RLO Storyboard Developed

by Anne Hill
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RLO Title Skilled vs Custodial Care
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Skilled Home Care
A Piece of the Puzzle


Puzzle flies in.



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Welcome!
Members share their stories with
you and depend on you to guide
them to the right services for their
health care needs. Listen to the
following example of a common
call:

Welcome to Skilled Home Care A Piece
of the Puzzle!
Members share their stories with you and
depend on you to guide them to the right
services for their health care needs.
Listen to the following example of a
common call by clicking on the Customer
Service Agent. You can also use the
Notes button in the upper left corner for a
transcript of this slide and the call:
Audio clip of call from member:
Script:
Sam Peters (son of Anna Peters): and
the zip code is 58227.
Customer Service Agent: Thank you for
verifying your moms information Mr.
Peters. How can I help you today?
S.P: Well now, my mom has been
needing more and more help lately.
Dads been taking care of her all of these
years, but she just suffered a minor
stroke, and she hasnt been able to help
herself as much as before. I try to stop
in when I can, pick up groceries, help
clean up n cook a bit and such, but I
work all week. My younger sister lives
down the road, but she aint worth a hill
of beans. My neighbor took care of his
dad for many years, an she suggested I
call you to see what kinda help is
available through her insurance.
Hotspot to click to activate
audio clip from member is the
Cust Serv picture.
Scrolling field for narration
and script audio text.

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animate to direct attention to
Cust Serv picture to start
audio.

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X5
How do you identify the pieces of
the puzzle necessary to identify
the care being received and if it is
covered by their insurance? this
text is in a bubble connected to
narrator. (insert text between
Paragraph 2 and 3 of audio)


Identify Skilled Care as a covered
benefit per Medicare guidelines.
The call you just listened to contained a
lot of information for you to decipher.
More questions may need to be asked to
get the complete picture.
While listening to the member tell their
story, you need to be able to identify
what kind of care they need or already
have in place.
In this lesson we are going to learn how
to identify Skilled Care as a covered
benefit per Medicare guidelines. We will
touch on Custodial Care in contrast to
Skilled Care, but Lesson 2 of this series
will more fully explain Custodial Care as
a non-covered benefit.
Lets get started!

Button to replay call links to
previous slide.

Question marks fly in from left
corner
4

Regarding Skilled Home Care, the
EOC reads as follows:
First, lets identify one reason WHY this is
a confusing topic for all parties involved.
It has to do with the Evidence of
Coverage (EOC), also called the
Explanation of Benefits (EOB) the
member receives when they purchase
their insurance. Regarding Skilled Home
Care, the EOC reads as follows:
(read graphic)



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5.1


At first glance, it seems pretty
straightforward, right? However, click the
Red Button to identify the main sticking
point:
(pause for click and notice of red circle)

MANY a member (and Customer Service
rep!) has misinterpreted those numbers
to mean they have 8 hours per day of
care available to them through their
insurance benefits. In fact, remember
this wording, because youll get asked
about it on calls!
This phrase is actually referring to the
fact that you cannot receive skilled home
care if your level of care is so high that
you might NEED more than 8 hours per
day and 35 hours per week of care. In
that case you might be better cared for in
a skilled rehab center.

Lets clear up some confusion by getting
into the definition of Skilled Home Care.
Sticking Point button appears
with start of At first glance
Have RED circle appear over
verbiage when user clicks on
STICKING POINT button
(slide layer)
Phrase CONFUSION
ENSUES appears over the
question mark (slide layer)

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What is Skilled Home Care?

Intermittent skilled nursing care
(RN)
Physical Therapy (PT)
Occupational Therapy (OT)
Speech Therapy
Social Worker visit
*Home Health Aide services
(HHA)






What is Skilled Home Care?
Per Medicare guidelines, home health
care includes part-time or intermittent
skilled nursing care and other skilled care
services like physical therapy,
occupational therapy, and speech
therapy. Services may also include
medical social services or assistance
from a home health aide.
Please note that a member must be
receiving Skilled visits by the RN, PT, OT
or speech therapist in order to get HHA
visits. Often the member has to ask for a
HHA. Normally the HHA visits are limited
to bathing a few times a week.

Some examples of situations that would
require skilled care include:
Teaching about diabetes care.
Wound care for pressure sores or a
surgical wound
Physical and occupational therapy (until
plateau has been reached, or member
has been taught how to do ongoing
exercises, then services end)
Intravenous or nutrition therapy (again,
once family can be taught to perform the
tasks the service would end)
Injections
Monitoring serious illness and unstable
health status

Button for Link to Medicare
Glossary opens in a new
window.
Disclaimer that info and
definitions were taken from
the Medicare.gov website.










