Chapter 15 Health Care Settings Continuum of Care

community health

improve the health status of communities or groups of people through public education, screen for early detection of disease, and provide services for people who need care outside the acute care setting

wellness center

include nutritional counseling, exercise programs, stress reduction, and weight control

private health care agency

include profit and non profit institutions, charge a fee for service, primary emphasis is cure disease and illness

public hospital (federal or state gov. )

include veterans health administration (VHA), state, county municipally owned and operated non profit hospitals

personal care

individuals who are neither trained or licensed can safely and reasonably provide services and supplies

gov. public health care agencies

local: funded by local tax money and subsidies from state and federal levels of gov. state: funded by state tax money, sometimes receives money from fed gov. federal (national): funded by federal taxes

Which service focuses on relational care within the family's and patient's environment as well as on restoring health? a) Primary care b) Hospice care c) Adult day care center d) Home health nursing

d) Home health nursing

An example of a private health care agency is: a) the American Cancer Society. b) the American Diabetes Association. c) the United Ostomy Association. d) a primary care physician.

d) a primary care physician.

Proprietary hospitals are primarily supported by: a) religious groups. b) community associations. c) major gifts and donations. d) private owners or corporations.

d) private owners or corporations.

skilled nursing facility

services and supplies can be provided by or under the supervision of nursing personnel

U.S. public health service (USPHS)

(agency responsible for the public health of the American people) has 8 agencies -food and drug administration (FDA) -centers for disease control/prevention (CDC) -national institute of health (NIH) -health resource and service administration (HRSA) -substance abuse and mental health service administration (SAMHSA) -agency for healthcare research and quality (AHRQ) -indian health services (IHS) -centers for medicare and medicaid service (CMS)

alternatives to nursing homes

(community based care) home health, community health, adult day care, independent living facility, assisted living, retirement community, board and care homes (institutional setting) nursing facilities

rehab centers

After a client has been stabilized following an acute illness or injury, lasting from days to years, These services help the client return to their pre-injury/pre-illness function or highest level of functioning possible.

Personal care includes which of the following? a) Getting into and out of bed b) Bedside glucose monitoring c) Medication administration d) Blood pressure monitoring

a) Getting into and out of bed

Which facilities are generally training sites for health care practitioners? a) Teaching and research hospitals b) Long-term care facilities c) Rehabilitation centers d) Skilled nursing facilities

a) Teaching and research hospitals

The rapid development of a variety of ambulatory services is directly related to: a) the rising cost of inpatient care. b) an influx of major gifts and donations. c) a lack of highly skilled practitioners. d) poor public health and awareness.

a) the rising cost of inpatient care.

Which federal health care agency advises the president of the Unites States in health matters? a) United Nations (UN) b) World Health Organization (WHO) c) Department of Internal Affairs d) Department of Health and Human Services (HHS)

d) Department of Health and Human Services (HHS)

A young, single female who is unemployed and without insurance has been diagnosed with genital herpes. Which type of setting would be most appropriate for this patient? a) Physician's office b) Outpatient primary care clinic c) Urgent care center d) Free clinic

d) Free clinic

food and drug administration (FDA)

Ensures that food, human/animal drugs, biological products, and medical devices and electronic products that emit radiation are safe and, if applicable, effective

national institute of health (NIH)

Funds biomedical research in its own laboratories and in universities, hospitals, private research institutions, and private industry. Trains new researchers and promotes collecting and sharing of medical knowledge. The NIH consists of 27 institutes and centers, including the National Institute of Nursing Research (NINR).

health resource and service administration (HRSA)

Improves access to medical care by strengthening the health care workforce, building healthy communities, and achieving health equity.

substance abuse and mental health service administration (SAMHSA)

Improves the quality and availability of prevention, treatment, and rehabilitation services for persons who are dealing with addictive and mental disorders, as well as for their families and communities.

indian health services (IHS)

Provides comprehensive health services to American Indians and Alaskan Natives.

centers for disease control/prevention (CDC)

Provides leadership in health prevention and promotion programs, and responds to public health emergencies.

centers for medicare and medicaid service (CMS)

Provides oversight of the Medicare Medicaid (federal), Children's Health Insurance Programs, the Center for Consumer Information and Insurance Oversight, and related quality assurance activities.

agency for healthcare research and quality (AHRQ)

Supports research aimed at improving the quality of care, reducing costs, broadening access, and improving client outcomes.

