Ch 1 textbook notes [cna]-2 PDF

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Chapter 1: Understanding Healthcare Settings Discuss the structure of the healthcare system and describe ways it is changing: • •

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Healthcare system refers to the different kinds of providers, facilities, and payers involved in delivering medical care Providers: o People or organizations that provide health care, including doctors, nurses, clinics, and agencies Facilities o Places where care is delivered or administered like hospitals, care facilities, and treatment centers Payers o People or organizations paying for healthcare services like insurance companies, government programs like Medicare and Medicaid and individual patients Two types of care: o Longterm care ▪ Given in long term care facilities for people who need 24 hour care o Skilled care ▪ Medically necessary care given by a skilled nurse or therapist and available 24 hours a day. Ordered by doctor with treatment plan ▪ For people who need high level of care for conditions Most people in LTC have chronic conditions meaning it will last for a long period of time, even a lifetime (heart disease and dementia) Home health care o Provided in a persons. home o Mainly for people who are older or chronically ill but able to live at home o Called clients o Home health aids and nursing assistants are pretty much the same o HHA: may do housework and usually have more contact Diagnosis: medical conditions determined by a doctor Assisted living o For people who need daily care help, meals, dressing o Do not need 24 hour care, more independent o Some AL may have memory care unit o Unable to live alone but still fairly independent Dementia: serious loss of mental abilities Adult Day Services o Need some assistance during certain hours but not seriously ill or disabled Acute care o 24 hour skilled care given in hospitals and ambulatory surgical centers for people who require short-term, immediate care, short stays for surgery Subacute care

Care given in hospitals or LTC Need less care then acute (sudden onset short term illness) but more care than for chronic (long term illness) o Treatment ends when conditions stabilize o Cost: less than AC but more then LTC Outpatient care o People who had treatments, procedures, surgeries and need short term skilled care o Do not require overnight stay Rehabilitation o Physical, occupational, and speech therapists restore function Hospice care o People who have 6 months to live o Payers control the amount and types of healthcare services people receive o 2010: PPACA signed by Obama ▪ Goals: increasing quality of health insurance, expanding insurance coverage, and reducing hc costs ▪ Controversial o Public health insurance programs like Medicare, Medicaid, CHIP, military o Private health insurance: purchased by persons employer, individual can get private health insurance directly o New discoveries and advanced equipment increased health care costs o Health insurance plans employ cost control strategies called managed care ▪ Examples of managed care: health maintenance organizations HMO or preferred provider organizations PPO ▪ Goal: to control costs by limiting plan members choice of healthcare providers and facilities ▪ Promoting wellness by reducing need for healthcare services (reducing costs) o Past goal of healthcare: make sick people feel well ▪ Today: more complicated ▪ Cost control is a consideration • Shortening hospital days by going to a LTC o o

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Describe a typical long term care facility: • • • • •

Provide 24 hours of nursing care Some specialized care, others have everyone Personal care: nails, skin, mouth, walking, eating, bathing o Activities of daily living ADL Physical, occupational, speech therapy, would care, tubes, nutrition, management of chronic diseases Non profit companies or for profit companies can own long term care

Describe residents who live in long term care facilities:

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84.9% over 65 67% female 76% white and non Hispanic 1/3 come from private residence 50% come from hospital or other facility Length of stay of over 2/3 is 6 months or longer Longest stay: developmentally disabled and often younger then 65 1/3: stay less then 6 months o Terminal care o Rehabilitation/temporary illness 90% dementia Lack of support system and ability to take care of self is why they end up in LTC

Explain policies and procedures: • • • • • • • •

Policy o Course of action that should be taken every time a certain situation occurs Procedure o Method for doing something All resident information must remain confidential: Health insurance portability and accountability act Plan of care must always be followed Nursing assistants should not do tasks that are not included in the job description Nursing assistants must report important events to nurse Nursing assistants should not take money or gifts Nursing assistants must be on time for work and must be dependable

Describe the long-term care survey process • • • • •

Inspections called surveys are performed periodically by state agency that licenses facilities To Cite means to find a problem through a survey Surveyors study how well staff care for residents, focus on resident's needs, and interview families Surveyors use tags that identify specific federal regulations (f-tags) Joint commission: independent not for profit organization that evaluates and accredits healthcare organizations o Standards: focus on improving quality and safety of care given to patients, clients and residents o For an organization to receive accreditation from joint commission, it must undergo a comprehensive survey process at least every three years ▪ Survey process includes carefully checking performance in specific areas like patient rights, treatment, and infection prevention ▪ Joint commission surveys not associated with state inspections ▪ Hospitals, long term care, rehabilitation centers can get joint commission accreditation

Explain Medicare and Medicaid •

Centers for Medicare and Medicaid Services (CMS): federal agency within US health department

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Medicare: o Federal health insurance program for people 65 and older, and for permanent kidney failure or certain disabilities o Part A: hospital insurance, pay for care in hospital or skilled nursing facility o Part B: medical insurance: pay for doctor services and equipment o Part C: Medicare advantage plans: allow private health insurance companies to provide Medicare benefits o Part D: prescription drug coverage

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Medicaid: o Medical assitance program for people who have low income and for people with disabilities o Funded by federal government and each state

Discuss the terms culture change and person centered care •

Culture change: process of transforming services for elders so that they are based on values and practices of the person receiving care o Core values: promoting choice, dignity, respect, self determination o To honor this change, healthcare settings may need to change their organization, environments and relationships

Person Centered Care • •

Emphasizes individuality of the person who needs care Improving quality of life...