Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 36 REHABILITATION, HOME HEALTH, LONG-TERM CARE, AND HOSPICE

Nonacute Health Care There has been a strong emergence in the past decade of nonacute health care services.

Reasons for Growth in Nonacute Health Care The number of Americans over the age of 65 has tripled in this century. As individuals age, the risk increases of acquiring a chronic disease requiring health care throughout life. Lives are being saved that would have been lost a few years ago. Ongoing health care services become necessary in such cases. Discharge from acute-care hospitals is occurring much earlier. Cost of acute care has reached critical proportions necessitating new forms of care management.

Clients’ and Family Rights in Home Care (i) To be treated with dignity, consideration, and respect. To have their property treated with respect. To be fully informed on admission of care, cost, and how payment will be made. To know in advance if they will be responsible for any payment. To participate in planning care.

Clients’ and Family Rights in Home Care (ii) To be informed in advance of any changes in care. To receive care from professionally trained personnel. To refuse treatment and be told of consequences of this action. To expect confidentiality. To be informed of termination of service. To know how to make a complaint.

Clients’ & Family Responsibilities in Home Care (i) To remain under a doctor’s care while receiving services. To provide the agency with a complete health history. To provide the agency with all requested insurance and financial information. To sign the require consents and releases for insurance billing. To participate in care by asking questions, expressing concerns, stating whether information is understood or not.

Clients’ & Family Responsibilities in Home Care (ii) To provide a safe home environment in which care is given. To cooperate with the doctor, the staff, and other caregivers. To accept responsibility for any refusal of treatment. To abide by agency policies that restrict duties the staff may perform. To advice agency administration of any dissatisfaction or problems with care.

Sources of Reimbursement Medicare. Medicaid. Private insurance.

Licensure A mandatory system of granting licenses according to specified standards. Regulated by each state.

Certification A voluntary process that establishes and evaluates standards of care. Required for any provider who seeks reimbursement from government funds. Standards generated by the federal government.

Accreditation An additional confirmation of quality. Generally indicates that the provider has gone above the minimum standards in the delivery of care and service.

Rehabilitation A process designed to help individuals reach their optimal level of physical, mental, and psychosocial functioning.

Interdisciplinary Health Care Team Process Admission Assessment Problem identification Care Plan Conference Evaluation Reassessment

Role of the LP/VN Rehabilitation nursing is a specialty practice and requires specialized knowledge, skills, and attitudes. Prerequisite is a sound knowledge base in the anatomy and physiology of the neurological, musculoskeletal, gastrointestinal, and urinary systems. The nurse must have excellent clinical skills in areas of therapeutic positioning, exercises, transfers, ambulation, and activities of daily living.

Rehabilitation Settings Hospital Inpatient Program. Skilled Nursing Facility. Outpatient Rehabilitation. Home Rehabilitation.

Home Health Care Encompasses a number of services delivered to persons in their homes. The fastest growing segment of health care delivery.

Role of LP/VN in Home Health Care Clients and their family caregivers must know: The disease process. Medications. Special skills (changing dressings, administering of insulin, etc.). Documentation and communication (how to keep records; when and how to contact nurse/physician/emergency services).

Long-Term Care Refers to a spectrum of services provided to individuals who have an ongoing need for health care. Long-term care facility may be licensed for either intermediate care or skilled nursing care.

Subacute Care Designed to provide services for clients who are out of the acute stage of their illnesses but who still require skilled nursing, monitoring, and ongoing treatments. Intended to fill the gap between the acute care hospital and the traditional long-term care facility.

Continuing Care Retirement Communities Designed to provide continuing levels of care as individual’s health care needs change. Levels include: Independent Assisted living Health care, either short-term or permanent.

Assisted Living A combination of housing and services for people who need help with the activities of daily living. Nursing care is not provided.

Adult Day Care Provide a variety of services in a protective setting for adults who are unable to stay alone but who do not need 24-hour care.

Respite Care May be offered by adult day care centers, long-term care facilities, or in private homes. Intended to provide a break to caregivers and may be utilized a few hours a week, for an occasional weekend, or for longer vacations. Planned activities, meals, and supervision included.

Foster Care Some states are investigating the use of foster homes for individuals who cannot live independently but who do not require the services of a health care facility. The legal structure is comparable to the foster home concept for children.

Hospice Humane, compassionate care provided to clients who can no longer benefit from curative treatment and have 6 months or less to live. Hospice care may be implemented in the client’s home, a special area of hospitals or nursing homes, or freestanding inpatient facilities.