General Information Page

Here, you can find some information that may be helpful. Feel free to use it for your own benefit.

This page includes:

1. Fall Prevention
2. Conflict Resolution
3. Medicare
4. Medicaid

1.  Fall Prevention
Cause of falls:
It has been helpful for some to classify falls based on environmental and physiologic factors as a way to better understand their causes. One approach, presented by researcher Janice Morse, suggests that falls be classified as accidental, unanticipated physiologic, or anticipated physiologic, as defined below:

Accidental falls occur when patients fall unintentionally. For example, they may trip, slip, or fall because of a failure of equipment or by environmental factors such as spilled water or urine on the floor.

Unanticipated physiologic falls occur when the physical cause of the falls is not reflected in the patients risk factor for falls.  A fall in one of these patients is caused by physical conditions that cannot be predicted until the patient falls. For example, the fall may be due to fainting, a seizure, or a pathological fracture of the hip.

Anticipated physiologic falls occur in patients whose score on risk assessment scales indicates that they are at risk of falling. According to the MFS, these patients have some of the following characteristics: a prior fall, weak or impaired gait, use of a walking aid, intravenous access, or impaired mental status.

According to Morse, approximately 14 percent of all falls in hospitals are accidental; another 8 percent are unanticipated physiologic falls; and 78 percent are anticipated physiologic falls.

It is generally accepted that patient falls are caused by multiple factors. Another popular classification scheme of falls is based on the assumption that they result from a complex interaction of intrinsic and/or extrinsic risk factors as illustrated in the figure below. The summary list that follows is derived from many studies incorporating different methodologies, settings, samples and overall quality. Individual risk factors may not be generalized across all settings and may not be applicable to a particular organization.

Intrinsic risk factors (i.e., integral to the patients system, many of which are associated with age-related changes):
- Previous fall studies have cited a history of falls as a significant factor associated with patients being more likely to fall again.
- Reduced vision vision affected by, for example, a decline in visual acuity, decreased night vision, altered depth perception, decline in peripheral vision, or glare intolerance can also cause a patient to fall.
- Unsteady gait or manner and style of walking can also cause a patient to fall. 
- Musculoskeletal system impact from factors such as muscle atrophy, calcification of tendons and ligaments, and increased curvature of the spine (osteoporosis) are associated with ability to maintain balance and proper posture.
- Mental status status affected by confusion, disorientation, inability to understand, and impaired memory is another cause of falling.
- Acute illnesses rapid onset of symptoms associated with seizures, stroke, orthostatic hypotension, and febrile conditions can also cause a patient to fall.
- Chronic illnesses - conditions such as arthritis, cataracts, glaucoma, dementia, diabetes and Parkinson's Disease - can all cause falling.

Extrinsic risk factors (i.e., external to the system and relating to the physical environment):
- Medications - those that affect the central nervous system, such as sedatives and tranquilizers, benzodiazepines, and the number of administered drugs - can also cause a patient to fall.
- Bathtubs and toilets equipment without support, such as grab bars, may cause a patient to slip and fall.
- If the design of furnishings or height of chairs and beds is ill-suited to the patient, the patient may fall while using those pieces of furniture.
- Condition of ground surfaces - floor coverings with loose or thick-pile carpeting, sliding rugs, upended linoleum or tile flooring, highly polished or wet ground surfaces - may cause a patient to slip and fall. 
- Poor illumination conditions or intensity or glare issues may be factors of a patient falling.
- Type and condition of footwear - ill-fitting shoes or incompatible soles such as rubber crepe soles, which, though slip resistant, may stick to linoleum floor surfaces, causing a patient to fall. 
- Improper use of devices - bedside rails and mechanical restraining devices that may actually increase fall risk in some instances.
- Inadequate assistive devices - walkers, wheelchairs and lifting devices - may also cause falling. 

General safety interventions

Given the numerous intrinsic and extrinsic factors leading to falls, it is possible to consider each factor and identify positive steps and safe interventions proven effective for preventing falls. A few examples of general interventions might be helpful before discussing measurement and development processes for risk assessment or a comprehensive program to reduce fall incidents.

