrator, director of nursing, or the
    social worker.

    Resident Trust Fund
    Since we strongly recommend that no resident keep more than
    $5.00 in their possession, residents can arrange to deposit money
    in the Business Office for safekeeping. The office manager will
    keep an accurate record of any money deposited and withdrawn



8                                    9
Section 3                                                                                                                Section 4


from this account. Complete policies and procedures regarding                                 Section 4
this fund are available from the office manager.                                  Important Information
Rates                                                            Clothing and Personal Items
Rates are determined by the amount of care required by the       You or your family are responsible for providing clothing. We
resident and are computed daily. Payments are due on the first   encourage residents to dress in street clothes if possible, and
of the month. Residents are charged for the day of admission,    we recommend that you bring several changes of whatever
but not the day of discharge. Rates are subject to change        clothing you wore at home. We also suggest having warm
whenever necessary due to economic factors or change in the      outerwear for outings.
level of care required by the resident.
                                                                 We strive to protect and preserve the personal property of each
                                                                 resident. For this reason, we require clothing be labeled with
                                                                 permanent marker. Clothing items requiring dry cleaning are
                                                                 the responsibility of the resident. Family members will need to
                                                                 take these items to the dry cleaners. We are concerned about
                                                                 lost items and will do our best to find them.

                                                                 All clothing items and all other personal items are listed on an
                                                                 inventory list when you are admitted. Please notify the Charge
                                                                 Nurse of any additional items brought into the facility and any
                                                                 items taken out of the facility.

                                                                 Confidentiality
                                                                 Resident’s medical record, including the plan of pare, is considered
                                                                 confidential information. Disciplinary action will be taken against
                                                                 any staff member who violates this confidentiality.

                                                                 Electrical Appliances
                                                                 Radios, televisions and electric clocks are allowed. Electrical
                                                                 appliances, such as, refrigerators, portable humidifiers, heating
                                                                 pads, electric blankets are not allowed. Electric heat lamps and
                                                                 extension cords are strictly prohibited by orders of the State
                                                                 Fire Marshal. If you have any questions, please ask.

                                                                 Gratuities
                                                                 Gratuities are not necessary and staff is prohibited from accepting
                                                                 them. A “smile and thank you”, are the best rewards.
                             10                                                                   11
Section 4                                                                                                                Section 4


Newspapers                                                         No alcohol is permitted in resident rooms. An order from the
Arrangements can be made with the business office or activity      physician is required for a resident to consume alcohol. Any
director to have a newspaper delivered to you. You are             alcohol will be kept at the nurse’s station.
responsible for payment of the subscription.
                                                                   Transportation
Food                                                               The facility is responsible to arrange transportation for the
Some residents have dietary restrictions which make it             residents to doctor and dental appointments, etc. We encourage
necessary to limit the amount and type of food they receive.       families to provide transportation and accompany residents to
For this reason, food items should not be taken to resident’s      appointments whenever possible. When family assistance is not
rooms without first checking with the charge nurse. We ask         available, other area transportation sources will be utilized to
that all food items be placed in covered containers, and that      meet residents’ needs.
items needing refrigeration be taken to the dietary kitchen to
be served by the staff to the residents.                           Room Changes
                                                                   No resident will move from one room to another without first
We cannot accept any “home canned” food items because of           notifying the family or guardian that a move will be made.
health regulations, but we love fresh vegetables and fruit.        However, room changes to protect the safety or welfare of any
                                                                   resident may be made at any time without prior notice. The
Personal Mail                                                      facility shall try to fulfill the wishes of the resident and the
Personal mail is delivered unopened daily, except Sunday and       family in room placement. The administrator, director of nursing
holidays, usually by noon. Outgoing mail is picked up each         services, and social worker will be in consultation to locate the
afternoon at approximately 4:30 p.m. at the mailbox located        residents in the room, which will best serve the physical and
at the nurse’s station. Incoming mail may be reviewed only if      social needs of the resident.
requested in writing by a legal guardian. Outgoing mail is never
censored.                                                          Room Decorations
                                                                   Since this is your home, you are encouraged to bring such
Postage stamps may be purchased in the business office during,     favorite items as pictures, lamps, afghans, small plants, etc.
normal business hours. Writing material is also available upon     to brighten your room and make it more homelike. You are
request and at the resident’s expense from the Business            permitted to bring whatever personal furnishings you wish as
Office.                                                            long as they do not infringe upon the rights of your roommate
                                                                   or violate any fire safety regulations.
Arrangements can be made to provide assistance reading and
sending mail if needed.                                            Throw rugs, extension cords and real ever-greenery are strictly
                                                                   prohibited by State Fire Marshal’s regulations.
Smoking and Alcohol
Afton Care Center is a “smoke free” facility. All residents will   We ask that you have the maintenance department hang all
be made aware of this policy on the pre-admission visit. An        items you would like on your walls. Minor TV hookups will be
outdoor area is provided where you can smoke.                      done by the maintenance department.
                              12                                                                   13
Section 4                                                                                                                Section 4


