1983: Medicare hospice care benefit is implemented. 1960: Kerr-Mills legislation provides Medical Aid for the Aged, including a home care benefit in selected states. 1983: Medicare hospice care benefit is implemented. 2000: Medicare Prospective Payment System (PPS) goes into effect. 1953: Life insurance companies stop supporting home nursing service. 1950 1960 1966: Home health services under Medicare and Medicaid begin providing support for official and non-official agencies in caring for the sick. 1970 1983: Health Care Financing Administration (HCFA) implements medical prospective payment, restricting hospital admissions and length of stay thereby increasing the acuity of home care clients. 1980 1990 1997: Balanced Budget Act of 1997 includes a change in Medicare reimbursement to incorporate the Interim Payment System. 2000 Year Event 1953 Life insurance companies stop supporting home nursing service. 1960 Kerr-Mills legislation provides Medical Aid for the Aged, including a home care benefit in selected states. 1966 Home health services under Medicare and Medicaid begin providing support for official and non-official agencies in caring for the sick. 1983 Health Care Financing Administration (HCFA) implements medical prospective payment, restricting hospital admissions and length of stay thereby increasing the acuity of home care clients. Medicare hospice care benefit is implemented. 1997 Balanced Budget Act of 1997 includes a change in Medicare reimbursement to incorporate the Interim Payment System. 2000 Medicare Prospective Payment System (PPS) goes into effect.

The Omaha System The 3 Omaha System Schemes Problem Classification Assess client Problem Classification (4 domains) Environmental Psychosocial Physiological Health-related Behavior Intervention (4 categories) Teaching, guidance, and counseling Treatments and procedures Case management Surveillance Intervention Develop case plans and services Problem Rating Scale of Outcomes Evaluate client PROBLEM RATING SCALE FOR OUTCOMES Start Evaluate problem outcome PROBLEM CLASSIFICATION Collect and assess data Individual, Family, or Community Identify interim /dismissal problem rating State problem INTERVENTION Identify admissions problem rating Plan and intervene

The 3 Omaha System Schemes Problem Classification (4 domains) Environmental Psychosocial Physiological Health-related Behavior Intervention (4 categories) Teaching, guidance, and counseling Treatments and procedures Case management Surveillance The 3 Omaha System Components Problem Classification Environmental Psychosocial Physiological Health-related behavior Intervention Teaching, guidance, and counseling Treatments and procedures Case management Surveillance Problem Rating Scale for Outcomes Knowledge Behavior Status