Chapters 37
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| 🇬🇧 | 🇬🇧 |
| Accreditation | A process whereby a professional association or nongovernmental agency grants recognition to a school or institution for demonstrated ability in a special area of practice or training |
| Certification | A process in which the government evaluates and recognizes an individual, institution, or educational program as meeting certain predetermined standards. |
| Eer | Erin |
| Q5 | Erg's |
| Q4 | Ref; j fj |
| Q3 | Erflkng |
| Diagnosis-related groups | (DRGs)- pays a set rate according to diagnosis for the hospitalized patient’s care rather than the “cost,” or charges an institution traditionally bills according to its own schedule of fees. |
| Home Heath Care | Services enable individuals of all ages to remain in the comfort and security of their home while receiving health care. |
| Medicaid | Program pays for home care services to indigent and low-income people of all ages. |
| Medicare | Is a federal program that requires agencies to be certified as meeting the federal conditions of participation, which sets forth specific requirements for organization, staffing, training, types of services covered, and agency evaluation. |
| Telehealth Services | This innovative approach to the provision of health care allows for the patient and care provider to interaction and monitoring through the use of telephones, computers, televisions, and two-way monitors. |
| HMO | Health Maintenance Organization |
| Home Health Care Patients | Patients older than 65 years old account for more than 82% of all home health patients, with 26% 85 years and older. Patients of all ages with various diagnoses account for the rest. |
| What does Home Health Care Include? | Wound care, ostomy assistance, setting up of oral medication, prefilling of insulin Syringes, administration of injections, intravenous (IV) administration, postoperative assistance for patients who have undergone total hip and knee replacements, and monitoring of patients with heart failure, diabetes, and hypertension. |
| Home health Care Defined, what are the four different perspectives | Official, Patient, Family, and provider |
| Official: Home Health Care Defined | A component of comprehensive health care in which an individuals and their families receive services in their place of residence for the purpose of promoting, maintaining, or restoring health, or of minimizing the effects of illness and disability. |
| Patient: Home Heath Care Defined | Skilled and compassionate care provided on a one-to-one basis in the comforting and familiar surroundings of the home. Providers base care on individual needs and personalized schedules and do so over a given period to enable adjustment, change, and learning to take place effectively. |
| Family: Home Health Care Defined | FAMILY- A means top keep the family together as a functioning, integrated unit. The goals are learning to adapt to change, preventing dysfunctional patterns for setting in, and attaining family wellness within the scope of an individuals member’s illness or disability. It provides needed emotional support and linkage with the larger community support systems. |
| Provider: Home Health Care Defined | Challenges all disciplines involved to provide excellent care in often excellent care in often less-than-excellent conditions and surroundings. Independence, creativity, communication, and excellent clinical skills are integral aspects of daily practice. It is an opportunity for nurses to demonstrate the best of their profession and themselves in cooperation with the health care team to patients and families with physical and phycological needs. |
| What affected the Home Health Care in 1965? | In 1965, Medicare(Title XVIII) and Medicaid (Title XIX) amendments to the social security act were passed. |
| Who is Medicare For? | Medicare provided direct federal funds for the health care of all citizens 65 years and older (or disabled), regardless of socioeconomic status. |
| Who is Medicaid for? | The companion of Medicaid bill covered the care needs of the poor and indigent of all ages. |
| When Medicare became effective, how did it revolutionize health care? | When Medicare became effective in 1966, it revolutionized health care by (1) changing it to a medical rather than nursing model of practice; (2) defining and limiting the services it reimbursed; and (3) changing the payment source and even changing the reason for providing home care. |
| What major influence on home care occurred in 1983? | Congress enacted the prospective payment system (PPS) as a part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement. This system based on major diagnostics categories and diagnosis-related groups (DRGs), pays a set rate (according to diagnosis) for the hospitalized patient’s care rather than the, “cost” or charges an institution traditionally bills according to its own scheduled fees. |
| What did the government use to control health expenditures? | In an effort to control home health expenditures, Congress imposed new limits on home health payments through the (Balanced Budget Act of 1997) or BBA called interim payment system. |
| BBA? | Balanced Budget Act |
| IPS? | Interim Payment System |
| What did BBA do? | Until BBA, there were no limits on payments for covered home health services provided to qualifying patients as long as visit costs were within “reasonable” cost limits. |
| What did the IPS do to reduce the growth of home health? | The IPS imposed lower pay visits and imposed a new agency-specific, aggregate per-beneficiary limit based on agencies’ federal fiscal year spending in 1994. |
| PPS? | Prospective Payment System |