Safety Precautions                                                   mealtime. A nominal fee is charged, and payment can be made
We are concerned with the safety of our residents, as well as        to the business office or, on week-ends, the charge nurse will
their physical care and mental well being. All doors are equipped    assist you.
with sensors that allow staff to know when a resident is near
the exit. Our main entrance is located on the south side of the
building.

Fire fighting equipment and alarm systems are checked regularly
to ensure proper working condition. Monthly fire drills are held,
and all residents are expected to comply with these drills. All
staff is trained in case of emergencies.

Televisions
Residents are able to have televisions in their rooms. We reserve
the right to require headphones as the need arises. All rooms
are cable ready. If you choose to hook into the cable lines, you
will need to contact the business office manager for payment
of the fees.

There is a large screen TV in our front living area. We ask that
you be respectful of activities in the area.

Visitors and Out-of-Facility Visits
Although there are no set visiting hours, relatives and friends
are encouraged to visit anytime. Please be considerate of
residents and their roommates during your visit, please do not
disrupt their schedules. Children are welcomed visitors, but it is
best if they remain with an adult.

Upon request, a private area can be arranged for family
members, clergy or other visitors.

Relatives of critically ill residents may visit at any time.

Your family may join you for a meal in the dining room.
Arrangements should be made with the business office or
the charge nurse, preferably no later than one hour before
                                14                                                                 15
                                                              Section 5


                                   Section 5

                          Services Provided
     Activity Program
     Planned activities are provided six days a week under the
     direction of a full-time activity director, with special arrangements
     for evening and weekend activities. A variety of activities are
     offered to meet the spiritual, physical, emotional, and social
     needs of each resident. A monthly activity calendar is distributed
     to each resident.

     Beauticians
     Beauticians visit the care center weekly to cut hair, set hair,
     and give permanents. These individuals are not employees of
     the facility, but are available for the resident’s convenience.
     Financial arrangements are the responsibility of each resident
     or responsible party.

     Dental, Optical and Hearing Services
     The facility will help you make arrangements for these services,
     both routine and emergency needs.

     Dietary Services
     You will be provided with regular, well-prepared, nutritious
     meals as ordered by your physician. Therapeutic diets and
     modified diets are also provided as ordered by the physician.
     A consulting dietitian is contracted by the facility to oversee all
     menus and diets.

     All residents are expected to eat in the dining room unless they
     are ill. We have open breakfast between 7:00 a.m. and 9:00
     a.m., lunch is served at 11:30 a.m., supper is served at 5:15
     p.m. Supplemental snacks are available at 10:00 a.m., 3:00
     p.m., and at bedtime.