Interventions:
- Instruct the patient or resident to request assistance as needed.
- Instruct the patient to wear non-skid footwear, considering the type and condition of footwear such as ill-fitting shoes or incompatible soles.
- Provide an appropriate armchair with wheels locked at the patients bedside.
- Ensure that the pathway to the restroom is free of obstacles and properly lighted
- Ensure the hallways are clear of obstacles.
- Place assistive devices such as walkers and canes within a patients or residents reach.
- Raise the side rails as appropriate for access to bed controls, support and repositioning.
- Evaluate chair and bed height.
- Consider peak effect for prescribed medications that affect level of consciousness, gait and elimination when planning patient care.
- Observe environment for potentially unsafe conditions, such as loose carpeting and water on the floor. Notify appropriate department(s) of hazardous conditions.
- Do not leave at risk patients or residents unattended in diagnostic or treatment areas.
- Ensure patients or residents being transported by stretcher/bed have all side rails in the up position during transport, or if left unattended briefly while awaiting tests or procedures.
- Inform and educate patients and /or family members regarding a plan of care to prevent falls.
- Include the patients family in the development of an individualized safety plan, considering age-specific criteria and patient cognition when planning care.
- Collaborate with the patients or residents family to provide assistance as needed while maintaining the patients independent functioning.
- Communicate the patients at risk status during shift report and with other disciplines as appropriate.


2.  Conflict Resolution
Create a Receptive Atmosphere:
Creating an atmosphere in which all individuals will be open to resolving the conflict is extremely important but often neglected. It starts with the planning and preparation prior to the discussion about the conflict. This includes setting the proper "mind set" for everyone involved in the conflict. This mind set includes avoiding rigid demands of what the solutions must be and all attempts to place guilt or blame for the conflict.

Identify Essential Needs:
You can always expect conflict when individual needs are ignored or obstructed. In the planning and preparation prior to the conflict discussion, it is critical to look at the current conflict and identify essential needs. If you are to develop meaningful relationships and deal with conflicts with coworkers effectively, you must focus on the needs of the people involved in the conflict. Only when you make an effort to focus on essential needs will the conflict resolution process be effective and the relationship improved.

Generate Viable Options
Your ability to discover new possibilities and to find effective ways to resolve conflict often is impaired by the "rigid positions" taken and limited visions held onto in times of conflict, stress and tension. Generating a variety of viable options can often break through the preconceived limitations that often created the original conflict.

Agree on an Action Plan
    The previous three steps move you toward the crucial task of implementing specific actions that will help improve the relationship and resolve the conflict. All individuals involved in the conflict must agree on specific acts that stand a good chance of improving trust and increasing agreement. Conflict resolution agreements must be realistic and effective enough to survive both current and future problems. If problems develop while implementing the action plan, all is not lost. As you have learned, conflict resolution is a process composed of four steps.
    If a problem develops during implementation, return to the first step (Create a Receptive Atmosphere) and start the conflict resolution process all over.
    Some conflicts involve extremely sensitive issues which create such tension within the group that it becomes impossible to resolve internally. These situations are best handled by a third-party facilitator.


3.  Medicare
Medicare Part A (Hospital Insurance):
What Is Part A?
Part A helps cover:
- Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
- Inpatient care in a skilled nursing facility (not custodial or long term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Non-medical Health Care Institution

You usually don't pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is called "premium-free Part A."
If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:
- You're 65 or older, you're entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
- You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work.

