Transcript Thurs, Sept 1

For your planner
 Thurs, Sept 1- complete power point, turn in
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homework
Fri, Sept 2 -clinical skills testing: PPE
Happy Labor Day Weekend!
Tues, Sept 6 - clinical skills testing: PPE
Wed, Sept 7 - test over Chapter 1
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Chapter 1
Introduction to Health Care
Agencies
Healthcare agencies
Providers
Doctors, nurses,
clinics, agencies
Facilities
Payers
Hospitals, long-term Insurance companies,
care facilities,
Medicare, Medicaid,
treatment centers
individuals
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Facilities
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Many agencies are learning sites for students.
The students assist in the purposes of health care.
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Health promotion: the goal is to reduce the risk of illnesses.
Disease prevention
Detection and treatment of disease
Rehabilitation and restorative care
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Facilities
 Hospital/ambulatory care centers:
 Provide care for all ages, immediate needs:
 Persons referred to as patients
 Acute care: ER, surgery, diagnostic procedures,
childbirth services
 Chronic care: outpatient therapy services, stabilize
people with complications of chronic illnesses
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Facilities
 Rehabilitation and subacute care agencies:
professionals provide care to restore the person to
his/her highest level of physical, psychological,
social, & economic function after illness or injury.
•Cardiac
•Brain injury
•Spinal cord injury
•CVA (stroke)
•Respiratory
•Orthopedic
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Facilities
 Long-term care facility: provide health care to
persons who cannot care for themselves at home
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Medical, nursing, dietary, recreational, rehabilitative,
social services provided
Housekeeping & laundry services
 Provide short term & long term care
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Description of long-term care:
 LTC facilities provide 24-hour skilled care
 LTC assist people with ongoing, chronic medical
condition
 Other terms for LTC are nursing homes, nursing
facilities, skilled nursing facilities and extended care
facilities
 LTC is the resident’s home
 Persons who live in LTC facility are called residents
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Residents in LTC facilities
 Almost 91% are over 65
 Almost 72% are female
 More than 85% are Caucasian
 50-90% have dementia (loss of mental abilities, such as
thinking, remembering, reasoning, & communicating)
 About 1/3 come from a private residence
 Over 50% come from a hospital
 50% stay 6 months or less
 Terminally ill & will die in facility
 Rehab or temporary illness: will recover & return to community
 50% stay longer than 6 months, don’t have a caregiver
 Longest average stay: persons with developmental
disabilities
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Facilities
 Mental health centers & outpatient clinics
 For persons having problems dealing with life events or in
danger to themselves or others (suicide, rape, drug
addiction centers)
 Some need short-term or lifelong inpatient care
 Outpatient care is most common
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Facilities
 Home care agencies: services provided by nurses,
nursing assistants, & other health team members
 Include hospitals, health care systems, public health
departments, & private businesses
 Wide range of services
 Persons referred to as clients
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Facilities
 Adult daycare centers:
 For people who are need some help during daytime,
but are not seriously ill or disabled.
 Care is given at a facility during working hours
 Provide a break for caregivers
 Often organized through
churches or community
centers
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Facilities
 Hospice: a health care agency or program for
persons who are dying
 Focus is on comfort, not cure
 Usually persons have less than 6 months to live
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Facilities
 Assisted living residence: provides housing,
personal care, support services, & social activities
in a home-like setting.
 Residents don’t need skilled, 24 hour care
 Residents are relatively independent
 They may need help with ADLs (activities of daily
living like showers, meals, dressing) or medications
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Multiple choice
1. Another name for a long term care facility (LTCF) is
a.
b.
c.
d.
Nursing home
Home health care
Assisted living facility
Adult day care facility
2. Assisted living facilities initially are for
a.
b.
c.
d.
People who need 24 hour intensive care
People who need some help with daily care
People who will die within 6 months
People who need to be in an acute care facility
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3. Which of the following is true of adult daycare?
a.
b.
c.
d.
It takes place in the person’s home
It takes place in a facility during daytime working hours.
Most people in adult daycare are seriously ill or disabled.
Most serious surgeries are performed at adult daycare
centers.