     Laundry Services
16                                     17
Section 5                                                                                                                    Section 5


Laundry services are available every day for all washable items.
Dirty clothing is removed from each room daily, and clean           We cannot accept medications from home or hospitals. Please
laundry is returned later and placed in the wardrobes.              give any medications to the charge nurse at time of admission.
                                                                    This includes, but not limited to, Tylenol, analgesics, aspirin,
Housekeeping                                                        Tums, etc.
Your room will be cleaned daily by one of the housekeeping staff.
Seasonal cleaning such as drapery cleaning, window washing,         Nursing Services
etc., is provided on a regular schedule.                            We provide 24-hour nursing service and maintain the
                                                                    nursing hours per resident as required by state and federal
Closets and drawers are the responsibility of the resident or       regulations.
their family to keep clean and orderly. If the resident or family
chooses not to clean, the facility’s housekeeping staff may         If a resident’s condition requires more care or has improved
periodically remove excess belongings in the presence of the        to require less care, the administrator, director of nursing
resident.                                                           services, and the social worker will evaluate the resident to
                                                                    determine if a different level of care would be appropriate.
Maintenance                                                         If the change in level of care necessitates a rate change, we
The facility employees a full-time maintenance director             would notify the resident or responsible party. If a resident’s
experienced in general maintenance and repairs. Resident should     condition is such that we can no longer provide adequate care,
notify the maintenance director, charge nurse, or housekeeping      we would notify the resident, physician, next of kin, and/or
staff of needed repairs.                                            other appropriate community agencies in accordance with the
                                                                    Admission Agreement.
Medications and Pharmaceutical Services
When necessary, medications are secured from the pharmacy           Medical Director
by the nursing staff. Residents may designate the pharmacy of       The facility contracts with a local physician to serve as our medical
their choice as long as the pharmacy will provide medications       director. The medical director is responsible for coordinating the
using the facility’s unit dose system. Your physician orders        medical care at the facility, as well as, implementing resident
all administered medications. Each resident has the right to        care policies. The medical director meets quarterly with the
self-administer medications unless the intermediary team has        Quality Assurance Committee, which is made up of staff from
determined that the practice is unsafe for that resident.           all departments.

Medications are billed directly to you or to medical assistance     Physician Services
for those who qualify. If you are covered under Medicare Part A,    You must remain under the care of a qualified physician during
the cost of medications is included in your Medicare billing.       your stay here. A local physician should be selected at the time
                                                                    of admission. All medications, treatments, and diets are subject
If you plan on being out of the building during a medication        to the physician’s direction. The facility will make provisions
pass, the nursing department will make arrangements to send         for emergency physician services, i.e., the facility medical
necessary medications with you or a responsible party.              director.
                              18                                                                      19
Section 5                                                                                                                    Section 5



Religious Services                                                    Volunteer Services
Residents are not required to participate in any religious            Our activity coordinator is in charge of volunteer services. We
activities. The facility provides inter-denominational services       encourage family members and community members to be
every Sunday with the assistance of area clergy. Clergy is            active in their local care center. Volunteers may be asked to do
encouraged to make visits to their members.                           special duties for certain residents, share their talents, and help
                                                                      with group activities.
Social Services
A qualified social worker is employed to help meet the medically
related social needs of the resident. Families are also encouraged
to utilize the services of the social worker about room changes,
financial concerns, or if you just wish to talk to someone. In
addition to assisting with problems and concerns you may have,
the social worker is also knowledgeable about other resources
in the community and coordinates all discharges.

The social worker is responsible to help meet the special needs
of the residents as well as orientating new residents at the time
of admission.

Therapy Services
The facility contracts with a licensed physical therapist, speech
pathologist, and occupational therapist to provide evaluations
and services to the resident needs. The therapists also provide
training and consultation to the therapy aides and nursing staff.
Their fees are not included in the daily room rate. All restorative
services are prescribed by your physician and are carried out
under the medical direction. This service, which is provided six
days a week, is directed toward assisting the resident to achieve
and maintain the highest level of self-care and independence.
Therapy includes such things as gait training, exercises, walking,
stair climbing, teaching how to dress, swallow, etc.
Survey Results
Residents have the right to examine the results of the most
recent state survey. A copy is located near the main door.