Further audio:
It is important to note at this
time that the information in
this lesson is taken from
Medicare.gov's description of
home care. Please refer to the
website as necessary for further
details and definitions by using
the Medicare.gov button
located in the lower right
corner of the screen. You will
be taken to the home care
section of the Medicare
website.

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Skilled Care How do you get it?
Change in Condition (CIC)
Certified as homebound by
their PCP
Have written an order for Skilled
Home Care for one or more
Skilled services.
A Medicare certified agency must
provide the care. You must need, and a doctor must certify that you need, one or more of the following:
How does a member get Skilled Home
Care?
First, there must be a Change in
Condition (CIC) an event that has
caused the members health to
deteriorate.
Then, the members Primary Care
Physician (PCP) must certify them
homebound and write an order for
home care for one or more Skilled
services.
Finally, the services must be provided by
a Medicare certified agency.
To reiterate, those services that can be
provided are:
Intermittent skilled nursing care (RN)
Physical Therapy (PT)
Occupational Therapy (OT)
Speech Therapy
Social Worker visit
*Home Health Aide services (HHA)
Regarding home health aide services, it is
important to point out that the need for
assistance with ADLs, or Activities of Daily
living, such as bathing, dressing, and toileting
alone is not sufficient for a Skilled Care order.
The need for this assistance, or help with
cleaning, cooking or other homemaking tasks,
is considered Custodial Care, and is not
covered by Medicare. You can learn more
about Custodial Care in Lesson 2 of this
series. Intermittent skilled nursing care
For full details on eligibility, please refer
to Medicare.gov.
Button linking to Medicare.gov
Link to website should open in
a new window.
Character turns to the text
after the question How does
a member get Skilled Home
Care?

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Animation character

Knowledge Check!
Listen to or read the following
case study:
Mrs. Jones calls and explains she
has been discharged home from
the hospital after a fall and broken
ankle. She is weak and is having
trouble standing for long periods
of time. She has new medications
to take after a new diagnosis of
diabetes and is confused about
what to take and when. She lives
alone and her nearest relative, her
granddaughter, lives an hour
away. She sometimes visits on
weekends to help cook meals and
clean. She states they told her in
the hospital that she should
qualify for home care, but she
hasnt heard from anyone. She
is worried that her little dog Teddy
isnt getting enough exercise.
Lets conduct a knowledge check on
what we have learned about Skilled
Care. Listen to or read the case study.
Then answer the question that follows.
Mrs. Jones calls and explains she has
been discharged home from the hospital
after a fall and broken ankle. She is
weak and is having trouble standing for
long periods of time. She has new
medications to take after a new diagnosis
of diabetes and is confused about what
to take and when. She lives alone and
her nearest relative, her granddaughter,
lives an hour away. She sometimes visits
on weekends to help cook meals and
clean. Mrs. Jones states they told her in
the hospital that she should qualify for
home care, but she hasnt heard from
anyone. She is worried that her little
dog Teddy isnt getting enough exercise.
Scrolling panel with audio text
9
Based on Mrs. Jones description
of her situation, identify the item(s)
that qualify her for Skilled Home
Care services from the following
list
a) Need for Physical Therapy
b) Someone to walk her dog
c) Medication Management
d) New diagnosis and injury from
fall
e) Lack of family support


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That is incorrect. Youre still
missing a piece of the puzzle.
Try again.
(feedback for b While that is a
concern for Mrs. Jones, it is not a
health care need)
(feedback for e While that is a
concern, it does not affect Skilled
needs)
Branching loop back to
Question- Slide 9
11
That is incorrect. Youre still
missing a piece of the puzzle. Try
Again.
Branching back to Question
Slide 9
12
Correct Answer (or last failed
attempt brings them to this slide
also?): Correct!
The need for PT, medication
management and her new
diagnosis and injury from a fall are
all valid reasons the PCP might
order Skilled Home Care.

Button to loop back to Slide 6
to review definition slides and
retake knowledge check.

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Here are a few main points to
emphasize as you put together
the pieces necessary to provide
the best service to our members
to ensure they access the
appropriate care:
Physicians order
Licensed professionals
Change in condition
Short-term need.

Here are a few main points to emphasize
as you put together the pieces necessary
to provide the best service to our
members to ensure they access the
appropriate care:
First, Skilled Care requires a PCPs
order. Occasionally PCPs will write an
order for bathing, cleaning and cooking.
Remember this is considered Custodial
Care! PCPs are just as confused as
everyone else when it comes to what
care is covered by health insurance.
Second, Skilled Care must be provided
by licensed professionals such as RNs,
PTs, and certified HHAs.
Also, the need for Skilled Care is often
preceded by a change in condition (CIC)
that requires nursing or other
professional intervention. Evidence of a
CIC includes a hospitalization, surgery,
or major deconditioning resulting in loss
of mobility and/or function.
Finally, Skilled Care is almost always a
short-term need. Long term needs for
bathing, housekeeping and cooking are
considered Custodial needs.

