© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Unit 1 Community Health Care

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Spell and define terms. List the five basic functions of health care facilities. Describe four changes that have taken place in health care in the past few decades. Objectives 2

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives State the functions of hospitals, long- term care facilities, home health care, hospice, and other types of health care facilities. Name the departments within a hospital and describe their functions. List at least five ways by which health care costs are paid. 3

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives State the purpose of health care facility surveys. Describe patient-focused care. Explain why transitional care is important. 4

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Introduction Health care facilities have five basic functions: Provide services for the ill and injured Prevent disease Promote individual and community health Educate health care workers Promote research in medicine and nursing 5

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Overview of Health Care Health care emphasizes patient-focused care. Many changes have occurred in health care in the past few years. Staff may be trained as multiskilled workers, enabling them to do more than one kind of work. 6

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Overview of Health Care There are several reasons for these changes: People are living longer Technology is becoming more advanced Health care costs have increased Many ethical questions must be answered by health care providers and consumers 7

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Overview of Health Care Managed care means the insurance company will: Not permit certain procedures or diagnostic tests until they have been approved by the insurer. 8

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Overview of Health Care Managed care means the insurance company will: Negotiate with specific physicians, hospitals, pharmacies, and other care providers to render services at a lower cost to the company’s members. 9

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Overview of Health Care Managed care means the insurance company will: Approve only a certain number of days of hospitalization for specific diagnoses. Require that specific procedures be done on an outpatient basis rather than having the patient admitted to the hospital. 10

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Needs of the Community Health care is needed throughout life Short-term or long-term care includes: Preventive Emergency Surgery Rehabilitation Hospice care 11

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Preventive Care Prenatal care Care of mother during pregnancy Well-baby checkups and immunizations Health education to teach individuals how to avoid disease and injury Physical examinations throughout life 12

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Emergency Care Short-term care given for sudden illness or injury Surgery To repair an injured body or remove a diseased organ 13

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Rehabilitation To help a patient regain abilities after an illness or injury Long-term care For persons who have chronic or incurable conditions 14

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hospice Care For patients who are dying and their families 15

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Needs of the Community People receiving health care are called health care consumers Identified by type of care they need 16

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Needs of the Community Patient Persons in acute care facilities such as hospitals Client Persons receiving care in their own homes Resident Persons in long-term skilled care facilities 17

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Health Care Facilities Short-Term CareLong-Term Care HospitalsSkilled care facilities Urgent care facilitiesAdult day care SurgicentersAssisted living facilities Rehabilitation centers Psychiatric hospitals Outpatient clinicsRespite care Psychiatric hospitalsTransitional & subacute care Physician’s officesHome care 18

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Long-Term Acute Care Hospitals Fully licensed hospitals in which a lengthy stay is anticipated Provide a higher level of care than other chronic care settings 19

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Long-Term Acute Care Hospitals Patients must have a medically complex condition Need acute care services Have a good chance of improvement 20

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Magnet Hospitals Magnet Program for Excellence in Nursing Services Based on quality indicators and nursing practice standards 21

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Magnet Hospitals Program is voluntary and recognizes hospitals for nursing excellence Hospitals that have been awarded Magnet status are usually progressive Desirable places to work 22

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Community Health Care Services Hospitals Most hospitals are licensed to care for patients of all ages and with a variety of problems Some hospitals take care of patients with special conditions or care for specific age groups 23

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 24 Pediatric hospitals Care for children from birth to 18 years Psychiatric hospitals Provide care for persons with mental illness Rehabilitation hospitals Provide restorative services to patients following disease, illness, or injury Community Health Care Services

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hospital organization Surgical department Cares for patients before, during, and after surgery Pediatric department Cares for sick and injured children 25 Community Health Care Services

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hospital organization Obstetric department Cares for newborns and their mothers Emergency department Cares for victims of trauma, natural disasters, or medical emergencies 26 Community Health Care Services

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Community Health Care Services Hospital organization Critical care department Cares for seriously ill patients who require constant monitoring and care 27

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Community Health Care Services Hospital organization Medical department Cares for patients with medical conditions such as pneumonia or heart disease 28

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Community Health Care Services Hospital organization Larger hospitals Many specialized units staffed by nurses and therapists Trained to care for persons with specific problems 29

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specialized Services Dietary Pharmacy Diagnostic Pathology (study of disease) Diagnostic imaging and radiology Laboratory 30

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specialized Services Rehabilitation services Physical therapy Occupational therapy Speech therapy Respiratory therapy Social services 31

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specialized Services 32 Environmental services Housekeeping Maintenance Laundry

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specialized Services Business services Medical records department Volunteer services Pastoral services 33

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Financing Health Care Health care is paid for by: Insurance Out-of-pocket payments Medicaid State and federal government program Pays for persons of any age who do not have financial resources for health care 34

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Financing Health Care Medicare is a federal government program Pays a portion of health care costs for persons 65 years of age and older For younger persons who are permanently disabled and qualify for benefit 35

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Financing Health Care Medicare payment is based on: Diagnosis related groups (DRGs) Actual cost of care is not considered 36

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Financing Health Care Instead, Medicare set the payment rates: Based on data from studies that determined the average length of stay Required for various medical diagnoses, procedures, and treatments Medicare does not pay for avoidable complications that begin in the hospital 37

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Payment for Care State Children's Health Insurance Program provides low-cost insurance Patient Protection and Affordable Care Act and Health Care Education and Reconciliation Act were passed into law in 2010 Combined, these laws made reforms that help ensure access to insurance 38

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Accreditation Agencies The Joint Commission (TJC) Inspects and accredits health care agencies Participation is voluntary Hospitals are not eligible to receive Medicare payment unless they are TJC accredited 39

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Accreditation Agencies Other accreditation organizations are: -- Healthcare Facilities Accreditation Program (HFAP) -- Det Norske Veritas Healthcare, Inc. (DNV) -- American Osteopathic Association (AOA) 40

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Regulatory Agencies Occupational Safety and Health Administration (OSHA) Surveys health care facilities Protects health and safety of employees 41

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Quality Assurance All health care facilities have a program called quality assurance (QA) Identifies problems and finds solutions for improvement 42