                               20                                                                      21
                                                           Section 6


                                 Section 6

                     Rehabilitation Services

     Physical Therapy
     A licensed physical therapist and/or physical therapy assistant
     provide physical therapy. The goals of physical therapy are to:

          • Provide screenings to determine the need for
            primary prevention services.
          • Provide evaluations and prevention/wellness
            activities to increase strength and flexibility of
            joints and muscles through carefully determined
            exercise programs.
          • Develop exercise programs; gait training, balance
            and coordination activities to reduce the risk of
            falls.
          • Initiate treatments to reduce pain through heat,
            massage, and electrical stimulation.
          • Develop individual wound care treatments, with
            use of electrical stimulation.
          • Assess the home environment for independence
            and safety.
          • Educate resident and their family/caregiver on
            preventative therapy techniques to increase their
            quality of life.

     Occupational Therapy
     A registered occupational therapist and/or certified occupational
     therapy assistant provide occupational therapy. The goals of
     occupational therapy are to:

          • Provide screenings to determine the need for
            primary prevention services.
          • Evaluate and educate residents in activities of
            daily living skills, including dressing, grooming,

22                                   23
Section 6                                                                                                             Section 7


      eating, bathing, homemaking tasks, as well as                                         Section 7

      community integration tasks.                                                 Resident Council,
    • Instruction, in use of adaptive equipment to
      increase the resident’s independence.
                                                                                     Records, And
    • Fabricating and monitoring upper extremity                                  Self-Determination
      splints.
    • Improve joint mobility, muscle strength, and             Resident Council
      physical endurance.                                      One way to exercise your rights as a resident is through the
    • Evaluate wheelchair positioning to ensure optimal        resident council. We hope you will take an active role in our
      mobility and positioning.                                resident council and attend the meetings. To help you better
    • Educate resident and family/caregiver on                 understand what resident council is and does, we have provided
      preventative therapy techniques.                         the following information for you.

Speech Therapy                                                 The resident council is an organization of the persons living
Speech therapy is provided by a speech language pathologist.   in Afton Care Center whose purpose is to provide a means for
The goal of speech therapy is to:                              residents to share concerns, problems, and ideas with other
                                                               residents and the staff. It also allows you and other residents
    • Provide screenings to determine the need for             the opportunity to participate in the affairs and decisions that
      primary prevention services.                             influence your life each day while you are a resident here. The
    • Evaluate and improve receptive and expressive            council is your voice at the care center and aims at responding
      language skills.                                         to your needs and interests.
    • Develop proper control of articulatory, resonary,
      and respiratory systems for better speech.               The council was started to assist in planning activities, outings,
    • Provide treatment of swallowing disorders.               and special events and to educate the residents of their facility
    • Evaluate, select, and develop augmentative               rights.
      communication systems.
    • Conduct hearing screenings and make referrals            The Resident Council operates independently, but in partnership
      for audiological services.                               with the administrator and other staff. All residents automatically
                                                               become members, but participation is voluntary.


                                                               Resident Records
                                                               Residents have the right to have information on their medical
                                                               records explained to them by their physician or other licensed
                                                               health professionals. If the physician determines this medically
                                                               inadvisable, an appropriate person may be informed on the
                                                               resident’s behalf. Resident records are only open to those
                            24                                                                  25
Section 6                                                                                                                      Section 7