| HH? | Home Health |
| What has the growing number of older adults resulted in? | The increased need for Home Health Care Services. |
| What has early discharge polices resulted? | Very ill older adults leaving the hospital. This increases the importance of patient teaching, early discharge planning, and appropriate referral to home health agencies by hospital staff nurses. |
| What amount of care do most older adults need? | Many older adults do not need total care but do need a limited amount of assistance. Home care reduces limited amount of assistance. Home care reduces disruption of lifestyle and is more cost effective than institutional placement. |
| What is the most comfortable environment of care for older people? | Transfer to a hospital or nursing home even on a temporary basis increase the stress level of older people. Stress is decreased if they receive care in a familiar environment. |
| What must caregivers consider when caring for older people? | Caregivers must learn the importance of preserving the older adult’s autonomy and make any modifications to the home environment with consideration of the older adults physical strengths and remaining functional abilities, not just the patient’s disabilities. |
| What are some Services that are often offered by agencies? | Many agencies assist older adults in their communities. The services offered by some of these agencies include Meals on Wheels, home health aides, homemakers, and home-based physical therapy services. Be familiar with home health services in your area of service. |
| Effects of Interim Payment System(IPS) | Lead to a reduction of Hone Health Care Services. The affect on individual agencies that were unable to maintain costs within per-visit and per-beneficiary limits was devastating. Once the current prospective into place in the year 2000, homes health care use saw a rise again. |
| Before and after our current prospective system? | According to 2016 statistics over 12,181 Medicare certified home health agencies were in operation throughout the United States. The number of beneficiaries receiving home health care services was 3,507,659, and 110,227,728 home visits were made. |
| How does Medicare Pay providers? | With HH PPS, Medicare pays providers of home health services at a fixed predetermined rates for services and supplies to cover an episode of care during a specific 60-day period. |
| What is the goal of PPS? | -The goal of PPS is to produce incentives for the home health provider to be more efficient in the delivery of home health services and still remain financially viable. -The goal is for home health care agencies to be more cognizant of limiting excess expenditures. -This is especially important given the concerns that have arisen the last several years about the amount of funds available through Medicare |
| How were Home care visits effected around 1980 and 1991? | Home care visits and Medicare expenditures for home care quadrupled between 1980 and 1991. This was attributed directly to shorter hospitalization, more seriously ill patients being discharged to home, and increased acceptance of the delivery of high technological care in the home. |
| What happened in home health care between 1990 and 1997? | Home health care grew five times faster than the average of other health care industries between 1990 and 1997 and accounted for more than 6% of heath service jobs. |
| What has been the Annual growth rate for Home Health Care since 2010? | The annual growth rate for home health care had been 1.7% in 2010, a 20% increase from 2002 with a slight decrease in costs cuts in Home Health Care are expected over the next several years. |
| Who is able to provide Home care services? | -delivery of home care services is possible by any individual, service group, organization, or agency with the desire to provide services to the older adult, disabled or ill of any age. -the type and qualifications of personnel used, the quality of services delivered, and the standards of care can vary widely, and these often depend on funding sources. |
| The Agency typically has to comply with federal, state, and local laws and regulations for the following?: | - License by the state -Certification by the State certifying body that the federal government designates. -Certificate of need -Accreditation by an outside agency that evaluates and judges how well the agency meters certain standards that the accredititing organization sets. |
| Description of License by the state? | This gives legal permission to operate within that state only. Regulations vary widely. Not all states require such laws. |
| Description of Certification by the State certifying body that the federal government designates? | The federal government set the rules that govern certification. Only certified agencies are permitted to receive Medicare payments. Many states piggyback Medicaid and reimbursement of certification, as do some insurers. |
| Description of Certificate of need? | Some states grant this according to rules and formulas that state regulators devise. Costs of starting and running the agency, availability of personnel, and need for their services are generally are considered in this process. |
| Description of Accreditation by an outside agency that evaluates and judges how well the agency meters certain standards that the accredititing organization sets? | An agency sometimes obtains this accreditation from organizations such as the National League of Nursing Community Health Accreditation Program, The Joint Commission of the Community Health Accreditation Partner. |
| CHAP? | Community Health Accreditation Partner |
