Dunn County Neighbors outlines short-term rehab, long-term, memory care and hospice services

Carmen, the community mentor/administrator for the Dunn County Neighbors campus, told the Dunn County standing committee that the campus is licensed as three separately certified skilled nursing facilities and can accept Medicare and Medicaid across the campus.

The explanation matters because payer rules and facility licensure shape who the campus can admit, what care residents receive and how services are billed. Carmen said roughly 70% of long-term residents are covered by Medicaid, with private pay and the Department of Veterans Affairs making up other long-term funding.

Carmen described two broad clinical categories of stay. Short-term rehabilitation stays typically follow a hospital admission for surgery, an acute illness or an injury; the stated goal is discharge to home or to a less-restrictive setting such as assisted living. Carmen said short-term stays rely on Medicare coverage (Medicare Part A or Medicare Advantage Part A) when residents meet clinical criteria, including an intensity of therapy usually described by staff as about five days per week and documented functional gains. If therapy or the interdisciplinary team determines a resident is no longer making progress, Carmen said the resident’s coverage can end with a “notice of noncoverage.”

Long-term stays, Carmen said, are for residents whose goal is not to return home and whose care focuses on maintaining functional and cognitive status. "Medicaid is our number one payer source with about 70% of all residents on Medicaid," she said. She said long-term care residents have individualized care plans and regular care conferences that include the interdisciplinary team and, when appropriate, family members or an activated power of attorney.

Carmen also described memory-care households and hospice services. Memory-care areas are not locked units at the Neighbors campus; instead, the campus uses a range of safety measures including bracelet-style wander-guard alarms that sound and lock doors when a resident tries to leave a secured area. Carmen said wander-guard bracelets can be removed by residents and that staff sometimes place them on wheelchairs or ankles when needed. The campus contracts with outside hospice providers to supply additional nursing, medications and end-of-life services; Carmen emphasized hospice enrollment depends on hospice provider assessments and a general prognosis expectation of about six months or less.

Committee members asked clinical and regulatory questions. Supervisor Loper asked about medications used in memory care; Carmen deferred on specific drugs and suggested the facility’s physician, Dr. Brown, would be a better source. Carmen and others also told the committee that federal rules (Centers for Medicare & Medicaid Services) set minimum requirements and state agencies (DHS/DQA) add state-specific requirements when applicable.

The explanation concluded with an offer by Carmen to answer further questions and with committee members thanking her for the presentation.