persons directly involved with the care of the resident or those                                  Section 8
authorized by law, such as health care evaluators.                                    Advocates For Residents
                                                                    Listed below are the names and phone numbers of volunteers
In order to provide continuity of care when a resident is           from your community who are on the Resident Advocate
being transferred to the care of another physician, pertinent       Committee at Afton Care Center.
information will be sent to the receiving facility or physician.
The resident or responsible party will be asked to sign a form      They are not employed by nor affiliated with the facility. Their
authorizing the release of records.                                 job is to visit with residents and families, and to work towards
                                                                    resolving issues of concern. Please give them a call!
Resident Self-Determination
The resident has the right to be informed of his/her health              Lucille Beaman Chairman 641.346.2274
status, including but not limited to, their medical condition and                                 PO Box 293, Arispe   50831
the right to accept or refuse treatment. The residents have              Maxine Norris   Member   641.782.2769
the right to make informed health care decisions, including                                       1715 W. Prairie #211, Creston 50801
decisions regarding life-sustaining measures. The care center            Norma Sweet     Member   641.346.2579
must act on physician orders; therefore, any agreements must                                      115 Dutcher,Afton, Iowa 50830
be between the resident and their physician.                             Kathy Flam      Member   641.347.5532
                                                                                                  2395 Railroad St, Afton, Iowa 50830


                                                                    The    following   agencies   are         available        to   assist
                                                                    residents and/or family members.

                                                                    Iowa Department Of Inspections and Appeals
                                                                      Division of Health Facilities inspects facilities to ensure
                                                                      compliance with state and federal standards. 1-877-686-0027
                                                                      (toll free) Lucas Building, 3rd Floor, Des Moines, lowa
                                                                      50319-0083

                                                                    Long-Term Care Ombudsman
                                                                       Answers questions or assists in resolving concerns raised
                                                                       by or on behalf of residents. Call 1-800-532-3213 (toll free)
                                                                       Iowa Department of Elder Affairs, 510 East 12th Street,
                                                                       Suite 2, Des Moines, Iowa 50319




                              26                                                                      27
Section 7                                                                                                                     Section 8


Operation Restore Trust                                                                            Section 9
  Answers questions or addresses concerns regarding Medicare                             Medicare Coverage
  or Medicaid fraud, waste or abuse. 1-800-423-2449 (toll
  free) PO Box 388 Waterloo, Iowa 50704
                                                                  Medicare will cover skilled care only if all of the following
                                                                  are true:
Iowa Protection And Advocacy
                                                                                  1. You have Medicare Part A* (Hospital
  Provides protection and advocacy for persons with mental
                                                                                     Insurance) and have days left in
  illness or disabilities. 1-800-779-2502, 950 Office Park Rd.,
                                                                                     your benefit period available to use.
  Suite 221, West Des Moines, Iowa 50265

                                                                                        2. You have a qualifying hospital stay.
                                                                                           This means an in-patient hospital
                                                                      * If you aren’t
                                                                   sure if you have        stay of 3 consecutive days or more,
                                                                        Part A, look       starting with the day the hospital
                                                                        on your red,       admits you as an inpatient, but
                                                                    white, and blue        not including the day you leave
                                                                    Medicare card.         the hospital**. You must enter the
                                                                         It will show      Skilled Nursing Facility (SNF) within
                                                                    “Hospital (Part        a short period of time (generally 30
                                                                   A)” on the lower
                                                                                           days) of leaving the hospital. See
                                                                       left corner of
                                                                      the card. You        item 5. After you leave the SNF, if you
                                                                       can also find       re-enter the same or another SNF
                                                                    out if you have        within 30 days, you may not need
                                                                   Part A if you call      another 3-day qualifying hospital
                                                                  your local Social        stay to get additional SNF benefits.
                                                                    Security office,       See item 5. This is also true if you
                                                                       or call Social      stop getting skilled care while in the
                                                                          Security at
                                                                                           SNF and then start getting skilled
                                                                  1-800-772-1213.
                                                                                           care again within 30 days.

