HIV: OPTIONS FOR MEDICAL CARE-ALTERNATIVES TO HOSPITAL CARE: CHRONIC CARE FACILITIES
HIV: OPTIONS FOR MEDICAL CARE-ALTERNATIVES TO HOSPITAL CARE: CHRONIC CARE FACILITIESChronic care facilities are nursing homes, facilities for the long-term care of people who do not require hospitalization but who cannot be cared for at home. People with HIV infection who use chronic care facilities are most likely to be those with AIDS dementia complex, those with severe nutritional problems, those who will have a prolonged convalescence from some infection, and those who are severely debilitated. The cost of chronic care facilities usually ranges from $200 to $400 per day and up, though the costs vary by facility, location, and the kinds of services needed. Both Medicare and Medicaid will fund chronic care, but only under limited circumstances. The amount of funding provided depends on the level of nursing care you need—intermediate (the least amount of care), skilled, or chronic (the most amount of care). The level of funding is lowest for intermediate care and highest for chronic care. Whether you are eligible for a level of care and which level of care you need is decided by the Professional Review Organization (PRO), which represents both Medicare and Medicaid, and commercial insurance companies. Once you are placed in a chronic care facility, funding continues indefinitely unless your needs change. PROs usually visit facilities and adjust levels of care intermittently. Both you and the chronic care facility have the right of refusal. That is, you (or your guardian) can refuse transfer from a hospital to a chronic care facility if you have a suitable alternative, and the chronic care facility can refuse to accept you. Many chronic care facilities in this country have resisted accepting people with HIV infection. Their reasons are that the nursing staff is afraid of HIV transmission, that accepting people with HIV infection might deter other applicants to the chronic care facility, and that people with HIV infection often require more intensive care than the usual person in a chronic care facility. In some areas, third-party payers have increased reimbursement for people with HIV infection; in other areas, other enticements have been offered. Nevertheless, in most areas, the number of beds in chronic care facilities for people with HIV infection still falls short of the number needed.*173\191\2*