In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

Services Part A Covers:
1.  Blood: In most cases, the hospital gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.
2.  Home Health Services: Limited to medically-necessary part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or a continuing need for occupational therapy. A doctor must order your care, and a Medicare-certified home health agency must provide it. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment (see page 30), and medical supplies for use at home. You must be home-bound, which means that leaving home is a major effort.
3.  Hospice Care: For people with a terminal illness. Your doctor must certify that you're expected to live 6 months or less. Coverage includes drugs for pain relief and symptom management; medical, nursing, social services; and other covered services as well as services Medicare usually doesn't cover, such as grief counseling. A Medicare-approved hospice usually gives hospice care in your home (or other facility like a nursing home). Medicare covers some short-term inpatient stays for pain and symptom management that cant be addressed in the home. These stays must be in a Medicare-approved facility, such as a hospice facility, hospital, or skilled nursing facility. Medicare also covers inpatient respite care which is care you get in a Medicare approved facility so that your usual caregiver can rest. You can stay up to 5 days each time you get respite care. Medicare will pay for covered services for health problems that aren't related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor re-certifies that you are terminally ill.
4.  Hospital Stays (Inpatient): Includes semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. Examples include inpatient care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care. This doesn't include private-duty nursing, a television or telephone in your room (if there is a separate charge for these items), or personal care items like razors or slipper socks. It also doesn't include a private room, unless medically necessary. If you have Part B, it covers the doctor and emergency room services you get while you are in a hospital.
5.  Skilled Nursing Facility Care: Includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury). To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn't cover long-term care or custodial care in this setting.

Medicare Part B (Medical Insurance)
What Is Part B?
Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

How Much Does Part B Cost?
    You pay the Part B premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.
Your modified adjusted gross income is your taxable income plus your tax exempt interest income. Social Security will notify you if you have to pay more than the standard premium. If you have to pay a higher amount for your Part B premium and you disagree (even if you get Railroad Retirement Board benefits), call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
    If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How You Get Part B
    If you get benefits from Social Security or the Railroad Retirement Board (RRB), in most cases you'll automatically get Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, your Part B will start the first day of the prior month.
    If you're under 65 and disabled, you'll automatically get Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You'll get your Medicare card in the mail about 3 months before your 65th birthday or your 25th month of disability.
    If you don't want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
    If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease), you automatically get Part B the month your disability benefits begin.

Services Part B Covers
There are two kinds of Part B-covered services:
1.  Medically-necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
2.  Preventive services:  Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best (for examples see Medicare & You Handbook ).
What You Pay for Part B Services

Costs for Part B services depend on whether you have Original Medicare or are in a Medicare health plan. For some services, there are no costs, but you may have to pay for the doctors visit. If the Part B deductible applies, you must pay all costs until you meet the yearly Part B deductible before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service. You can save money if you choose doctors or providers who accept assignment.

Medicare Advantage (Part C)
    Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are health plans offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.
    Medicare Advantage plans always cover emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers, except hospice care. (Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.)
    Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also include Medicare prescription drug coverage.
    Medicare Advantage Plans must follow rules set by Medicare. However, each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).
    You usually pay one monthly premium to the Medicare Advantage plan, in addition to your Part B premium.
Different Types of Medicare Advantage Plans
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Medical Savings Account (MSA) Plans
- Special Needs Plans (SNP)
Other less common types of Medicare Advantage Plans include:
- Point of Service (POS): Plan similar to HMOs, but you may be able to get some services out-of-network for a higher cost.
- Provider Sponsored Organizations (PSOs): Plans run by a provider or group of providers. In a PSO, you usually get your health care from the providers who are part of the plan.
What You Pay in a Medicare Advantage Plan
Your out-of-pocket costs in a Medicare Advantage Plan depend on:
- Whether the plan charges a monthly premium in addition to your Part B premium.
- Whether the plan pays any of the monthly Part B premium. Some plans offer this option, usually for an extra cost.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (co-payments).
- The type of health care services you need and how often you get them.
- Whether you follow the plans rules, like using network providers.
- Whether you need extra coverage and what the plan charges for it.
- Whether the plan has a yearly limit on your out-of-pocket costs for all medical services.
How to Join a Medicare Advantage Plan
Not all Medicare Advantage Plans work the same way, so before you join, find out the plans rules, what your costs will be, and whether the plan will meet your needs. Contact the specific plans you're interested in to get more information about their benefits and costs. Once you choose a plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plans Web site. Get started comparing Medicare Advantage plans in your area.