                                                                  **Time you are being observed in a hospital before you are
                                                                  admitted doesn’t count toward the 3-day qualifying in-patient
                                                                  hospital stay.
                                                                                  3. Your doctor has ordered the services
                                                                                     you need for SNF care, which



                             28                                                                        29
Section 8                                                                                                     Section 8


              require the skills of professional                           diagnosis or treatment of your
              personnel such as registered nurses,                         condition.
              licensed practical nurses, physical                       7.You get these skilled services in a
              therapists, occupational therapists,                         SNF that is certified by Medicare.
              speech-language pathologists or
              audiologists, and are furnished by,        How long does Medicare cover my Skilled Nursing Facility
              or under the supervision of, these         (SNF) care?
              skilled personnel.                                         Medicare uses a period of time called
                                                                         a benefit period to keep track of how
            4. You require the skilled care on a                         many days of SNF benefits you use,
               daily basis and the services must                         and how many are still available. A
               be ones that, as a practical matter,                      benefit period begins on the day you
               can only be provided in a SNF on an                       start using hospital or SNF benefits
               inpatient basis. If you are in a SNF                      under Part A of Medicare. You can
               for skilled rehabilitation services                       get up to 100 days of SNF coverage
               only, your care is considered daily                       in a benefit period. Once you use
               care even if the therapy services are                     those 100 days, your current benefit
               offered just 5 or 6 days a week.                          period must end before you can
                                                                         renew your SNF benefits.
            5. *If you need these skilled services
               for a medical condition that                             Your benefit period ends
                • was treated during a qualifying                          • when you have not been in a SNF
                  3-day hospital stay, or                                    or a hospital for at least 60 days in
                • started while you were getting SNF                         a row, OR
                  care for a medical condition that                        • if you remain in a SNF, when you
                  was treated during a qualifying                            haven’t received skilled care there
                  3-day hospital stay. For example, if                       for at least 60 days in a row.
                  you are in a SNF because you broke                         There is no limit to the number
                  your hip and then have a stroke,                           of benefit periods you can have.
                  Medicare may cover rehabilitation                          However, once a benefit period
                  services for the stroke, even if you                       ends, you must have another
                  no longer need rehabilitation for                          3-day qualifying hospital stay and
                  your hip.                                                  meet the Medicare requirements

            6.The skilled services must be
              reasonable and necessary for the

                         30                                                            31
Section 8                                                                                                       Section 8


                    before you can get up to another                             SNF benefit days remaining in
                    100 days of SNF benefits.                                    your current benefit period.

What if I stop getting skilled care in the Skilled Nursing
Facility (SNF), or leave the SNF altogether? How does        What if I stop getting skilled care in the Skilled Nursing
this affect Medicare SNF coverage if I need more skilled     Facility (SNF), or leave the SNF altogether? How does
care in a SNF later on? This depends on how long your        this affect Medicare SNF coverage if I need more skilled
break in SNF care lasts.                                     care in a SNF later on? This depends on how long your
                                                             break in SNF care lasts.
               If your break in SNF care lasts for
                                                                            If your break in SNF care lasts for
                  • You don’t need a new 3-day hospital
                    stay to qualify for coverage of                            • You don’t need a new 3-day hospital
                    additional SNF care (see item 2 on                           stay to qualify for coverage of
                    page 18).                                                    additional SNF care (see item 2 on
                  • Since your break in SNF care                  Less           page 18).
                    lasted for less than 60 days in a             than         • Since your break in SNF care
                    row, your current benefit period                30           lasted for less than 60 days in a
                    would continue. This means that               days           row, your current benefit period
                    the maximum coverage available                               would continue. This means that
                    would be the number of unused                                the maximum coverage available
                    SNF benefit days remaining in                                would be the number of unused
                    your current benefit period.                                 SNF benefit days remaining in
                  • Medicare won’t cover additional                              your current benefit period.
                    SNF care unless you have a new
                    3-day qualifying hospital stay. The                        • Medicare won’t cover additional
                    new hospital stay need not be for                At          SNF care unless you have a new
                    the same condition that you were             least           3-day qualifying hospital stay. The
                    treated for during your previous            30 but           new hospital stay need not be for
                    stay.                                          less          the same condition that you were
                  • Since your break in SNF care                  than           treated for during your previous
                    lasted for less than 60 days in a                60          stay.
                    row, your current benefit period             days          • Since your break in SNF care
                    would continue. This means that                              lasted for less than 60 days in a
                    the maximum coverage available                               row, your current benefit period
                    would be the number of unused                                would continue. This means that
                                                                                 the maximum coverage available
                           32                                                             33
Section 8                                                                                                        Section 8


