Many Medicare beneficiaries find that they need short-term nursing home services (also referred to as Skilled Nursing Facilities; or SNFs) at some point in their lives. For example, if an individual receives a hip replacement as a hospital inpatient, he or she may need to enter into a SNF to continue rehabilitation and recovery prior to being discharged home. Medicare does cover short-term nursing home services.
But, what can a patient do if he or she is not satisfied with the care received at the nursing home?
The simplest action is for patients or family members to talk with the nursing home staff providing the care (e.g., physical therapist, certified nursing assistant) or nursing home management (e.g., director of nursing, administrator) to voice complaints and, hopefully, resolve the issue. If this does not resolve the issue, however, as Medicare beneficiaries, other options are available.
Following are three tips on actions beneficiaries can take to ensure they are receiving high-quality nursing home care:
1) Request Immediate Advocacy: Beneficiaries can call their Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) and request immediate advocacy to quickly get their complaints addressed. This process involves the BFCC-QIO directly contacting a practitioner or provider, usually by telephone. Examples of concerns that can be resolved using immediate advocacy include communication issues with staff and poor customer service at the nursing home facility.
2) File a Complaint: If Medicare beneficiaries have concerns about the quality of care received at an SNF, they can contact their BFCC-QIO to file a complaint. Quality of care complaints include worsening pressure ulcers, incorrect medication distribution and poor discharge planning.
3) Request an Appeal: When Medicare beneficiaries receive SNF services, they should receive a notice entitled “Notice of Medicare Non-Coverage” at least two days before covered services end. If they do not receive this notice, they or a family member can request it. If they believe SNF services are ending too soon, they have the right to a fast appeal and can contact their BFCC-QIO for immediate assistance.
Click here for more information about the BFCC-QIOs and how they help bring the voice of Medicare beneficiaries and their families into healthcare case review activities to increase communication and improve the care experience.