1 Understanding Healthcare Settings 1. Discuss the structure of the healthcare system and describe ways it is changing Define the following terms: providers.

1 Understanding Healthcare Settings

1. Discuss the structure of the healthcare system and describe ways it is changing

Define the following terms:providers

people or organizations that provide health care, including doctors, nurses, clinics, and agencies.

facilities in medicine, places where health care is delivered or administered, including hospitals, long-term care facilities, and treatment centers.

payerspeople or organizations paying for healthcare services.



Define the following terms:long-term care (LTC)

care given in long-term care facilities (LTCF) for people who need 24-hour skilled care.

skilled care medically-necessary care given by a skilled nurse or therapist.

length of staythe number of days a person stays in a healthcare facility.

terminal illnessa disease or condition that will eventually cause death.



Define the following terms:chronic illness

a disease or condition that is long-term or long-lasting and requires management of symptoms.

home health care care that takes place in a person’s home.

diagnoses physicians’ determinations of an illness.

assisted livingresidences for people who do not need skilled, 24-hour care, but do require some help with daily care.



Define the following terms:dementia

the serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating.

adult day services care for people who need some assistance or supervision during certain hours, but who do not live in the facility where care is given.

acute care 24-hour skilled care for short-term illnesses or injuries; generally given in hospitals and ambulatory surgical centers.



Define the following terms:subacute care

care given in a hospital or in a long-term care facility for people who need less care than for an acute illness, but more care than for a chronic illness.

outpatient care care given for less than 24 hours for people who have had treatments or surgery and need short-term skilled care.

rehabilitation care that is given by specialists to help restore or improve function after an illness or injury.



Define the following terms:hospice care

holistic, compassionate care given to dying people and their families.

health maintenance organizations (HMOs)a method of health insurance in which a person has to use a particular doctor or group of doctors except in case of emergency.



Define the following terms:preferred provider organizations (PPOs)

a network of providers that contract to provide health services to a group of people.

managed carea system or strategy of managing health care in a way that controls costs.


Transparency 1-1: Traditional Healthcare System



The following major changes have a serious impact on how health care is provided: • Increased use of expensive technology • Rising costs of health care • New ways to control costs of care


2. Describe a typical long-term care facility

Define the following terms:activities of daily living (ADLs)

daily personal care tasks, such as bathing; caring for skin, nail, hair, and teeth; dressing; toileting; eating and drinking; walking; and transferring.

catheter a thin tube inserted into the body to drain fluids or inject fluids.



REMEMBER:

There are many different models of long-term care facilities, including facilities for residents with dementia and facilities with assisted living wings.



Think about these questions:

What services do you think all long-term care facilities offer?

What services might some long-term care facilities offer for residents with different needs?


Transparency 1-2: Residents in Long-term Care Facilities

•89% are over 65•54% are over 85•11% are younger than 65•70% are female•More than 90% are white and non-Hispanic•About 1/3 come from a private residence•Over 50% come from a hospital


3. Describe residents who live in long-term care facilities

Think about this question:

Why is important for an NA to know what kinds of residents he will likely be caring for?



REMEMBER:

Residents with different lengths of stay may have different care needs.



Residents with a length of stay of six months or more• Make up over 2/3 of residents • Require 24-hour care • Did not have caregivers able to give enough care at home



Residents with a length of stay of less than six months• May be admitted for terminal care (will die in the facility) • May be admitted for rehabilitation or temporary illness (will

recover and return to the community)



Think about this question:

How might care for a resident admitted for temporary care be different from care for a resident who will live in the facility for years?



REMEMBER:

Many residents in LTC lack outside support. This means it is very important for NAs to care for the whole person - addressing social and emotional needs as well as physical needs.


4. Explain policies and procedures

Define the following terms:policy

a course of action that should be taken every time a certain situation occurs.

procedure a method, or way, of doing something.



The following are common policies and procedures in long-term care facilities:• All resident information is confidential. • Resident’s care plan must be followed.• NAs only perform tasks in job descriptions. • NAs report to a nurse. • NAs should not discuss personal problems with residents or

families.• NAs should not accept gifts and money from residents or

families.• NAs must be dependable.



REMEMBER:

It is very important for NAs to ask questions about policies and procedures or review the procedure manual when they are unsure about care.


5. Describe the long-term care survey process

Define the following terms:cite

in a long-term care facility, to find a problem through a survey.

Joint Commission an independent, not-for-profit organization that evaluates and accredits healthcare organizations.



Surveyors use these methods to study residents’ care and determine how their needs are being met:• Interview residents and their families • Observe staff interactions with residents and care given • Review residents’ charts • Observe residents’ meals



Think about these questions:

Why is it very important for NAs to tell the truth when asked questions by surveyors?

What should an NA do if she doesn’t know the answer to a surveyor’s question?



REMEMBER:

Surveys conducted to the Joint Commission are not affiliated with state inspections. Facilities participate in Joint Commission surveys on a voluntary basis.


6. Explain Medicare and Medicaid

Define the following terms:Centers for Medicare & Medicaid Services (CMS)

a federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities.

Medicare a federal health insurance program for people who are 65 or older, are disabled, or are ill and cannot work.

Medicaida medical assistance program for low-income people.


Transparency 1-3: Facts About Medicare and MedicaidMedicare

•Medicare is for people 65 or older and people under 65 who are disabled and cannot work.

•Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice.

•Part B helps pay for doctor services and other medical services and equipment.

•Part C allows private health insurance companies to provide Medicare benefits.

•Part D helps pay for medications prescribed for treatment. Medicaid

•Medicaid is a medical assistance program for low-income people.

•People qualify based on income and special circumstances.


7. Discuss the terms culture change and person-directed care and describe Pioneer Network and The Eden Alternative

Define the following terms:culture change

a term given to the process of transforming services for elders so that they are based on the values and practices of the person receiving care; core values include choice, dignity, respect, self-determination, and purposeful living.

person-directed carea type of care that places the emphasis on the person needing care and his or her individuality and capabilities.



These are the core values of culture change:• Choice• Dignity• Respect• Self-determination• Purposeful living



The Pioneer Network• Was formed in 1997 by a small group of people in LTC• Advocates for person-directed care• Called for change in how elders are treated everywhere in the

community



The Eden Alternative• Was founded in 1991 by Dr. William Thomas• Seeks to improve the lives of elders and their caregivers• Creates environments that support growth and development

and eliminate loneliness, helplessness, and boredom• Offers education, resources, and consulting services

1 Understanding Healthcare Settings 1. Discuss the structure of the healthcare system and describe ways it is changing Define the following terms: providers.

Documents

subacute care care

outpatient care care

home health care care

longterm care ltc care

hour care

compassionate care

necessary care

rehabilitation care