               would be the number of unused          What does Medicare cover when I qualify for SNF (Skilled
               SNF benefit days remaining in          Nursing Facility) care?
               your current benefit period
                                                          Medicare Services                                   Covered
              • Medicare won’t cover additional
                                                          Semi-private Room                                      √
                SNF care unless you have a new            (A room you share with other patients)
                3-day qualifying hospital stay. The
         At     new hospital stay need not be for
                                                          Meals                                                  √
      least     the same condition that you were
        60                                                Skilled Nursing Care                                   √
                treated for during your previous
      days      stay.
                                                          Physical Therapy*                                      √
              • Since your break in skilled care
                lasted for at least 60 days in a          Occupational Therapy*                                  √
                row, this would end your current
                benefit period and renew your             Speech-Language Pathology Services*                    √
                SNF benefits. This means that
                the maximum coverage available            Medical Social Services                                √
                would be up to 100 days of SNF
                benefits.                                 Medications                                            √

                                                          Medical Supplies and Equipment Used in Facility        √

                                                          Ambulance Transportation (when other
                                                          transportation endangers health) to the nearest
                                                          supplier of needed services that aren’t available      √
                                                          at the SNF


                                                          Dietary Counseling                                     √



                                                          *Medicare covers these services if they are needed to meet your
                                                          health goal.




                       34                                                                  35
Section 8


What do I pay for Skilled Nursing Facility (SNF) care in
2008?


                    SNF Care in 2008
   In the Original Medicare Plan, for each benefit period
   in the calendar year 2008 you pay:

                      You Pay For       Medicare Pays For
        For Days    Covered Services    Covered Services

          1-20          Nothing               Full Cost

        21-100     Up to $128 per day    All but $128 per day

      Beyond 100        Full Cost              Nothing


   You must also pay all additional charges not covered
   by Medicare (like telephone charges and cable TV
   fees).




 Information on the preceding pages of Section 8 was taken from
 Medicare and Medicaid Skilled Nursing Care Facility Coverage
 Download from the Medicare Website -

 http://www.medicare.gov/Publications/Search/Results.asp?PubID
 =10153andType=PubIDandLanguage=English



                                  36                              37
INDEX                                                                                                                                                                                    INDEX