| What are agencies classified by? | 1. Tax status- for non profit or profit 2. Location- free standing or institutional based 3. Governance- private or public |
| What has caused the number of agencies to go up? | Although the late 1980s saw a decrease in agencies, the number of numbers rebounded largely because of increases in hospital-based agencies and specialized agencies that provide highly technical types of care including intravenous therapies, peripherally inserted central catheter(PICC) line care and ventilator-dependent care services. |
| PICC? | Peripherally inserted central catheter |
| Telehealth Services | A newer method of care; This innovation approach to the provision of care allows for patient and care provider interaction and monitoring through the use of telephones, computers, televisions, and two-way monitors. The use of this technology allows the patient care to take place outside of the traditional inpatient setting. |
| Home Health Agency type 1? | Status: VOLUNTARY: Public, nonprofit, freestanding. Governance:Community based board of directions Source of Support: Tax Deductible, contributions, grants, fees from all sources Services offered: Community health public health, home health Nature of Staff: RN, LPN/LVN, aide, homemaker, social worker, therapists Time of Service: Generally 30 min to 8 hrs. Ex: Visiting nurse association |
| Home Health Agency type 2? | Status: OFFICIAL: Public, nonprofit, freestanding Governance: State, county, city, or other local unit of government and volunteer board representatives or the area. Source of Support: State local, or county revenues, grants, fees, from limited sources, charitable contributions. Services Offered: Community health, public health, home health Nature of Staff: RN, LPN/LVN, aide, homemaker, social worker, therapists Time of Service: Generally 30 min to 4 hrs Ex: State health departments, country health departments, city health departments. |
| Home Health Agency Type 3? | Status: COMBINATION: Public, nonprofit, freestanding Governance: Jointly operated by the two types of agencies previously mentioned under a combination board of directors Source of Support: State, local or country revenues, grants, fees from limited sources, charitable contributions Services Offered: Community health, public health, home health Nature of Staff: RN, LVN/LPN, aide, homemaker, social worker therapists Time of Services: Generally 30 min to 4 hrs Ex: Country Based visiting nurse association |
| Home Health agency Type 4? | Status: HOSPITAL: private, nonprofit, or for profit, institution-based hospital Governance: Hospital board of directors Source of Support: Fees from all sources Services Offered: Home health, community health (limited) Nature of Staff: RN lPN/LVN, aide, social worker, therapists Time of Services: Generally 30 min to 4 hrs Ex: XYZ hospital home health agency |
| Home Health Agency Type 5: | Status: PROPRIETARY: private, for profit, freestanding Governance: Governed and owned by individual, cooperation, or other organizational structure; board appointed by owner Source of Support: Fees from most sources; some do not participate in Medicare-Medicaid Services Offered: Some offer limited Home health, private duty, homemaker Nature of Staff: RN, LVN/LPN, aide Time of Service: 1 to 24 hrs Ex: Home health care of XYZ |
| Home Health Agency Type 6: | Status: PRIVATE, not for profit, free standing Governance: Governed and owned by individual, cooperation, or other organizational structure, board appointed by owner Source of Support: Fees from most sources, some do and some do not participate in Medicare-Medicaid Services Offered: Some offer limited Home health services, private duty, homemaker Nature of Staff: RN, LPN/LVN, aide Time fo service: 30 min to 24 hrs Ex: ABC home health agency |
| Home Health Agency Type 7: | Status: OTHER, private, for profit or nonprofit, institution based Governance: Based within formalized institution, governed by that board or designated board Source of Support: fees from all sources Services Offered: Hone health services limited, limited homemaker Nature of Staff: RN, LPN/LPN, aide, therapists, may have homemaker, social worker Time of Service: 30 min to 8 hr Ex: ABC Nursing home-home health agency; ABC rehabilitation facility, home care |
| What is the role of a social worker? | Social workers provide assistance with a patient’s emotional, financial, and household problems, thus allowing the nurse more time to perform nursing interventions. |
| What are home health agencies employing more of? | Home health agencies are employing more of nurse pain specialists to assess and manage pain control in the home. The can provide education to patients and staff band provide greater benefits in relief of pain and reduce the cost of ineffective pain management. |
| Pet care? | Pet care programs are a new inclusion in some areas to reduce stress for home health patients who are too ill to care for their pets. A “durable power of attorney for pet care” allows patients to make arrangements for pet care if they become hospitalized or die. Sone home health agencies provide special pet services, such as transportation of pets to veterinarian appointments or in-home pet care. |
| Rapidly growing segment in Home Health? | One of the most rapidly growing segments in home health is home infusion therapy; an increasing number of home health agencies are offering home infusion services in an effort to compete for patient referrals. Helath care facilities are eager to have this service because it is cost cutting. |
| Most common forms of home IV therapy | Antibiotics, hydration, and total parental nutrition (TPN), the practitioner may order them for patients at home without prior hospital admission |