4. Care given by specialists to restore or improve function
after an illness or injury is called:
a.
b.
c.
d.
Acute care
Subacute care
Rehabilitation
Hospice care
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5. Care given to people who have 6 months or less to live
is called:
a.
b.
c.
d.
Acute care
Subacute care
Rehabilitation
Hospice care
6. People who live in LTC facilities are usually called
a.
b.
c.
d.
Patients
Healthcare providers
Regulators
Residents
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Healthcare agencies
Providers
Doctors, nurses,
clinics, agencies
Facilities
Payers
Hospitals, long-term Insurance companies,
care facilities,
Medicare, Medicaid,
treatment centers
individuals
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Payers
 Traditional insurance: can be purchased privately or as part
of an organization.
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Group insurance: Usually part of plan at place of work
Rising costs have made it so many employers & employees can’t afford this
option.
 Medicare: federal program for persons 65 or older (&
some young people with certain disabilities)
 Part A: pays for hospital, SNF, hospice, & some home care
 Part B: helps pay for doctors’ services, out-patient care, PT & OT,
some home care & other services
 Medicaid: sponsored by feds, operated by states
 For low income people, no insurance premium
 Limited services are covered
 Some older, blind, & disabled people are covered
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Payers
 Prospective payment systems: limit amount paid by
insurers, Medicare, & Medicaid
 DRGs (diagnosis related groups): regulate hospital
costs
 RUGs (resource utilization groups): regulate SNF
payments
 CMGs (Care mix groups): used for rehab centers
 HHRGs (home health resource groups): for home
health care
 Length of stay, treatment costs predetermined. If
costs are less, agency benefits, if costs are greater,
agency covers the loss.
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Payers
 Managed care options: cost control strategies
 HMOs: health maintenance organizations:
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Require persons to use a particular doctor or group who
are paid to provide needed care out of prepaid fee
Often need for services must be approved, except ICE
Focus of preventing disease.
 PPOS: preferred provider organizations:
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Network of providers on contract to provide health
services to a group for reduced rates
Members given incentives to use network providers
Person can choose any doctor or hospital in the PPO
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Matching
7. _____ HMOs
A. Cost-control strategies that are replacing
traditional insurance plans.
8. _____ facilities
B. People or organizations that give health
care .
9. _____ managed care
• Places were care is delivered or
administered.
10. _____ payers
• A health plan that states that clients
must use a particular doctor or group of
doctors.
11. _____ PPOs
12. _____ Providers
• People or organizations paying for
health care services.
• A network of providers that contract to
provide health services to a group of
people.
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Short answer
13. List 2 groups of people who qualify for Medicare.
a) _____________________________________________
b) _____________________________________________
14. List 2 parts of Medicare and what each helps pay for.
a) ______________________________________________
b) ______________________________________________
15. How is eligibility for Medicaid determined?
______________________________________________
____________________________________________
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Healthcare agencies
Providers
Doctors, nurses,
clinics, agencies
Facilities
Payers
Hospitals, long-term Insurance companies,
care facilities,
Medicare, Medicaid,
treatment centers
individuals
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Providers
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ORGANIZATION
An agency has a governing body called the board of
trustees or board of directors.
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The board makes policies.
An administrator manages the agency.
Directors or department heads manage certain areas.
The health team (interdisciplinary health care team)
involves the many health care workers whose skills
and knowledge focus on the person’s total care.
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The goal is to provide quality care.
The person is the focus of care.
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Providers
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Providers
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Nursing service
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The director of nursing (DON) is an RN.
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The DON is responsible for the entire nursing staff.
Nurse managers assist the DON.
Nursing areas usually have charge nurses for each
shift.
Staff RNs report to the charge nurse.
LPNs/LVNs report to staff RNs or to the charge
nurse.
You report to the nurse supervising your work.
Nursing education (staff development) is part of
nursing service.
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Providers
 Care team: the group of
people with different kinds of
education and experience
who provide resident care.
 Continuity of care
 Chain of Command
-is the order of authority
within a facility
 Delegation – authority
transferred for a specific task
 Functional nursing
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Providers

THE NURSING TEAM:
The nursing team involves those who provide nursing care
(focused on the needs of the whole person).