A                                                  F
                                                                                                     M                                                  Rates ................................. 10
Activity Coordinator .............. 21                 Financial Matters .................... 9      Medical Social Services ......... 35               Rehabilitation Services .......... 23
Activity Director ............. 12, 17                 Fire Drills ............................ 14   Medical Supplies &                                 Release from Responsibility for
Activity Program .................. 17                 Fire Safety Regulations ......... 13           Equipment Used in Facility ... 35                  Discharge Form.................... 7
Admission Policy .................... 5                Food................................... 12    Medicare ............................. 35          Religious Activities ............... 20
Admission Requirements ......... 5                                                                   Medicare Card ....................... 1            Religious Services ................ 20
                                                                                                                                                        Resident Advocate Committee 27
Advanced Directives ............... 5              G                                                 Medicare Coverage ............... 29
                                                                                                                                                        Resident Council .................. 25
Advocates For Residents ....... 27                                                                   Medicare Fraud .................... 28
Ambulance Transportation ..... 35                      Goal of Speech Therapy ........ 24            Medicare & Insurance ............. 9               Resident Records ................. 25
Audiologists......................... 30               Goals of Occupational Therapy 23              Medicare Part A.. 1, 9, 18, 29, 31                 Resident Rights .................... 25
                                                       Goals of Physical Therapy ...... 23           Medicare Services ................ 35              Resident Self-Determination .. 26
                                                                                                                                                        Resident Trust Fund ................ 9
B                                                      Gratuities ............................ 11    Medications .......... 3, 18, 19, 35
                                                                                                                                                        Room Changes .................... 13
                                                       Guardianship Papers ............... 2         Medication Services .............. 18
Beauticians ......................... 17               Guest Meals ........................ 14                                                          Room Decorations ................ 13
Benefit Period ........... 31, 33, 36                                                                N
Business Office ...................... 9           H                                                                                                S
                                                                                                     Necessities to Bring ................ 2
                                                                                                                                                        Safe Precautions .................. 14
C                                                      Health Status ...................... 26       Newspapers ........................ 12
                                                                                                                                                        Semi-Private Room........... 3, 35
                                                       Hearing Services .................. 17        Nursing Services .................. 19
Check Cashing ....................... 9                Housekeeping ...................... 18                                                           Services Provided ................. 17
                                                                                                                                                        Skilled Care ........................... 1
Children .............................. 14                                                           O                                                  Skilled Nursing Care ............. 35
Clergy ................................ 20         I                                                                                                    “Smoke Free” Facility ............ 12
Clothing .......................... 2, 11                                                            Occupational Therapists .. 20,         30
Clothing & Personal Items ..... 11                     Important Information .......... 11           Occupational Therapy ..... 23,         35          Smoking & Alcohol ............... 12
Confidentiality ..................... 11               Insurance Cards..................... 1        Operation Restore Trust ........       28          Social Security Card ............... 1
Co-Payment .......................... 2                Insurance Policies .................. 9       Optical Services ...................   17          Social Security office ............ 29
Covered Services ................. 36                  Iowa Department of Inspections                Out-of-Facility Visits .............   14          Social Services .................... 20
                                                         & Appeals ......................... 27                                                         Social Worker .... 6, 7, 13, 19, 20
                                                                                                                                                        Special Equipment.................. 3
D                                                      Iowa Protection & Advocacy ... 28             P                                                  Speech-Language Pathologists 30
                                                       Items Not to Bring ................. 3
Dental Appointment ............. 13                                                                  Personal Mail ....................... 12           Speech-Language Pathology
                                                                                                                                                         Services ............................ 35
Dental Services.................... 17             L                                                 Personal Property ................. 11
                                                                                                                                                        Speech Pathologist ............... 20
Dietary Counseling ............... 35                                                                Pharmaceutical Services........ 18
Dietary Restrictions .............. 12                 Laundry Services ................. 17         Physical ................................ 5        Speech Therapy ................... 24
Dietary Services................... 17                 Legal Guardian .................... 12        Physical Therapists .... 20, 23, 30                Supplemental Health Insurance 1
Diets .................................. 17            Living Will ............................. 2   Physical Therapy ............ 23, 35               Survey Results..................... 20
Director of Nursing ...... 7, 13, 19                   Long-Term Care Ombudsman . 27                 Physician Services ................ 19
Discharge Planning Meeting ..... 7                     Long-Term Insurance .............. 2          Postage Stamps ............... 9, 12           T
Discharge Policy ..................... 6                                                             Power of Attorney for Finances . 2
                                                                                                                                                        Televisions .......................... 14
Doctor Appointments ............ 13                M                                                                                                    Therapy .............................. 20
Do Not Resuscitate Status ....... 2                                                                  Q                                                  Therapy Services ................. 20
Door Sensors....................... 14                 Maintenance ........................ 18
Durable Power of Attorney ....... 2                    Meals ................................. 35    Quality Assurance Committee            19          Transfer Policy ....................... 6
                                                       Medicaid ............................... 2                                                       Transportation ..................... 13
E                                                      Medicaid Fraud .................... 28        R
                                                       Medical Director ................... 19                                                      U
Electrical Appliances ............. 11                 Medical Records ................... 25        Rate Change........................ 19
                                                                                                                                                        Union County DHS ................. 2



                                              38                                                                                                   39
INDEX




V
Visiting Hours ...................... 14
Visitors ............................... 14
Volunteer Services ............... 21

W
Welcome Letter ..................... ix




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