Ethica Skilled Nursing Health Company Profile
CHSGa’s post-acute and long-term care inpatient services are provided under Ethica, a not-for-profit organization that provides clinical and related health care and consulting services to member long-term care centers in the state of Georgia. Ethica serves patients in 52 skilled nursing centers across Georgia and one assisted living facility in Treutlen County; the company’s operations are organized by three divisions, North, Central and South (each supported by a division Vice President).
In addition to clinical expertise in skilled nursing, therapy services and support for activities of daily living (ADLs), Ethica centers attend to the emotional, spiritual, social, psychological and physical needs of both long-term residential and short-stay skilled patients on a daily basis. Family councils, care planning meetings that include caregivers and satisfaction surveys contribute to engagement of family and other informal caregivers of Ethica patients.
Ethica nursing centers are Joint Commission accredited. Most are located in rural communities and nearly all are in medically underserved areas. Payors for skilled nursing include Medicare Part A, Medicare Advantage and commercial insurance (primarily covering short-stay skilled nursing and therapy) and Medicaid (primary payor for long-stay residents); a majority of patients in Ethica skilled nursing centers are dually eligible for Medicare and Medicaid. While providing both services,
CHSGa has a strategic focus on caring for long-stay patients, with a majority of patient days funded by Medicaid.
Skilled Nursing Facility Eligibility
Long-stay:
Georgia’s Medicaid nursing home eligibility states that a person must have a physical and/or mental impairment, which requires continued nursing care, monitoring and supervision (nutrition, skin care, etc.), under the direction of a licensed doctor. The person must be
unable to provide this nursing care to him/herself. Functional impairments include needing assistance with moving around/transferring, maintaining continence or feeding. Mental status impairments include memory deficiencies (beyond just forgetfulness), trouble making decisions and problem behavior.
Completion of a Medicaid DMA-6:
Physician’s Recommendation Concerning Nursing Facility Care form documenting a potential patient’s need for long-term nursing facility care is required in Georgia prior to SNF admission. Alliant Health Solutions,
a third party contractor with the Georgia Department of Community Health, reviews the completed DMA-6 of skilled nursing center applicants and must confirm a nursing facility level of care prior to Medicaid reimbursement. Potential patients must also be screened for
mental illness and intellectual disabilities under the federal PASRR program, with a higher level of review and care planning required if there is evidence of a mental illness, an intellectual/developmental disability, or a related condition.
Short-term:
Requirements for Medicare skilled nursing facilities include a qualifying hospital stay, a physician’s order for inpatient services in a SNF and the need for skilled care on a daily basis that can only be delivered as an inpatient in a SNF.
Services at Ethica Nursing Centers
Care provided at Ethica skilled nursing centers includes:
• Skilled nursing
• Rehabilitation—physical therapy, occupational therapy, speech-language pathology
• Restorative services
• Assistance with activities of daily living (ADLs)
• Memory care and secure units at designated centers
• Physician/advance practice provider primary care services
• Pharmacy services
• Social services
• Therapeutic Activities
• Transitions of care
• Wound care support
• Respiratory therapy
• Individualized care plans
• Behavioral health
• Palliative care
• Telehealth for designated specialty care
• Hospice
• Respite care
CHSGa supports Ethica with management, governance and consulting, including:
• Financial reporting and accounting
• Business enablement and governmental payor relations
• IT resource management
• Customer service/experience
• Medical supply distribution
• Equipment and non-clinical supplies
• Human resources
• Legal, risk management and compliance
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