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Registered nurses
Licensed practical nurses and licensed vocational nurses
Nursing assistants
Registered Nurse (RN) - a licensed nurse who has
completed two to four years of education; RNs assess
residents, monitor progress, provide skilled nursing care, give
treatments, and supervise the care given by nursing assistants
and other members of the care team.
Licensed practical nurse (LPN) or License Vocational Nurse
(LVN)-licensed nurse who has completed one to two years
education; passes medications, gives treatment, and
supervise daily care of a resident. They are supervised by RNs,
doctors , etc.
Nurse practitioner (CNP) -a RN with advance education 30
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Providers
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The person is always the focus of care.
Patient-focused care is when services are moved from
departments to the bedside.
Holistic approach: includes physical, social,
emotional, & spiritual needs
Staff members have special talents, knowledge, and
skills.
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All work to meet the person’s needs.
All should be empathetic (identifying with &
understanding another’s feelings)
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Providers
 All employees must know where to find a list of policies &
procedures of the agency
 Policies: course of action that must be taken every time a
certain situation occurs.
 Healthcare information must remain private (this is also a
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law: HIPAA)
Plan of care must be followed
Nursing assistants should not do tasks outside their job
description
Report changes to the nurse.
Do not discuss personal problems with residents or
residents’ families.
Do not take money or gifts from residents or families.
Be on time for work. Be dependable.
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Providers
 Procedure: the official method or way of doing a
task.
 Equipment needed
 Specific steps to take
 Guidelines for documentation
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True or false
1. _____ A policy is a course of action that must be
followed. For example, employees must not accept
money or gifts from residents or their families.
2. _____ Facilities will have procedures for reporting
information about residents.
3. _____ It is all right to do tasks not listed in the job
description if they are very simple.
4. _____ It is all right for nursing assistants to discuss
their personal lives with residents.
5. _____ Each step in a written procedure is important
& must be followed.
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Long-term care survey process
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Inspections are done by licensing agency in the
state every 9 – 15 months to make sure agencies are
following state & federal regulations.
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Called surveys.
If cited (found to have deficiencies), surveys are done
more frequently.
Inspection teams are made up of variety of trained
healthcare professionals.
Residents & family members are interviewed.
Care is observed.
Charts are reviewed.
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Long-term care survey process
An agency must meet standards for:
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Licensure – based on state standards
Certification – required to receive Medicare funds, federally
regulated.
Accreditation – Joint Commission (JCAHO) is independent,
not-for-profit organization that does a comprehensive survey on
a volunteer basis at least every 3 years.
Surveys are done to see if the agency meets set standards.
If standards are met, the agency receives a license,
certification, or accreditation.
When problems (deficiencies) are found:
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The agency is given time to correct them.
The agency can be fined for uncorrected or serious deficiencies.
The agency can lose its license, certification, or accreditation.
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Long-term care survey process
 Role of the CNA in the survey process
 Provide quality care
 Protect the person’s rights
 Provide for the person’s & your own safety
 Help keep the agency clan and safe
 Conduct yourself in a professional manner
 Have good work ethics
 Follow agency policies & procedures
 Answer questions honestly & completely. Don’t guess.
Find someone who knows the answer if you don’t.
 Do not offer information unless asked.
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Multiple choice
1. What is the purpose of surveys in long-term care
facilities?
A.
B.
C.
D.
To count the number of residents
To refine the care planning process
To study how well residents are cared for
To help the facility decide appropriate visiting hours
2. If a surveyor asks you a question you don’t know the
answer to, how should you respond?
A.
B.
C.
D.
Guess
Offer information on another topic
Say what surveyor wants to hear.
Admit that you don’t know and find the answer.
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Multiple choice
3. Which of the following statements is true of the Joint
Commission?
A. Facilities are required to participate in the Joint
Commission’s surveys.
B. State surveys are the same as Joint Commission surveys.
C. The goal of the Joint Commission’s survey process is to
improve safety & quality of care.
D. The survey process does not check on performance
relating to patient rights.
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