Your Care At Virginia Convalescent Center

Admissions
The VCC Social Worker arranges the time and day of your admission with the appropriate parties and gathers needed admission information.  The social worker will meet with you upon admission, and a time will be set aside to go over admission paperwork.  Financial arrangements will be discussed with you and your designated responsible party.

You will be informed of the Resident's Bill of Rights and resident responsibilities.  You will also receive a copy of this handbook and information on the charges to be incurred for your care.

Plan of Care and Care Team
Soon after admission, a care plan is designed with input from you, your family (if you choose), and the interdisciplinary care team (Social Service, Recreation Therapy, Nutrition Services, Nursing and Rehabilitation).  Through this care plan, goals are written for your stay here and a care conference will be scheduled within 21 days of admission to address your plan of care.  The interdisciplinary care team reviews your care plan with your input at least quarterly and changes are made as necessary.  You will be notified of the date and time for each patient care conference.

Care Planning
During your first weeks as a resident at the Virginia Convalescent Center, an interdisciplinary team works with you to assess your needs and strengths.  A nurse, dietician, recreation therapist, social worker and if appropriate, physical therapist, occupational and/or speech therapist will participate in this process.  Once all assessments are completed, the care planning team meets with you and any family member or representative you wish to invite.  The assessments are discussed and a care plan is written.  The care plan includes specific aspects of your care such as dietary preferences, leisure time preferences and nursing needs.  Goals are established to help you achieve the highest practicable level of functioning.  These conferences are scheduled quarterly and more often if you experience a significant change in your care needs.  Your participation in the care planning is essential.

Care Team
We have a variety of personnel to meet your needs including registered nurses (RN), licensed practical nurses (LPN), and nursing assistants/registered (NA/R).  There is a registered nurse supervisor in the facility 24 hours a day 7 days per week.  Nursing assistants are the primary care givers.  The Nurse Supervisor and the Director of Nursing are available to answer your questions at 218-749-9440.

The Activities Department promotes a sense of community within our facility and offers a wide variety of daily programs, special events and community outings designed to meet the social and emotional health of each resident.  Staff are committed to encouraging leisure time experiences, socialization, creativity and self -expression. 

The Social Service Department consists of professional, licensed social workers.  The social workers are responsible for pre-admission counseling, tours of the facility, admission counseling, and completing admission paperwork with the resident and/or family members.  The social workers are responsible for monitoring the adjustment of new residents, participating on the care planning team, short-term counseling for residents and families, crisis intervention, referrals, discharge planning and promoting resident autonomy via the Resident Bill of Rights.  The social workers also serve as a primary link between staff and families.  To reach them, call:  218-741-3340 ext. 2344 or ext. 2422.

Payment for Services

Case Mix
RUG's case mix reimbursement has been in effect since October 1, 2002.  This system of reimbursement is an effort by the State of Minnesota to reimburse operating costs based on the condition and needs of a resident.  The daily rate will be set according to the amount of nursing care needed at the time of admission.  Your care category will be based on an assessment to determine the rate per day.  For example, a person who requires special nursing treatment in addition to help with dressing and eating needs more nursing care and is billed accordingly.  This procedure applies to both private pay residents and Medical Assistance (Medicaid) recipients.

We are able to give you only an approximate daily rate at the time of your admission, and a final determination is made by the Minnesota Department of Human Services.  Reassessments are done every six months or with a significant change in condition.

Private Pay
If you are a private pay resident, the amount of the first month's charges will be assessed through an estimated RUG's case mix score detrminied by the facility.  If the final RUG's case mix determination differs from the estimated one, the following month's statement will reflect an increase or decrease in the rate.  Private pay residents are billed for the current month (i.e. in advance).

