CH 36 Home health care
Patient Perspective
Skilled and compassionate care is provided on a one-to-one basis in the comforting and familiar surroundings of the home.
In the home care setting, which type of service is most frequently provided? 1 Skilled nursing 2 Speech therapy 3 Physical therapy 4 Occupational therapy
Skilled nursing
The four different perspectives of home health care are?
Official Patient Family Provider
Home health nursing services enable individuals of all ages to
remain in the comfort and security of their homes while receiving health care
Formerly home care was defined as.....
simply providing physical care to the sick in their homes
Services may include
skilled nursing, physical therapy, speech language therapy, occupation therapy, social services, intravenous therapy, nutritional support, home health aide, respiratory therapy, acquisition of medical supplies and equipment, and homemaker and companion care
The first home health care program in the United States was organized in
1796 as the Boston Dispensary.
Family Perspective
It is a means to keep the family together as a functioning, integrated unit.
When Medicare became effective in 1966, it revolutionized home care by
*Changing it to a medical rather than nursing model of practice *Defining and limiting services for which it would reimburse *Changing the payment source and even changing the reason home care was provided *A number of service agencies exist that are in a position to assist older adults in their communities. The agencies include Meals on Wheels, Home Health Aides, Homemakers, and Home Based Therapies (Physical and Occupational)
Diagnosis-Related Groups (DRGs)
*Congress enacted this prospective payment system in 1983 as a part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement. *Based on major diagnostic categories, a set rate is paid for the hospitalized patient's care rather than the "cost" or charges traditionally billed by institutions
Agencies may have to comply with federal, state, and local laws and regulations via the following:
*Licensure by the state *Certification by the state certifying body designated by the federal government *Certificate of need granted by some state according to rules and formulas devised by state regulators *Accreditation by an outside agency that evaluates how well the agency meets certain standards set by the accrediting organization
Diagnosis-Related Groups (DRGs) (continued)
*The net effect of the change was a major shift of patients out of the hospital into their homes, extended-care facilities, or skilled nursing facilities. *This created a challenge in terms of volumes of patients seen, necessity of more skilled nursing care over intensive times, and the evolution of highly technical procedures in the home
Seven types of Home Care agencies:
*Voluntary *Official *Combination *Hospital *Proprietary *Private not-for-profit *Other
A patient is to receive home health care paid for by Medicare. The nurse knows the patient must be recertified for treatment that extends beyond which length? 1 14 days 2 30 days 3 60 days 4 6 months
60 days
Medicare
A federally funded national health insurance for certain people older than 65 years of age
Medicaid
A federally funded, state-operated program of medical assistance to people with low income; authorized by Title XIX of the Social Security Act
Improvement:
Achieving better health and a higher level of functioning than at admission
Provider perspective
All disciplines involved are challenged to provide excellent care in often less-than-excellent conditions and surroundings.
What are the two major skills needed for a nurse working in the home care setting? 1 Assessment and teaching 2 Communication and planning 3 Assessment and documentation 4 Communication and documentation
Assessment and teaching
What medical diagnosis is seen most commonly in home care patients? 1 Cancer 2 Liver failure 3 Renal failure 4 Diabetes mellitus
Diabetes mellitus
The nurse is caring for a patient in a home health agency that is a public, nonprofit organization. The patient asks the nurse about the source of support for hospital bills. What does the nurse suggest to the patient? Select all that apply. 1 Grants 2 Charity 3 Medicaid 4 Medicare 5 State revenue
Grants Charity State Revenue
The first visiting nurse service in the United States was formed where in 1886?
Philadelphia
Maintenance:
Preserving functional capacities and independence by maintaining current level of health
Certification
Process in which an individual or institution, agency, or educational program is evaluated and recognized as meeting certain predetermined standards
Accreditation
Process whereby a professional association or nongovernmental agency grants recognition to an institution or agency for demonstrated ability in a special area of practice
Restorative goal example
Pt able to self feed without signs of choking
Promotion goal example
Pt demonstrates compliance in low-fat, low-cholesterol, low-sodium diet
Maintenance goal example
Pt demonstrates compliance with daily exercise routine to maintain strength and prevent further decline
Improvement goal example
Pt verbalizes understanding of signs of impending heart attack or brain attack and when to call emergency assistance
Restorative:
Returning to a previous level of functioning as appropriate and realistic
Official Perspective
Services are provided to individuals and their families in their place of residence for the purpose of promoting, maintaining, or restoring health or of minimizing the effects of illness and disability
Home health care
Services that enable individuals of all ages to remain in the comfort and security of their homes while receiving health care
Diagnosis-related Groups (DRGs)
System that classifies patients by age, diagnoses, and surgical categories; used to predict the use of hospital resources, including the length of stay
Promotion:
Teaching healthy lifestyles that keep the effect of illness or disability to a minimum and prevent the recurrence of illness
A home care agency discontinued providing services when the patient relocated to a different state. What can the nurse infer about the home care agency? 1 The agency has a certification by the state. 2 The agency has licensure by the state government. 3 The agency has accreditation by the outside agency. 4 The agency has certification by the federal government.
The agency has licensure by the state government.
When planning nursing interventions for the pt, who must the nurse work with i setting goals?
The pt and the family
Telehealth Services
This innovative approach to the provision of care allows for patient and care provider interaction and monitoring through the use of telephone, computers, televisions, and monitors
The most common diagnoses for home care patients are:
diabetes mellitus, hypertension, heart and circulatory diseases, osteoarthritis, stroke, acute and chronic wounds, COPD, cancer, and endocrine disorders