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Ch 1 ppp, v7 with groups
- 1. Chapter 1 Introductionto Health Care Agencies
- 2. The person isalways the focus of care. Staff members have special talents, knowledge, and skills. All work to meet the person’s needs.
- 3. AGENCY PURPOSES Thepurposes of health care are: Health promotion The goal is to reduce the risk of illnesses. Disease prevention Detection and treatment of disease Rehabilitation and restorative care Many agencies are learning sites for students. The students assist in the purposes of health care.
- 4. Get into yourGroups! Health care is provided in a variety of settings. Describe the type of care provided in: hospitals rehabilitation and subacute care agencies long-term care centers mental health centers home care agencies hospices. You have 5 minutes…Be ready to share with the entire class!
- 5. TYPES OF AGENCIESHospitals Rehabilitation and subacute care agencies Long-term care centers (nursing homes, nursing facilities, nursing centers) Skilled nursing facilities (SNFs) Assisted living residences Mental health centers Home care agencies Hospices Health care systems
- 6. ORGANIZATION An agencyhas a governing body called the board of trustees or board of directors. The board makes policies. An administrator manages the agency. Directors or department heads manage certain areas. The health team (interdisciplinary health care team) involves the many health care workers whose skills and knowledge focus on the person’s total care. The goal is to provide quality care. The person is the focus of care.
- 7. Nursing service Thedirector of nursing (DON) is an RN. The DON is responsible for the entire nursing staff. Nurse managers assist the DON. Nursing areas usually have charge nurses for each shift. Staff RNs report to the charge nurse. LPNs/LVNs report to staff RNs or to the charge nurse. You report to the nurse supervising your work. Nursing education (staff development) is part of nursing service.
- 8. THE NURSING TEAMThe nursing team involves those who provide nursing care. Registered nurses Licensed practical nurses and licensed vocational nurses Nursing assistants
- 9. NURSING CARE PATTERNSThe pattern used depends on how many persons need care, the staff, and the cost. Functional nursing focuses on tasks and jobs. Team nursing involves a team of nursing staff led by an RN. Primary nursing involves total care. Case management is like primary nursing. A case manager (an RN) coordinates a person’s care. Patient-focused care is when services are moved from departments to the bedside.
- 10. PAYING FOR HEALTHCARE Private insurance is bought by individuals and families. Group insurance is bought by groups or organizations for individuals.
- 11. Medicare is afederal health insurance program for persons 65 years of age or older. Some younger people with certain disabilities are covered. Part A Part B Medicaid is a health care payment program sponsored by the federal government and operated by the states.
- 12. Prospective payment systemslimit the amount paid by insurers, Medicare, and Medicaid. Diagnosis-Related Groups (DRGs) are for hospital costs. Resource Utilization Groups (RUGs) are for SNF payments. Case Mix Groups (CMGs) are used for rehabilitation centers. Home Health Resource Groups (HHRGs) are used for home health care.
- 13. Managed care Managedcare deals with health care delivery and payment. Managed care limits: The choice of where to go for health care The care that doctors provide
- 14. MEETING STANDARDS Standardsare set by: The federal and state governments Accrediting agencies An agency must meet standards for: Licensure Certification Accreditation
- 15. Surveys are doneto see if the agency meets set standards. If standards are met, the agency receives a license, certification, or accreditation. When problems (deficiencies) are found: The agency is given time to correct them. The agency can be fined for uncorrected or serious deficiencies. The agency can lose its license, certification, or accreditation.
Editor's Notes
- #2 Health care agencies offer services to persons needing health care. Types of health care agencies include hospitals, long-term care centers, home care agencies, adult day-care centers, assisted living residences, board and care, homes, rehabilitation and subacute care facilities, hospices, doctor’s offices, clinics, centers for persons with mental illnesses, centers for persons with developmental disabilities, drug and alcohol treatment centers, and crisis centers for rape, abuse, suicide, and other emergencies.
- #4Â Health promotion includes physical and mental health. People receive teaching and counseling about healthy living. Risk factors and early warning signs of disease are identified. Measures are taken to reduce risk factors and prevent disease. Detection and treatment of disease involve diagnostic tests, physical exams, surgery, emergency care, and drugs. The goal of rehabilitation and restorative care is to return persons to their highest possible level of physical and mental functioning and to independence.
- #6Â People need hospital care to have babies; for physical and mental health problems; for surgery, to heal broken bones, or to die; and for acute, chronic, or terminal illnesses. A person needing rehabilitation or subacute care does not need hospital care but is too sick to go home. Long- term care centers are for persons who cannot care for themselves at home but do not need hospital care. An assisted living residence provides housing, personal care, support services, health care, and social activities in a home-like setting. Mental health centers are for persons with mental illnesses. Home care agencies provide a wide range of services to people where they live. A hospice is a health care agency or program for persons who are dying. In a health care system, agencies join together as one provider of care
- #7Â Local, state, and federal rules are followed. The administrator reports directly to the board. Review Table 1-1 on pp. 5-6 in the textbook. Many health care workers are involved in the care of each person.
- #8Â Director of nursing services, vice president of nursing, and vice president of patient services are some other titles used for DON. Nurse managers manage and carry out nursing department functions. Nurse managers are usually registered nurses (RNs). Nursing education staff: Plan and present educational programs (in-service programs) Provide the nursing team with new and changing information Teach the nursing team how to use new equipment and supplies Review key policies and procedures on a regular basis Educate and train nursing assistants Conduct new employee orientation Provide programs that meet federal and state educational requirements
- #9Â All focus on the physical, social, emotional, and spiritual needs of the person and family. RNs assess, make nursing diagnoses, plan, implement, and evaluate nursing care. RNs can study to become clinical nurse specialists or nurse practitioners. These RNs have limited diagnosing and prescribing functions. Licensed practical nurses (LPNs)/license vocational nurses (LVNs) are supervised by RNs, licensed doctors, and licensed dentists. They have fewer responsibilities and functions than RNs do. Nursing assistants perform delegated nursing tasks under the supervision of a licensed nurse
- #10Â Nursing care is given in many ways.
- #11Â Health care is a major focus in society. The goals are to provide health care to everyone and to reduce the high cost of care. Health care bills cause worry, fear, and emotional upset.
- #12 Medicare Part A pays for some hospital, skilled nursing facility (SNF), hospice, and home care costs. Medicare Part B helps pay for doctors’ services, outpatient hospital care, physical and occupational therapists, some home care, and many other services. It is voluntary. The person pays a monthly premium. People who qualify for Medicaid usually include those with low incomes and some older, blind, and disabled persons. There is no insurance premium.
- #13Â Length of stay and treatment costs are determined for each group.
- #14Â Many states require managed care for Medicaid and Medicare coverage. Many insurers must approve the need for health care services. If the need is approved, the insurer pays for the services. If the need is not approved, the person pays the costs.
- #15Â A license is issued by the state. An agency must have a license to operate and provide care. Certification is required to receive Medicare and Medicaid funds. Accreditation is voluntary. It signals quality and excellence.
- #16 Your role in the survey process involves: Providing quality care Protecting the person’s rights Providing for the person’s and your own safety Helping keep the agency clean and safe Conducting yourself in a professional manner Having good work ethics Following agency policies and procedures Answering questions honestly and completely