1 Understanding Healthcare Settings Understanding Healthcare Settings Chapter One

1 Understanding Healthcare Settings

providers people or organizations that provide health care, including doctors, nurses, clinics, and agencies facilities in medicine, places where health care is delivered or administered, including hospitals, long-term care facilities, and treatment centers payers people or organizations paying for healthcare services

1 Understanding Healthcare Settings long-term care (LTC) care given in long-term care facilities (LTCF) for people who need 24-hour skilled care skilled care medically-necessary care given by a skilled nurse or therapist length of stay the number of days a person stays in a healthcare facility terminal illness a disease or condition that will eventually cause death

1 Understanding Healthcare Settings chronic illness a disease or condition that is long-term or long- lasting and requires management of symptoms home health care care that takes place in a person’s home diagnoses physicians’ determinations of an illness assisted living residences for people who do not need skilled, 24- hour care, but do require some help with daily care

1 Understanding Healthcare Settings dementia the serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating adult day services care for people who need some assistance or supervision during certain hours, but who do not live in the facility where care is given acute care 24-hour skilled care for short-term illnesses or injuries; generally given in hospitals and ambulatory surgical centers

1 Understanding Healthcare Settings subacute care care given in a hospital or in a long-term care facility for people who need less care than for an acute illness, but more care than for a chronic illness outpatient care care given for less than 24 hours for people who have had treatments or surgery and need short- term skilled care rehabilitation care that is given by specialists to help restore or improve function after an illness or injury

1 Understanding Healthcare Settings hospice care holistic, compassionate care given to dying people and their families health maintenance organizations (HMOs) a method of health insurance in which a person has to use a particular doctor or group of doctors except in case of emergency

1 Understanding Healthcare Settings preferred provider organizations (PPOs) a network of providers that contract to provide health services to a group of people managed care a system or strategy of managing health care in a way that controls costs

1 Understanding Healthcare Settings activities of daily living (ADLs) daily personal care tasks, such as bathing; caring for skin, nail, hair, and teeth; dressing; toileting; eating and drinking; walking; and transferring catheter a thin tube inserted into the body to drain fluids or inject fluids

1 Understanding Healthcare Settings The healthcare system and ways it is changing

1 Understanding Healthcare Settings The following major changes have a serious impact on how health care is provided: Increased use of expensive technology Rising costs of health care New ways to control costs of care

1 Understanding Healthcare Settings Typical Long-term Care Facility

1 Understanding Healthcare Settings REMEMBER: There are many different models of long-term care facilities, including facilities for residents with dementia and facilities with assisted living wings

1 Understanding Healthcare Settings Think about these questions: What services do you think all long-term care facilities offer? What services might some long-term care facilities offer for residents with different needs?

1 Understanding Healthcare Settings Residents who live in long-term care facilities

1 Understanding Healthcare Settings Residents in Long-term Care Facilities 89% are over 65 54% are over 85 11% are younger than 65 70% are female More than 90% are white and non-Hispanic About 1/3 come from a private residence Over 50% come from a hospital

1 Understanding Healthcare Settings Think about this question: Why is important for an NA to know what kinds of residents he will likely be caring for?

1 Understanding Healthcare Settings REMEMBER: Residents with different lengths of stay may have different care needs Residents with a length of stay of six months or more Make up over 2/3 of residents Require 24-hour care Did not have caregivers able to give enough care at home

1 Understanding Healthcare Settings Residents with a length of stay of less than six months May be admitted for terminal care (will die in the facility) May be admitted for rehabilitation or temporary illness (will recover and return to the community)

1 Understanding Healthcare Settings Think about this question: How might care for a resident admitted for temporary care be different from care for a resident who will live in the facility for years?

1 Understanding Healthcare Settings REMEMBER: Many residents in LTC lack outside support. This means it is very important for NAs to care for the whole person - addressing social and emotional needs as well as physical needs

1 Understanding Healthcare Settings Policies and Procedures

1 Understanding Healthcare Settings policy a course of action that should be taken every time a certain situation occurs procedure a method, or way, of doing something

1 Understanding Healthcare Settings Common policies and procedures in long-term care facilities: All resident information is confidential Resident’s care plan must be followed NAs only perform tasks in job descriptions NAs report to a nurse NAs should not discuss personal problems with residents or families NAs should not accept gifts and money from residents or families NAs must be dependable

1 Understanding Healthcare Settings REMEMBER: It is very important for NAs to ask questions about policies and procedures or review the procedure manual when they are unsure about care

1 Understanding Healthcare Settings The long-term care survey process

1 Understanding Healthcare Settings cite in a long-term care facility, to find a problem through a survey Joint Commission an independent, not-for-profit organization that evaluates and accredits healthcare organizations

1 Understanding Healthcare Settings How it works ~ Surveyors use these methods to study residents’ care and determine how their needs are being met: Interview residents and their families Observe staff interactions with residents and care given Review residents’ charts Observe residents’ meals

1 Understanding Healthcare Settings Think about these questions: Why is it very important for NAs to tell the truth when asked questions by surveyors? What should an NA do if she doesn’t know the answer to a surveyor’s question?

1 Understanding Healthcare Settings REMEMBER: Surveys conducted to the Joint Commission are not affiliated with state inspections. Facilities participate in Joint Commission surveys on a voluntary basis.

1 Understanding Healthcare Settings Medicare and Medicaid

1 Understanding Healthcare Settings Terminology Centers for Medicare & Medicaid Services (CMS) a federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities Medicare a federal health insurance program for people who are 65 or older, are disabled, or are ill and cannot work Medicaid a medical assistance program for low-income people

1 Understanding Healthcare Settings Medicare Medicare is for people 65 or older and people under 65 who are disabled and cannot work Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice Part B helps pay for doctor services and other medical services and equipment Part C allows private health insurance companies to provide Medicare benefits Part D helps pay for medications prescribed for treatment Medicaid Medicaid is a medical assistance program for low-income people People qualify based on income and special circumstances

1 Understanding Healthcare Settings Culture change and person-directed care Pioneer Network The Eden Alternative

1 Understanding Healthcare Settings culture change a term given to the process of transforming services for elders so that they are based on the values and practices of the person receiving care; core values include choice, dignity, respect, self- determination, and purposeful living person-directed care a type of care that places the emphasis on the person needing care and his or her individuality and capabilities

1 Understanding Healthcare Settings These are the core values of culture change: Choice Dignity Respect Self-determination Purposeful living

1 Understanding Healthcare Settings The Pioneer Network Was formed in 1997 by a small group of people in LTC Advocates for person-directed care Called for change in how elders are treated everywhere in the community

1 Understanding Healthcare Settings The Eden Alternative Was founded in 1991 by Dr. William Thomas Seeks to improve the lives of elders and their caregivers Creates environments that support growth and development and eliminate loneliness, helplessness, and boredom Offers education, resources, and consulting services

1 Understanding Healthcare Settings