Medicare
If you are admitted with a Medicare-coverable condition, Medicare will pay the full charges (care/supplies/medications) up to 20 days as long as your condition meets skilled care guidelines.  If at day 21 you continue to qualify, Medicare will pay a percentage of your bill up to day 100, and you are responsible for the remaining bill (co-pay).  If you have a supplemental policy, this may cover your portion of the remaining bill.  Check your policy for clarification.  The facility will submit the Medicare claims for you.  Please contact the Business Office at 218-742-8612 if you have any questions.

Medical Assistance
Medical Assistance is a program designed to assist persons whose financial resources are insufficient to meet the costs of medical costs.  Eligibility is based on the income and resources of the applying person.  The Virginia Convalescent Center is certified to accept recipients with Medical Assistance.

If you need to apply for assistance, contact St. Louis County Social Service Department at 218-749-7128.  During your first contact with Medical Assistance, be prepared to give information such as income, assets, social security income and number, previous address, and date of birth.  You will then receive forms by mail to complete.  You must apply for Medical Assistance from the county in which you lived prior to nursing home placement.  VRMC/VCC is not responsible for making application to Medical Assistance. 

Medical Assistance recipients pay their monthly income (called "recipient resource") to the facility less a predetermined amount for living expenses (called "personal needs allowance").  The Medical Assistance program pays the remainder of the bill.  The facility bills Medical Assistance directly.

MSHO (Minnesota Senior Health Options)
MSHO is a managed health care program that combines Medicare and Medicaid financing and services for seniors age 65 and over who are eligible for Medical Assistance (MA), with or without Medicare.  MSHO offers all medically necessary MA state plan services, all Medicare services including prescription drugs covered by the Medicare Prescription Drug Program (Part D).

Change in Financial Status
If you anticipate a change in your financial status from private pay to Medical Assistance, we ask that you alert the Business Office of this change as soon as possible at 218-742-8612.

You can obtain guidelines for Medical Assistance from the St. Louis County Social Services Department.  To apply, contact St. Louis County Social Service Department at 218-749-7128.

Billing
At the beginning of the month, a bill is sent to you or the person you designate to help with your financial matters.  When appropriate, the facility bills your insurance company, Medical Assistance and/or Medicare directly.  The bill is calculated with the daily rate that coincides with your care level.  Payment is required for the full month.  Individial accounts are to be paid by the 10th of the month.  Failure to keep accounts paid in full may lead to discharge from this facility and/or collection activity.

Bed Hold Policy

When you leave the facility for hospitalization or theraprutic leave, you will be given the option of holding or releasing the bed, and your response will be documented.

Private Pay
The number of bed hold days for a private-pay resident is at the discretion of the financilly responsible party.  Minnesota Law indicates that residents pay 60% of the Case Mix rate for a leave day if the facility is at 93% of total resident capacity.  The Virginia Convalescent Center has routinely been above the 93% percentile.

Private Insurance
A resident receiving benefits from a private insurance will generally NOT receive coverage for a bed hold. The resident's alternate payment source takes over to hold the bed if he/she is hospitalized.

Medicare
Medicare Part A does not pay for bed hold days.  If a resident transfers to the hospital, the resident is discharged from Medicare, and the bed hold days would be paid privately or by Medical Assistance if eligible.  Therapeutic leave days also are paid privately or by Medical Assistance if eligible.

Medical Assistance
The bed of a resident on Medical Assistance will be held for 18 days for a hospital transfer with the approval of the financially responsible agency.  The bed will also be held for 36 days of therapeutic leave each year with the approval of the financially responsible agency.  The bed hold begins the day of transfer from the facility.

Minnesota Health Department Survey

The Minnesota Health Department conducts a survey of all Long Term Care facilities annually.  The purpose of the survey is to monitor our compliance with State and Federal regulations as related to the provision of health care services.

The results of the survey, and our daily staffing information are always posted by the hallway bulletin boards near the elevator entrance on each floor.

If you want clarification regarding the process and results of the survey, the Administrator (218-749-9441) or Director of Nursing (218-749-9440) will be happy to assist you.