1: CH 14 1. Chapter 14 introduces the idea of surveyors and the responsibilities

1: CH 14 1. Chapter 14 introduces the idea of surveyors and the responsibilities they hold by stating that, “All state surveyors attend mandatory training conducted by state and federal agencies, in preparation for the survey process” (McSweeney-Feld & Molinari, 2023). The survey process is one in which a survey team review’s a facility’s operation by reviewing past survey reports, complaint investigations and quality indicators. According to the Colorado Department of Health Public Health and Environment, complaint investigations are conducted whenever a formal regulatory-related complaint falls under their jurisdiction, specifically complaints regarding quality life and care at a facility. Complaints regarding billing or insurance concerns however are not investigated by surveyors. Surveys and inspections are conducted by interdisciplinary teams as they evaluate the care and services that are provided to residents in accordance with regulatory requirements. Members of the team review the facility’s background by looking at previous survey results, complaint investigations, occurrence reports and quality indicators, much like the overall responsibilities mentioned above. According to CMS, “Surveyors are expected to investigate the basis and interventions affecting residents” (State Operations Manual, 2023) a few examples include determining whether a transfer or discharge is resident or facility initiated, ensure discharges related to specific circumstances, ensure the facility has evaluated the resident and does not use the resident’s status as a basis for discharge, as well as determine that the interventions to assist residents are not only identified but implemented immediately. CH 15: 1. Although long term care services in the United States is financed through both public and private resources, according to the textbook, “Government funding sources pay for most formal long-term care services in the United States” (McSweeney-Feld & Molinari, 2023, p.409), the two main public programs being Medicaid and Medicare. However there are a variety of payment sources for long term care including, personal funds, federal and state government programs, and private financing. Medicaid is funded by both the states and the federal government and is the largest government funded source for long term care. Generally, services provided in skilled nursing facilities, at home, and in the community are covered and standards for eligibility, payment rates, and scope of services are determined by each state through the guidelines at the federal level. Medicare on the other hand, “Covers care given at home and a limited amount of care in skilled nursing facilities for individuals aged 65 or older, those who have received Social Security disability benefits for more than two years” (McSweeney-Feld & Molinari, 2023, p. 411). Four parts are discussed in the textbook and describe the various programs provided. Part A covers hospital and skilled nursing facility stays of up to 100 days. Part B covers physician, durable medical equipment, and outpatient services. This part is a voluntary program where a monthly premium is paid. Part C is a managed care version of Medicare in which the benefits of Part A and B are replaced with a comprehensive managed care network. Part of Medicare addresses prescription drug expenses depending on the level of coverage selected by patients. 2: Each state has its own qualifications, position descriptions, and job responsibilities for health facility surveyors. In my state, Colorado, health facility surveyors are typically required to have a background in healthcare, such as nursing or healthcare administration. They also undergo specific training in state and federal survey protocols, regulations, and procedures to ensure they have the knowledge and skills needed for the role. As for their position description, health facility surveyors in my state are responsible for conducting inspections and assessments of healthcare facilities to ensure compliance with state and federal regulations. They review medical records, observe patient care practices, and assess the overall quality of care provided. They also document any deficiencies or areas of improvement and work with the facility to develop corrective action plans. Job responsibilities of health facility surveyors include conducting interviews with staff and patients, analyzing policies and procedures, and providing education and guidance to healthcare facilities. They play a vital role in ensuring that healthcare facilities meet the required standards and provide safe and quality care to patients. In the United States, the main sources of payment for long-term care services can vary depending on the individual’s situation. Some common sources of payment include private health insurance, Medicare, Medicaid, and out-of-pocket payments. Private health insurance plans may cover certain long-term care services, but the coverage can vary widely. Medicare, the federal health insurance program for people aged 65 and older, may cover some limited long-term care services, such as skilled nursing care, but it’s important to note that it doesn’t cover custodial care, which is assistance with daily activities like bathing or dressing. Medicaid, on the other hand, is a joint federal and state program that provides coverage for low-income individuals and families. Medicaid often covers a broader range of long-term care services, including nursing home care and home health services. Lastly, individuals may also pay for long-term care services out of pocket. This means they use their personal funds to cover the costs of care. It’s worth mentioning that there may be other sources of payment available depending on specific circumstances, such as long-term care insurance or veterans’ benefits.