Indicate which statements accurately describe differences between community health nursing services and home health agencies. (Select all that apply.) a. Home health agencies provide direct nursing services to people in their home. b. Community health nursing services work on prevention and case finding. c. A Visiting Nurse Association is an example of a home health agency. d. Home health agencies have an increased focus on family and the client's environment. e. Home health agencies focus on population health versus individual health.

a. Home health agencies provide direct nursing services to people in their home. b. Community health nursing services work on prevention and case finding. c. A Visiting Nurse Association is an example of a home health agency. d. Home health agencies have an increased focus on family and the client's environment.

How will you explain the different levels of long-term health care to someone planning to seek placement for an elderly relative? (Select all that apply) a. Personal care can provide assistance with basic care needs and supervision to maintain a safe environment. b. Assisted care facilities offer 24-hour supervision and support the elderly to "age in place"—providing a flexible menu of services. c. Specialty hospitals can provide rehabilitation services following a major neurological event (i.e., stroke). d. Skilled care facilities can provide 24-hour supervision and access to many health care services, including dementia care. e. Assisted living facilities can provide total nursing care for immobile clients.

a. Personal care can provide assistance with basic care needs and supervision to maintain a safe environment. b. Assisted care facilities offer 24-hour supervision and support the elderly to "age in place"—providing a flexible menu of services. c. Specialty hospitals can provide rehabilitation services following a major neurological event (i.e., stroke). d. Skilled care facilities can provide 24-hour supervision and access to many health care services, including dementia care.

board and care homes

adult care homes, group homes, or family-type homes. The facilities offer temporary or long-term residential care, housekeeping, and personal care for a small number of adults unrelated to the operator. Assistance with ADLs,

world health organization (WHO)

agency of the united nations (UN), acts as a coordinating authority on international public health, funded through fees paid by member nations of the UN, works worldwide to promote health, keep the world safe, and serve the vulnerable, coordinates international efforts to control outbreaks of infections such as coronavirus, Ebola, sudden acute respiratory syndrome (SARS), malaria, tuberculosis, influenza, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Also sponsors programs to prevent and treat such diseases.

independent living facility

are not licensed or regulated for health care delivery. People living in these facilities are not there for personal or medical care, but they like to live with seniors who share their interests. Generally, planned activities and trips and bus service for shopping are offered. Aging in place has been a trend in the last several years.

Which health care agency is considered private? a) County health department b) Family practice physicians c) Department of Health and Human Services (DHHS) d) Visiting Nurse Association (VNA)

b) Family practice physicians

The World Health Organization (WHO) is an agency of the: a) U.S. Public Health Service (USPHS). b) National Institutes of Health (NIH). c) United Nations (UN). d) American Cancer Society (ACS).

b) National Institutes of Health (NIH).

Which health care delivery type provides 24-hour nursing services per day but does not always have licensed RNs available? a) Assisted living b) Skilled nursing home c) Custodial care d) Adult day care

b) Skilled nursing home (Assisted living includes various types of assistance for adults who are independent; nursing care is available on an as needed basis)

A family member of a patient who suffers from severe chronic pain and who requires 24-hour care in an institutional setting asks a practical nurse why the patient cannot enter a hospice where "patients receive wonderful care for pain." Which response by the practical nurse would be most accurate? a) Hospice care is only available in the community. b) The hospice care philosophy is to maintain comfort as death approaches. c) The focus in hospice care is on relief of symptoms. d) Hospice care is only available to those who are certified as terminally ill.

b) The hospice care philosophy is to maintain comfort as death approaches.

A mother with a 5-year-old child has recently relocated. Her child has a cough and sore throat that is worsening. She would like the child to be seen by a health care provider but does not yet have a family physician. Which type of health care facility would be the most appropriate for the mother to obtain care for her child? a) Primary care b) Urgent care c) Emergency room services d) Outpatient clinic

b) Urgent care

The purpose of adult day care centers is to provide: a) end-of-life care for the terminally ill. b) daytime supervision for those not eligible for nursing homes. c) a higher level of nursing and rehabilitative care. d) outpatient follow-up and care.

b) daytime supervision for those not eligible for nursing homes.