| List of medications for home intravenous therapies? | Analgesics, chemotherapeutic agents, hormones, and antiemetic agents. |
| Primary services offered by home health agencies? | Most home health agencies follow the basic Medicare model services they offer. Primary services include; -Skilled nursing -physical therapy -speech-language therapy -occupation therapy -medical social services -Homemaker-home health aide |
| Other therapy services? | Ex: respiratory, nutritional counseling, pharmacy, podiatry, dentistry, and psychiatric or mental health, homemaker, companion, and respite are all therapy services that can sometimes be offered. These services are not always reimbursable by Medicare. |
| DME? | Durable Medical Equipment |
| Do agencies provide medical supplies? | The agency commonly provides medical supplies, including durable medical equipment (DME). Home medical supplies ranging from the traditional hospital bed to highly sophisticated items such as respirators and apnea monitors is possible to buy or lease from companies that specialize in equipments provision. |
| What are the most common diagnosis for home care patients? | The most common diagnosis for home care patients are diabetes, mellitus, hypertension, heart and circulatory diseases, osteoarthritis, stroke, acute and chronic wounds, chronic obstructive pulmonary disease, cancer, and endocrine disorders. |
| What are Commonly performed treatments in the home? | Administration of infusion therapy such as antibiotic administration, patient controlled analgesia for pain management, enteral feedings, parenteral nutrition, chemotherapy, hydration therapy, and psychiatric counseling and education. |
| Is medical equipments provided in a home? | The nurse and rehabilitation team member sometimes also provide medical equipment in the home to facilitate medical treatment and safety, such as electrical beds, wheelchairs, commodes, walkers, and other assistive devices. |
| Who does Medicare require? | -Medicare requires a plan of treatment signed by the physician that outlines all disciplines, treatment, frequency, and duration. -The physician or designated medical provider (nurse practitioner or physician assistant), working in conjunction with physician must provide a face-to-face visit with the patient. -If the patient is to receive home care benefits beyond the original 60-day period, a recertification must be completed for each subsequent 60 day period. -Requires face to face encounter with provider |
| What do some agencies require of RN’s? | A bachelors degree in nursing |
| Who is the LVN supervised by in Home Health Care? | RN Registered Nurse |
| What are the Four major goals of skilled nursing services? | 1. Restorative 2. Improvement 3. Maintenance 4. Promotion |
| Restorative description: | -Returning to a previous level of functioning as appropriate and realistic -Restorative goals may include; patient able to feed self without signs of chocking. |
| Improvement description: | -Achieving better health and a higher level of functioning than at admission. -Improvement goals may include; Patient verbalizes understanding of signs of impending heart attack or brain attack and when to call emergency assistance. |
| Maintenance description: | -Preserving functional capabilities and independence by maintaining current level of health. -Maintaining goals may include; Patient demonstrates compliance with daily exercise routine to maintain strength and prevent further decline. |
| Promotion description: | -Teaching healthy lifestyles that keep the effect of illness or disability to a minimum and prevent the reoccurrence of illness. Ex: the patient who just had a stroke -promotion goals may include: Patient demonstrates compliance in low-fat, low cholesterol, low-sodium diet. |
| What are some characteristics home health nurses must have? | -Nurses who practice in the home setting are caregivers, teachers, counselors, case managers, and advocates. -Attributes of an effective home health nurse are technical proficiency and self-motivation, good organizational skills, innovation, independence in decision making, and response to problems promptly. -Nurses who prefer the structure of the institutional setting and benefit from immediate direction and frequent peer support find the independence of hoe care practice difficult. |
| What must a home health care nurse respect at all times? | The patient’s cultures, values and beliefs |
| Duties of Home Health Care nurse? | - They must have strong communication skills for teaching, counseling, interviewing, and listening. -They must have a high energy level, cheerfulness, and a positive attitude. -Respect for the patient’s dignity, privacy, and need for autonomy. -Commitment to professional standards of practice, ongoing continuing education, and updates on skills. |
| What LVN’s have to offer for Home Health Care? | An RN has to supervise LPN/LVN’s. Although the LPN/LVNs are not empowered to make detailed patient assessments or clinical judgements, their observations, reporting, documentation, teaching, and technical care capabilities are important to home health care. |
| What professional Attributes should LVN’s and RN’s have? | -Personal and professional attributes describes for RNs also apply to the LVN/LPN. Independent practice is not allowed, but self-direction, motivation, creativity, clinical proficiency, flexibility, compassion, empathy, and patience are essential attributes. -Good communication skills written and spoken are necessary -The ability to work alone, follow directions, recognize important changes in condition, patient teaching, and evaluation of care |
