What is skilled care?

“Skilled care usually takes place after an acute hospital stay — someone who has fallen and broken a hip, or had a long hospital stay for pneumonia or a surgical visit,” said Denise Helmick, R.N. “Skilled care is that step-down from hospitalization.”

Medicare requires that patients referred to skilled care must be in need of a daily skilled service, such as physical therapy, occupational therapy, speech therapy, intravenous antibiotics or wound care. Medicare will allow patients 100 days of skilled care provided they meet the the criteria, Helmick said. Medicare also requires that patients have at least a 3-day inpatient hospital stay before they can qualify for skilled care.

Medicare will pay 100 percent of the first 20 days of skilled care. For the remainder, the patient is charged a co-pay for each day. But the co-pay is often picked up by supplemental insurance, if the patient has that, according to Maureen Carver, RN, care coordination supervisor.

Private insurance and Medicare Advantage will also pay for skilled care, but patients need to obtain authorization before starting skilled services.

“But we can take care of that for people,” Helmick said.

Private insurance usually will approve skilled care for a week at a time, with a review to ensure progress is being made, said Anthony Wubben, BSW, hospital social worker.

During the patient’s time in skilled care, weekly care team meetings are held with the patient and family members to assess and monitor their progress. The team helps the patient work towards their individual goals. It’s also an opportunity to make plans for when the patient goes back to their home.

“We also facilitate that next level of care,” Helmick said. “Are you going home? Do you need some care in your home? Or maybe the next level is assisted living. We can help with all of that to make the transition as smooth as possible.”

Once the patient goes home, Carver said the staff calls weekly over the next four weeks, to make sure the transition is going well.

Staying active and engaged during what can be a long hospital stay is also important, Carver said.

“We help them find books or magazines or newspapers they may like. Maybe they want to watch movies — we have a DVD player they can use. Some might want to listen to music, We have relaxing music to listen to,” she said.

The bedside volunteers also make the rounds to the skilled nursing patients. Often the volunteers spend a little time with patients, chatting and visiting.

“They’re building a strong relationship with our patients that are here for an extended stay,” said Wubben.

Another benefit to utilizing skilled care at VDMC is the access to the physicians and providers.

“In the hospital, we require the physician to see the skilled patients every 7 days,” Helmick said. “But if there’s something that we need, or we need them to see the patient, the physicians are here everyday.”

Once the hospital gets a referral for skilled care, Wubben, Carver and Helmick jump into action to work through a large checklist, making sure the facility can meet the patient’s needs.

“We have therapy sign off on it and pharmacy. If respiratory is involved, they sign off. We have a nurse who oversees the program,” he said. “And of course, the doctor signs off on it.”

“We want everyone to know what the patient’s needs are and to be sure that we can develop a care plan to meet those needs,” he said.

Many patients choose VDMC after a hospital visit at a Des Moines, Ames or Fort Dodge hospital, often to be closer to home and to make it more convenient for family members to visit.

Wubben said the approval process for the skilled care patient often takes just a few hours to complete.

Local resident Bob Erickson had high praise for the staff at VDMC. He’s been a skilled care patient since Jan. 20, receiving IV antibiotic treatments.

“I think the top thing is the teamwork I see here,” he said. “It’s just unbelievable. They all pull together and help each other.”

Erickson said he welcomes the contact that he has with the staff and their attitude toward the patients.

“There’s a lot of comfort conversation here. Not just in my room, but I hear it in the hallways with other patients,” Erickson said. “The staff says, ‘We’re glad you’re here and we’re glad to be helping you.’ I think that really makes a difference to patients.”

Erickson said when he was considering where to receive his skilled care, the fact that his provider was right in the hospital played a big role in his decision.

“We came to the conclusion that this was the place I needed to be. And it’s convenient for my family too. Sometimes too convenient,” he said, chuckling.

Jade Williams, ARNP, who recently joined the staff at Van Diest Family Health Clinic, is another member of the team.

“We’re excited to have her on board. She’s a familiar face. She’s only required to visit once a week, but already we’ve seen her visit patients multiple times, make referrals, and fine-tune every single need the patient has,” Wubben said.

For more information on the skilled care program at VDMC, contact helmick at dhelmick@vandiestmc.org, or call 832-7725, or Wubben at awubben@vandiestmc.org or call 832-7717 or Carver, mcarver@vandiestmc.org or call 832-7727.