Which of the following health agencies is most likely to be a major resource if you have a measles outbreak at your health care institution? a. WHO b. CDC c. NIH d. FDA

b. CDC

The family of a person who is in treatment for alcoholism is seeking support in the community so that they can better deal with the alcoholism as a family. Which volunteer agency could be suggested that is specific to their needs? a) A private clinic b) Ambulatory care c) Alcoholic Anonymous d) ALS Society of America

c) Alcoholic Anonymous

A patient has recently been diagnosed with terminal cancer and wants to try a drug that may prolong her life that is available in other countries. Her specialist says that it is not available in the United States. The patient questions why and the specialist explains that its safety has not yet been established for human use. He further explains that it has to be approved at a federal level by which of the following agencies? a) National Institute of Health b) Centers for Disease Control and Prevention c) Food and Drug Administration d) Agency for Toxic Substance and Disease Registry

c) Food and Drug Administration

A practical nurse is hired for home health nursing and wonders what types of skills or knowledge might be required within this type of patient care practice. Which knowledge or skills might the practical nurse be expected to have? a) Performance of skilled physical therapy b) Sufficient knowledge to change treatment orders to meet patient needs c) Provision of catheter and ostomy care d) Prescribing of basic medications, such as ointments

c) Provision of catheter and ostomy care (LPNs do not have prescriptive authority or authority to change treatment orders.)

Which type of hospital is operated by the Department of Veterans Affairs? a) Proprietary hospitals b) Research hospitals c) Public hospitals d) Voluntary community hospitals

c) Public hospitals

Improving the status of communities or groups of people through public education is a focus of: a) short-term care facilities. b) physical therapy. c) community health nursing. d) home health nursing.

c) community health nursing.

A personal care facility provides: a) 24-hour nursing and rehabilitation care. b) urgent and outpatient care. c) personal care services. d) nutritional counseling and stress reduction.

c) personal care services.

Nutritional counseling, exercise programs, and stress reduction are programs commonly provided by: a) home health nurses. b) rehabilitation facilities. c) wellness centers. d) specialty hospitals.

c) wellness centers.

What quality/skill set described below would indicate a need for staff training when working with hospice? a. Knowledge of the physiologic process occurring as death approaches. b. Ability to sit without the need for dialogue, if desired by the individual. c. Feeling the need to tell the individual your beliefs about life after death. d. Willingness to honor the person's request for food, conversation, visitors, and so on.

c. Feeling the need to tell the individual your beliefs about life after death.

How do new elder living models differ from traditional nursing homes? (Select all that apply.) a. Traditional homes provide personal care by assigning an LPN/LVN to give total care to the resident. b. New elder living models follow strict schedules for eating, bathing, and so on to provide a sense of security. c. In new elder living models, elders have flexibility in when they get up, eat, bathe, go outdoors, and receive visitors. d. New elder living models home design could minimize the need for wheelchairs. e. Traditional homes establish time frames for meals that meet the needs of the majority of the resident.

c. In new elder living models, elders have flexibility in when they get up, eat, bathe, go outdoors, and receive visitors. d. New elder living models home design could minimize the need for wheelchairs. e. Traditional homes establish time frames for meals that meet the needs of the majority of the resident.

Which statement best describes how official and voluntary agencies differ? a. Official agencies are proprietary. b. Voluntary agencies are tax supported. c. Official agencies provide primary care. d. Voluntary agencies emphasize research.

c. Official agencies provide primary care.

After hearing about the outbreak of Zika virus, a woman who has recently returned from a country where Zika virus was first identified wonders why there is not an international response to this type of outbreak. Which response is appropriate? a) "Outbreaks are a national responsibility and are handled individually by each country." b) "Your impression is correct because there is no international or national coordination of such outbreaks." c) "There is reluctance by countries to fund international health concerns, and so their international response is limited." d) "The World Health Organization is funded by members of the United Nations and coordinates outbreak efforts."

d) "The World Health Organization is funded by members of the United Nations and coordinates outbreak efforts."

A family with an older adult relative who is no longer able to care for herself and her personal needs would like her to stay close to them in their community in an alternative setting. The family finds a board and care home close by that has an opening. The family is concerned, however, about whether the owner is able to provide safe and compassionate care for their relative and wonders who oversees the residence. Which response would be the most appropriate? a) "Because this is a private living arrangement, oversight is provided by the owner and by family members." b) "Professionals such as an RN or an LPN/LVN provide oversight of care of the residents." c) "If needed, extra skilled help will be brought in to assist with health care issues." d) "The home is under the oversight of the Department of Social Services."

d) "The home is under the oversight of the Department of Social Services."

