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