Have reasons appear around
graphic with puzzle piece.

Animation, reasons grow
separately time with
narration.

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Of course, very few calls will be simple.
You may identify multiple care issues
within a complex situation. Lets do a
final knowledge Check!
Listen to the following call, or read the
script provided, then answer the
questions that follow.
Script:
Customer Service Agent: How can I help
you today Mrs. Plowman?
Mrs. Plowman: Well, Im um Im looking
at our paperwork and it says that we can
get something like 8 hour a day of help a
day. My daughter said I needed to call,
since I cant keep up like I use to.
Customer Service Agent: Hmmm Can
you tell me more about the kind of help
you need Mrs. Plowman?
Mrs. P: Well now, I have a bad back and
knees. I cant get down the stairs to do
the laundry or clean the floors. We set up
meals coming in, since most of my time is
spent making sure Bob checks his
sugars and stays safe and clean.
Customer Service Agent: Oh, I see
ummm Bob is your husband?
Mrs. P: Oh yes, my husband of 42 years.
A dear, sweet man, but since his fall last
week he isnt very steady. He cant get
around very well anyway due to the
neuropathy in his feet. Its hard to get him
into the shower to clean up. Im afraid
hes going to get hurt, or Im going to
seriously injure myself, and then where
will that leave us?



Click Cust Serv pic to start
Audio Clip trigger leads to
new layer
Scrolling screen for script
option for narration and call
audio.

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15 Match your choice of what kind of
care would be appropriate, Skilled
or Custodial, for the needs
described by Mrs. Plowman:
Choices:
Laundry and meals - Custodial
Injury from fall - Skilled
Cleaning the house - Custodial
Diabetes management Diabetes
management
Neuropathy - Skilled

Question 1- Drag and Drop

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You did not select the correct
response. Remember that
homemaking is not a covered
benefit and would not be
considered Skilled Care.

19
Thats right! You selected the
correct response.



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Is the following statement True or
False Is the following statement
true or false - A PCP can write an
order for only a Home Health Aide
to give Mr. Plowman a weekly
bath.
Question 2 - True/False

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You did not select the correct
response. Custodial needs do
not require a PCP order and
would not be covered by
insurance. While a home health
aide could be part of a PCP's
order, they would have to be in
addition to a Skilled need such as
nursing or physical therapy.

22
False. That's right! You selected
the correct response. Custodial
needs do not require a PCP order
and would not be covered by
insurance. While a home health
aide could be part of a PCP's
order, they would have to be in
addition to a Skilled need such as
nursing or physical therapy.


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Mrs. Plowman claims she has
paperwork that seems to indicate
she has 8 hours of day available
for care in the home. What
document is Mrs. Plowman
referring to?
a) Affordable Care Act
b) Primary Care Physician order
(PCP)
c) Evidence of Coverage (EOC)
correct choice
d) Medicare Certified Agency
contract
Question 3 Multiple Choice
24
That's right! You selected the
correct response. The EOC has
the phrase "8 hours per day and
35 hours per week" that member's
frequently misread as the amount
of care coverage they have
available.

25
You did not select the correct
response. The EOC has the
phrase "8 hours per day and 35
hours per week" that member's
frequently misread as the amount
of care coverage they have
available.

26
Results
Your Score:
Passing Score:
Results Slide total score for
3 questions. Option to Retake
Quiz.

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Articulate Character
Congratulations!
You have completed this course
on Skilled Home Care. You are
now prepared to identify what kind
of care a member may have or
need as they tell their story.
Congratulations!
You have completed this course on
Skilled Home Care. You are now
prepared to identify what kind of care a
member may have or need as they tell
their story. We hope the examples and
resources given will give you the
additional tools to guide the members in
accessing the care they need to ensure
they stay healthy and happy in their
homes. You are an important piece of the
health care puzzle!
Caption Balloon around
onscreen text.
Button that gives choice to
return to beginning of course.
Animate character to change
position.
Graphic spins/grows and flies
in from top.
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Instructional Design and
Production: Anne Hill

Created for: EDUC 767 Designing
Computer-Based Training (CBT)

Authoring Tools: Articulate
Storyline and Snag It

Graphics: Pixabay and Microsoft
Clip Art
Graphics in four corners.
Text flies in slowly from the
bottom.