Attendant Care is dedicated staffing for one specific resident in a medical foster care environment. This is typically a 1 to 1 arrangement, however, in highly behavioral cases a 2 to 1 arrangement may be required for oversight and safety.
Why not just a daily general oversight arrangement and reimbursement to match? Because the medical foster care home accepts the same responsibilities for care as does hospitals and nursing homes when it comes to how care is divided and billed. Hospitals and nursing homes typically bill Medicare and other insurers a daily rate for room and bed occupancy, known as the “per diem” rate. This rate covers the basic costs associated with a resident’s stay, including accommodation, meals, and basic utilities. However, services that require additional labor or specialized care, such as nursing care, sitters, and various therapies (physical, occupational, and speech therapy), are billed separately. These services are considered ancillary or non-routine and are itemized on a resident’s bill, reflecting the additional resources required to provide them.
According to Medicare policy, under the Prospective Payment System (PPS) for skilled nursing facilities (SNFs), the per diem rate is determined by the Resource Utilization Groups (RUGs) classification, which considers the intensity of services provided to the patient. However, Medicare Part A covers these services as part of the bundled payment for inpatient stays, meaning that while the room and board are covered under the per diem, additional services are reimbursed separately if they meet specific criteria for medical necessity.
Does this mean the attendant is within eye shot of the resident 24/7? Absolutely not, after all we must accord the resident rights afforded to them by State of Michigan Administrative Rule. Note this right:
- The right to associate and have private communications and consultations with his or her physician, attorney, or any other person of his or her choice.
Accordingly, our team members are trained to provide privacy as needed, while remaining available in a dedicated format to that resident’s needs.
How about high-tech arrangements?
Within Care First Rehabilitation, “High-Tech Attendant Care” typically refers to the use of advanced medical technology, knowledge, and/or equipment to provide specialized care and support to individuals with complex medical needs. This type of care is typically provided by trained healthcare professionals, such as nurses or respiratory therapists and those they train and oversee, who are skilled in operating and managing certain conditions, including behavioral oversight, amputation care, wounds and fall risks.
Examples of high-tech attendant care may include the use of mechanical ventilators, feeding tubes, infusion pumps, or other medical devices that require specialized training and expertise to operate. This type of care is often necessary for individuals with chronic or life-threatening medical conditions, such as spinal cord injuries, traumatic brain injuries, or neuromuscular disorders.
Other examples includes those who cannot walk a reasonable distance without falling, which means those trained to brace and respond to the resident’s lack of balance are nearby during waking hours. A resident with a wound, amputation or more recent injury may have special instructions from specialty physicians requiring special preparation for staff and task oversight. (www.carefirsttrainingportal.com/www.carefirstprolearning.com).
This care is not only provided in the residential setting, but accompanies the patient being served in all clinical and therapeutic settings.
High-tech attendant care can help individuals with complex medical needs to achieve a higher quality of life and greater independence, while also reducing the risk of complications and hospitalizations. It can also be provided for a certain amount of time and once the matter is re-evaluated, it could be determined it can be suspended, at least for a time.
Another level of High-Tech Attendant Care provided would include services delivered by team members who are routinely in-serviced to deal with complex behavioral problems, including among manipulative residents who pose a risk to their safety and the safety of others. For this reason, Care First includes on its team Behavioral Analysts and Psychologists who intervene as necessary and who are proactive in managing behavior, although this is likely not billed separately. Their involvement, however, with hourly staff, also justifies the High-Tech designation.
A medical practice must have intimate familiarity with a patient to determine if a high-tech approach is warranted. When it is, there should not be hesitation regarding using specific language to order the right level of care.
However, Care First acknowledges it can be costlier and require significant resources, supervision, and expertise to be provided effectively. Lastly, we must consider the contribution to our own heightened liability when the appropriate level of care and supervision are not provided.