Component 1: Introduction to Health Care and Public Health in the U.S. Unit 2: Delivering Health Care Lecture 4 This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Objectives of This Lecture Describe a variety of health care settings, with emphasis on their function, including: School-based health centers Home health care Group living Assisted living, retirement communities, nursing homes Hospice care (end-of-life care) Long-term, psychiatric, and specialty hospitals Community mental health centers Discuss important health care issues for older adults Increasing need for assistance with daily activities Financial, legal, ethical issues Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

School-Based Health Centers Children can and should receive physical and behavioral health care in school Providers are nurses, physicians, social workers, substance abuse counselors, other providers Further medical or hospital services are arranged as needed Parental consent is required Health care may be periodic (for example, mobile health center) or off-site (health center serving more than one school) Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum The Aging Population http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Difficulty with ADLs (Activities of Daily Living) by Age Percentage of adults http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Long-Term-Care Facilities and Services Service or facility Help with ADLs Help with other services Help with care needs Range of costs Community-based services Yes No Low to medium Home health care Low to high In-law apartments Housing for aging and disabled individuals Board and care homes Assisted living Medium to high Continuing care retirement communities High Nursing homes http://www.medicare.gov/longtermcare/static/TypesOverview.asp Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Financial and Quality Issues Centers for Medicare and Medicaid Services (CMS) Provides health insurance for older adults, disabled, poor Covers 25% of U.S. population; 94% of people age 65 or older Reimburses qualifying health care facilities Joint Commission (JC) certifies quality, safety Independent nonprofit agency Examines hospitals, nursing homes, home care organizations, mental health programs, etc. Health care facilities volunteer for JC certification JC accreditation is a major factor in CMS approval for reimbursement Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Home Health Care Home health care is assistance with ADLs and chores inside the home Family, friends, volunteers may help Community services may be available Skilled nursing is needed for medical issues May be reimbursed by Medicare Home health care agency is another option Professional service Includes hospice care (end-of-life care) Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Board and Care Homes (Group Homes) Group living arrangements for people who cannot live alone and need help with ADLs Residents may have physical or mental disability, cognitive impairment, substance abuse Residents may be elderly, but not necessarily Meals are provided, but medical care is not Services, quality, and fees vary widely May be paid in part by private insurance, Medicare/Medicaid, other assistance Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Assisted Living Person has own room or apartment in a large complex Receives assistance with ADLs, 24-hour care Offers group dining, social/recreational activities, housekeeping/laundry Medical services may be available on site Service plan for each resident evolves over time Facilities are licensed in most states Billing is monthly rent plus fees for extra services Insurance may cover some costs; Medicare does not Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Continuing Care Retirement Communities Offer different types of housing, depending on the level of assistance needed Separate homes/apartments for independent living Assisted living facility for help with ADLs Nursing home on site May be accredited or not Billing is a large entry fee plus monthly payments Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Nursing Homes Care for people who cannot live in home or community May have medical, physical, mental problems Facilities help with ADLs, provide nursing care Some homes are hospital-like, others are home-like (for example, have kitchen facilities and social activities) Services include medical, nursing, personal care A physician draws up a plan of care Nursing care pertains to routine medications, acute conditions, rehabilitation, special care units Facility should be licensed/accredited, although Medicare usually does not pay Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Other Long-Term-Care Options for Older Adults Community-based services Various programs, coordinated by state agencies State Medicaid may help with costs In-law apartments Defined as a separate living space on a property Subject to local and state laws Subsidized housing Provide residence for older adults/disabled/poor, other services Federal or state agency funds the program Billing is a percentage of monthly income Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Hospice Care Intended for patients with a terminal illness Focus is palliative, or comfort care Care is provided at home, dedicated hospice facility, hospital, assisted living facility, or nursing home Services may include medical/nursing care, medical equipment, counseling, social services, help with ADLs and housework, respite care Home care workers should be licensed/bonded Contact with family is an important focus Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Legal and Ethical Issues Patients may/may not be able to make decisions Family may not be available; patient may need legal guardian Patient has right to participate in important decisions Long-term care options Informed consent Informed refusal Advance directives, living wills Do-not-resuscitate order (DNR), termination of treatment Power of attorney for health care Long-term-care facilities have ethical/legal obligations Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Long-Term Hospitals Acute-care hospitals that provide prolonged care (for more than 25 days) Patients may have complex medical problems May come from intensive care units May have more than one condition May need rehabilitation Medicare covers hospital stay if hospital is certified Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Specialty Hospitals, Rehabilitation Care Specialty hospitals focus on particular diseases or medical fields Common examples are cardiology, orthopedics, women’s health, and surgery Less common example: end-stage kidney disease Rehabilitation hospitals Stand-alone hospitals or units within a hospital Provide intensive daily rehabilitation Outpatient rehabilitation is also available through agencies, clinics Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Psychiatric Hospitals Psychiatric care has evolved Hospitalization is voluntary in most cases Care may be inpatient or outpatient Many types of care exist Open units Crisis stabilization units Medium-term units Juvenile wards Long-term-care psychiatric hospitals Some psychiatric hospitals specialize in certain illnesses or addictions Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Day Hospitals Provide mental health treatment during the day Patient goes home at night Considered an alternative to outpatient care Distinct from hospitalization, residential treatment, and day care Patients are adults or children Most facilities are hospitals or community centers Provide individual/group therapy, other treatments Goal is for patient to function within community Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Community Mental Health Centers Provide treatment for elderly, adults, or children Patients have chronic mental illness or recent hospital discharge Services include outpatient care, emergency care, partial hospitalization, rehabilitation May be reimbursed by Medicare Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Substance Abuse Treatment Centers Help patients overcome drug and/or alcohol abuse Various facilities Residential treatment centers Outpatient programs Hospitals Programs may specialize By drug (for example, cocaine addiction) By age group (for example, adolescents) Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4

Health IT Workforce Curriculum Summary Multiple health care options exist for medical, mental health, substance abuse, and end-of-life issues Care location can be school, home, community, hospital Large variation exists in services, quality, costs Facilities may or may not be licensed/certified Services may or may not be reimbursed by Medicare/Medicaid Complex financial, legal, ethical issues apply Need for elder care will only grow in the future Health IT Workforce Curriculum Version 2.0/Spring 2011 Component 1/Unit 2-4