| What are some services the LVN/LPN may provide? | -Bowel and bladder training, catheter care and teaching, emotional support, enemas, finger sticks for blood glucose readings, injections, insertion of urinary catheter, irrigation, and observation for infections, monitoring physical status (such as; lung sounds, bowel sounds, pulses, edema, and weight), Nutrition, ostomy care and teaching, pain management, patient and family teaching, prefilling of insulin syringes, preventative health measures, respiratory care, management of oxygen therapy, mechanical ventilation, and physiotherapy, specimen collection, teaching monitoring, or setting up medications, therapeutic diet teaching or reinforcement, Tracheostomy care, including Suctioning, vital signs, wound care, sterile dressing changes. |
| Physical Therapy description: | - Qualified and licensed physical therapist is required to provide service -Treatments range from muscle strengthening to transcutaneous nerve stimulation and ultrasound treatments, which also may aid in pain management. -Patient’s who have orthopedic conditions such as repair or fractured hip or total knee replacement, frequently receive physical therapy services. -Other common reasons for Home health physical therapy include wound care, heart failure complications, and diabetes and medication teaching. -The therapist actively teaches the patient and the family of the rehabilitation plan to promote self-care and independence |
| Speech Language Therapy description: | - A master’s-prepared clinician who has been certified by the by the American Speech and Hearing is required to provide speech services - Some insurances except a practitioner, at bachelors level -Therapy goals; reducing communication disorders, and their physical, emotional and social impact -Independent functioning and maximum rehabilitation of speech and language abilities are primary treatment goals -Speech language services are often needed after a stroke or surgery - Care ranges from language relearning to working with eating or swallowing disorders. |
| Occupational Therapy description: | -Therapists have the opportunity to earn the occupational therapist, registered (OTR) designation if they meet the registration requirements of the National Occupation Therapy Association. OTR required for Occupational Therapy Services Services of Occupational Therapy include; 1. Techniques to increase dependence 2. Analysis of activities 3. Expanding the disease management approach into lifestyle management approach 4. Design, fabrication, and fitting of orthotic or self-help devices 5. Assessment for vocational training -Occupational Therapists assist patients to improve in their performance of activities of daily living (ADLs), and their sensory-motor, cognitive, and neuromuscular functioning. Patient centered education is necessary for independence in self-care. |
| Medical Social Services Description: | -Social workers prepared at the master’s level provide medical social services -Their focus is emotional and social aspects of illness. -The patient, or family, undergo evaluation for social, emotional, and environmental factors. -The care plan includes; education, counseling, payment source of identification, and referrals. -coping with stress and crisis intervention are also part of social workers services |
| Homemaker- Home health aide description: | -Medicare requires that a primary skilled or therapy service be provided before HHA services are arranged -Many insurances do not reimburse this care -Most aide advices fall under these three categories; 1. Personal care, such as; assistance with bathing, oral hygiene, eating, dressing, and toileting 2. Physical assistance, such as; transfers, medications, and ambulation 3. Household Chores, such as; cooking, light housekeeping, shopping and laundry |
| OTR? | Occupational Therapist Registered |
| HM-HHA? | Homemaker-Home Health Aide |
| Home Health Process? | Referral and Admission -Referral- entry point into the health care system, This comes form the patient, family, hospital, physician, or an agency. Discharge planning process with a central agency intake coordinator to a direct call from the patient’s physician to the agency staff. -Admission-The RN makes the initial evaluation and admission visit within 24 to 48 hrs of the referral. The evaluation and admission process generally includes; 1. Complete patient evaluation, 2. Environmental assessment, 3. Identification of primary functional impairments, 4. Identification of the impact of the disease of disability on the patient and family, 5. Assessment of the support system of family of significant other, 6. Determination of knowledge and adherence to treatments and medications, 7. Determination of desire for care and services, 8. Involvement of the patient and the family in the development of the plan of care and goals, 9. Notification of the patient rights to self-determination, including information on costs, payment sources, and billing practices.10. Explanation of the patients rights to self-determination, including information and implementation policies for advanced direction, 11. Provision of initial nursing interventions |
| Care Plan description: | -If the agency is to admit the patient, the physician must be contacted for specific orders before delivery of care -This plan describes he current physical status of a patient, medications, treatments, the disciplines needed to provide care, the frequency and the duration of services, the goals and outcomes, and the time frame for implementation. -The physician is required to sign the plan for treatment |
| CCRC? | Continuing Care Retirement Community |
| ADPIE- need to memorize | A-assessment D-Diagnosis P-planning I-Implementation E-Evaluation |