A 75-year-old male suffered a stroke with right extremity weakness and dysphasia and was hospitalized in acute care for 4 days. Which setting would be most appropriate to include in this patient's discharge plan? a) Home with home health care b) Home with hospice c) A Green House home d) A subacute rehabilitation unit

d) A subacute rehabilitation unit

areas that have shown improvement in health care

declining use of physical/chemical restraints, lower rates of UTI's and catheters, fewer hospitalizations

non profit agency

dependent on gifts and donations to supplement sources of revenue

Innovative elder living models

focused on deinstitutionalizing LTC by eliminating large nursing facilities and creating smaller units that mirror more closely a typical home environment. A relationship between staff, management, residents, and families is encouraged, including introducing pets, gardens, and children to the nursing home. These models generally are focused on allowing the resident to have more autonomy as they would living in their own home. (ex: when to get up in the morning and timing for meals and activities)

hospice care (end of life service)

maintain comfort as death approaches. offered in institution, also available to those who wish to die in their own home. Palliative care provides comfort care, similar to hospice care. However, palliative care is often initiated at the onset of treatment and can be accessed at any stage of illness, whether terminal or not—from diagnosis to cure. While receiving palliative care, the client may still choose to receive life-saving implementations

long term care facilities (LTC)

medical services designed to help pts who have disabilities or chronic care needs

critical access hospital

no more then 25 inpatient beds, located in a rural area, provides care for common conditions; outpatients, an annual average length of stay of no more than 96 hours for acute inpatient care

voluntary health care agency

non profit, complementary to official (gov) health care agencies

community hospitals

nonfederal/acute care general/specialty hospital, may not have specialists with expertise for treating serious or unusual medical problems. They also may not have the equipment, laboratory facilities, and other resources necessary to treat a serious or unusual medical condition

ambulatory service

offer less expensive care because admission to an acute care facility is avoided, come to these facilities for assessment, advice, monitoring, teaching, treatment, evaluation, and care coordination.

for profit (proprietary) agency

operated for financial benefit of the owner of hospital and investors

one day surgical care center

perform surgery at a scheduled date and time

primary care

point at which people enter the health care system, free clinics provide primary care for people who cant afford traditional health care services, family physicians are a source of primary care

areas that have shown limited change in health care

pressure sore rates, malnutrition, dehydration, increase bowel incontinence cases

assisted living

provide "a home with services" (assisted care) that emphasizes a resident's privacy and choice. Living quarters are used by older adults who want to remain as independent as possible but cannot manage all of their ADLs. Residents typically have private, locking rooms and bathrooms (or apartments), shared only by choice. Living quarters are handicap accessible and are planned to accommodate the changing needs of residents as they age. Help with daily routine is available, but not 24-hour basic care. designed specifically to support "aging in place."

outpatient clinic

provide follow up care to pts after hospitalization, freestanding

free clinics

provide primary health care for pts who cant afford/are reluctant to traditional health services, have an age/income limit, staffed by one salaried administrator and volunteer health care provider/nurse

adult day care

provide services for individuals who need supervision because of physical or safety needs but are not candidates for residing in a nursing home. purpose of adult day care is to provide mental stimulation, socialization, assistance with some activities of daily living (ADL), basic observation skills, and a safe environment. Some typical services include transportation, meals, therapeutic activities, nursing interventions, and rehabilitation activities.

retirement community

provides a continuum of living options from independent living, enriched living, assisted living, and skilled nursing home, all on one campus. Residents can move from one level of care to another, accommodating their changing needs.

home health

public or private agencies that provide home health services, supervised by a licensed health professional in the client's home, either directly or through arrangements with other agencies

omnibus budget reconciliation act (OBRA)

response to evidence of mistreatment, abuse, and neglect of nursing home residents. The IOM set out detailed recommendations for improving care, and these recommendations became the basis of OBRA.

urgent care centers

services available in ambulatory care centers for walk in clients who dont have an appointment

(institutional setting) nursing facilities

specialize in skilled nursing care, provided and directed by RNs. Basic nursing services are provided by LPNs/LVNs under the supervision of an RN. Depending on state regulations and agency policy, LPNs are able to provide home health. Coordinated care is focused on the goal of achieving the highest level of functioning for the client. The plan of care for all disciplines requires a treatment plan signed off by a physician and recertified

public health care agencies

supported by tax money, accountable to taxpayers and the gov., emphasis on delivery of disease prevention and wellness promotion, provider of direct health care services

voluntary health care agencies

supported by voluntary contributions, charges a fee for services, tuned into public opinion, accountable to supporters, activities determined by support interest not legal mandate, emphasis on research education, offer direct health services

teached/research hospitals

treat pts with serious/unusual conditions, training sites for physicians, nurses and other health professionals, research and develop treatments

dept of health and human services (HHS)

• A person appointed by the President is head of the agency. This person advises the president in health matters. • It is funded by federal taxes. (has 11 operating divisions)