Medicare Sign Up pack sample

www.pnsystem.com page 5 ELIGIBILITY CRITERIA FOR ADMISSION Admission to this Agency can only be made under the directions of a physician, based upon the patient’s identified care needs, homebound status, face to face compliance, and the type of services required that we can provide directly or through coordination with other organizations. If we cannot meet your needs, either directly by our Agency or indirectly through service agreement with other providers, we will not admit you or will not continue to provide services to you. NOTICE OF MEDICARE PROVIDER NON-COVERAGE (IF ANY) YOUR RIGHT TO APPEAL THE DECISION: You have the right to an immediate, independent medical review (appeal), while your services continue, of the decision to end Medicare coverage of these services. If you choose to appeal, the independent reviewer will ask for your opinion and you should be available to answer questions or supply information. The reviewer will also look at your medical records and/or other relevant information. You do not have to prepare anything in writing, but you have the right to do so if you wish. Our Agency will bring to you a detail form at least 48 hrs before your discharge. THE HOME HEALTH AIDE The Home Health Aide is an employee who has been specifically trained to provide personal care and related services to the patient. In order to receive an aide, you must be receiving the services of a registered nurse, physical therapist or speech therapist. The Home Health Aide MUST perform personal care: 1. Bath, sponge or shower 2. Shampoo 3. Skin care 4. Make patient’s bed only Additional duties which may be included at each visit: Laundering Personal undergarments only: i.e. nightgowns and pajamas, Straighten bathroom- Clean tub and sink, Ambulation if requested by nurse or therapist, Meal preparation-One light meal of sandwiches, salad or soup. Aide will wash dishes associated with this meal. DUTIES NOT INCLUDED IN SERVICES: Mopping floors, Re-lining drawers, Bathing Pets, Washing windows and furniture, Shopping at more than one store, Defrosting and cleaning refrigerators, Transporting patients in aide’s cars, Cleaning ovens, Vacuuming , Wiping or washing walls, Vacuuming any room other than patients bedroom SERVICES WILL NOT COVER HOUSEKEEPING OR COMPANION SERVICE. In the event that the patient is alone and unable to physically assume household duties, or, if the patient’s spouse is equally disabled, the Home Health Aide may also assume responsibility for: 1. Shopping - once a week 2.Laundry- for patient only 3.Prepare meals for patient only 4. Wash dishes for patient Because of the number of patients and the traveling involved, we are unable to promise specific times of day for each visit, however, every effort will be made to accommodate your schedule and needs. If you have a Doctor’s appointment, please call our office the day before and we will schedule our visits around your doctor’s visits. INFORMATION REGARDING THE DISPOSAL OF BIOHAZARDOUS WASTE If Patients requir e Biohazardous Waste Disposal while rendering medical treatment in your house, the Agency will be placing a biohazardous waste container in your home. We are required by state law to dispose of biohazardous waste in this manner. The waste box or sharps container in your home is only to be used to dispose of biohazardous waste. This container is not to be used for any other purpose. Our agency has contracted with ___________________________ to pick up this waste within twenty- eight days after set up. The waste must be removed within this time limit in order to comply with state law. The above company will contact you to arrange for pickup of the container within the time frame mentioned above. Please help us by accommodating them when they call. THE WASTE CONTAINER MUST STAY INSIDE YOUR HOME UNTIL IT IS REMOVED BY THE WASTE MANAGEMENT COMPANY. NEVER PUT THE WASTE CONTAINER IN THE GARBAGE OR OUTSIDE YOUR HOME FOR ROADSIDE PICKUP. THIS IS ILLEGAL! IF IT HAPPENS OUR AGENCY OR YOU COULD FACE PROSECUTION IF THE WASTE HARMS ANOTHER PERSON. If you need your container removed prior to the scheduled pickup or you have any questions regarding the waste management system in your home, call our Agency office and speak to your case manager. If you would like to continue this service after you have been discharged from home health services please call the above company. HOME CARE AND ALZHEIMER’S Home care is a very helpful choice for both the person with Alzheimer’s disease and their families because it provides the very kind of care that is most important – service in the comfort and familiarity of the patient’s own place of residence. Criteria for home care admission, for persons with end stage dementia, may not always be well known - the issues of mobility, nutrition and weight, verbal communication, problems with infection and overall decline are evaluated. The psychological and physical support provided by home care teaching and supportive equipment can greatly relieve the family caregiver. Caring for a person with Alzheimer's Disease (AD) is a challenge that calls upon the patience, creativity, knowledge, and skills of each caregiver. Our home heath agency treats patients with every kind of terminal condition and many different forms of dementia, including persons with ADRDs. A proper assessment of a patient addresses the needs of the person and his or her caregivers and family in a comprehensive fashion. This is especially important to the family of a person suffering from ADRDs, since this person may have difficulty communicating his or her needs to family members. More than those with other diseases, these patients spend a long period at the end of their lives bed bound, mostly unresponsive, and in need of total care. As with all of our patients, it is the goal of our home care program to care for the ADRD patient while supporting and comforting family and loved ones regardless of the setting or the patient’s daily abilities. sample