Community nursing Exam III Chapter 33 Home care and Hospice – Flashcards

ANS: A Currently, most reimbursement for nursing services is based on the patient's need for skilled nursing. On each patient visit, the nurse must document that the care provided is of a skilled nature that requires the knowledge and assessment skills of a nurse and must verify that the patient or a family member could not provide the same level of care. The only thing the nurse can do if the care needed is maintenance and assistance with activities of daily living is suggest a home health aide if the family can afford it, or teach the family how to help the client.

ANS: B Managed care agencies contract with payers, such as insurance companies, to provide specified services to the enrolled clients at a predetermined price. Managed care agencies receive payment before offering services and are responsible for taking the financial risk of providing care to patients within the budgeted allotment.

ANS: C Taxpayers fund official home health agencies, but they also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies.

ANS: D Agencies within chains have a financial advantage over single agencies. The chains have lower administrative costs because a larger single corporate structure provides many services. For example, a multiagency corporation has greater purchasing power for supplies and equipment because they purchase a larger volume. A single corporate office can provide administrative services such as payroll and employee benefits for all chain employees, thereby reducing duplication of these services.

ANS: C Certified home health agencies meet federal standards; therefore they are able to receive Medicare payments for services provided to eligible individuals. Not all home health agencies are certified.

ANS: D Medicare pays for short-term, skilled health care on a part-time or intermittent-care basis for persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act. To be eligible, the person must have contributed to FICA (Social Security system tax) for at least 10 years. If family and caregiver support is available in the home to care for the patient between nurse visits, the patient is eligible.

ANS: B OASIS is a data set that measures outcomes of adult home care patients to monitor outcome-based quality improvement. These items are used to monitor outcomes, plan patient care, provide reports on patient characteristics for each agency, and evaluate and improve clinical performance. The use of OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care.

ANS: C An underlying premise of Albrecht's conceptual model is that professional satisfaction and effective patient outcomes depend on the education and experience of the home health nurse. Within the Albrecht nursing model, the three major elements for measuring the quality of home health care patient outcomes include structural, process, and outcome elements. Although nurses are usually the case managers, Medicare pays for skilled services including occupational therapy and physical therapy. If nursing is not involved, the skilled professional would be the case manager.

ANS: C The nurse prepares for the home visit by reviewing the referral form including the purpose of the visit, the geographic residence of the family, and any other pertinent information.

ANS: C The nurse contacts the client and informs him or her about the service referral. The first telephone contact with the client or family consists of an exchange of essential information, including an introduction by the nurse, identification of the agency that received the referral, and the purpose of the visit. After the initial exchange of information, the nurse informs the client of his or her desire to make the home visit, the client gives permission, and the group sets a mutually acceptable time for the visit. The nurse is a guest in the client's home but not in the usual social sense. Public health nurses who are reimbursed by tax dollars may not require evidence of insurance coverage.

ANS: B Not all clients have a telephone. If that is the case, the nurse should check the referral for a telephone number where messages can be left. It is also worthwhile to contact the health care provider who made the referral to see whether the telephone number was omitted unintentionally. If the client does not have a telephone, the nurse may choose to make a drop-in visit. This type of visit consists of an unannounced visit to the client's home, during which the nurse explains the purpose of the referral, receives the client's permission for the visit, and appoints a time for a future visit with the client. The client may agree to the first visit while the nurse is there.

ANS: A An environmental assessment begins as the nurse leaves the agency en route to the client's home. The nurse should make specific observations.

ANS: D Many clients in need of nursing visits do not trust the health care system and are uncomfortable with the representative from an agency visiting their home. The nurse must build a trust relationship early in the visit or the client will not allow additional visits. Beginning with social topics is often a helpful tool to help establish trust and rapport.

ANS: D Home health nurses often identify documentation as a frustration. Medicare holds a prominent position as a home health care payer; therefore the HCFA's regulations determine the home health industry's documentation. Correct and accurate completion of required Medicare forms is the key to reimbursement. The forms require documentation of the nurse's care given.

ANS: A It is not unusual to find inconsistencies between information the patient provides during hospitalization concerning the amount of physical and emotional support available to the patient in the home and the amount of help actually available to the patient in the home. The nurse validates or modifies the referral information to reflect the actual home situation.

ANS: C There are differences between the treatment plan and the nursing care plan. The plan of treatment includes the type of home health services received, the projected frequency of visits by each discipline, and the necessary interventions. The nursing care plan addresses specific nursing interventions designed to treat the patient's actual or potential problems and includes identified goals with measurable outcomes.

ANS: D The plan including short-term and long-term goals is developed in consultation with the client and the family. To maximize the plan's success, it is important that the patient and family are involved. If the client expresses a disinterest, the nurse will be limited in possible interventions. Goals are identified that the client is willing to work toward with the nurse's assistance.

ANS: D Under the Health Insurance Portability and Accountability Act (HIPAA), it is doubtful any agency would suddenly call to share such information with the nurse. If the family always agrees with the nurse's suggestion, it may be cultural rather than actual interest in the suggestion. Although the family may prefer the nurse do all the work of calling and setting up services, they may do so simply because they aren't really that interested and they can always cancel later. However, if the family calls and sets up the service, it demonstrates commitment to the plan to use those resources.

ANS: A The average visit should not exceed 1 hour. The client receives a great deal of information during that hour, and the nurse collects a great deal of information. Most clients are tired at the end of a 1-hour visit and often cannot retain additional information.

ANS: D The home health nurse spends much of the visit assessing the skills of the caregiver. The home health nurse instructs the caregiver in the correct procedures for providing care and in recognizing the signs and symptoms of problems that must be reported to the health care provider. The goal of the home health nurse's instruction is to provide the caregiver with the skills necessary to care for the patient successfully in the home without intervention of the nurse. Information not retained can be repeated.

ANS: D Although the nurse tries to do everything possible for the client, the caregiver, and the whole family, the nurse must prevent a decline in the caregiver's health. Although the dying patient is the focus of all skilled nursing care, the experienced home care nurse knows that a careful assessment of the caregiver's mental and physical health is important. The spouse, lover, children, friends, and neighbors who have made the commitment to stay until the end need the nurse's time and attention as much as, if not more than, the patient. Although the patient's wishes are important, all decisions regarding care are made considering the health of the caregivers.

ANS: C The key to successful pain control for the terminally ill is to convince patients to take their medications on a regular basis. Many patients, especially the elderly, are afraid of becoming "junkies" or "druggies" and want to delay using pain medication until they "get really bad." Many people believe that using these medications signals "the end of the line," and they are amazed to learn that patients do well while receiving this drug for months, even years, before death occurs. Almost every family must learn that addiction is not the same as tolerance and that their physicians will not "cut off their supply if they take too much."

ANS: C Medicare-certified health care agencies must ask patients about advance directives and provide patients with the advance directive form if the patient is interested in completing the document.

ANS: A, B, C, F Numerous factors generated the growth of home health services, including the increasing costs of hospital care and the subsequent introduction of the prospective payment system. Providing home care services contributes to cost containment in a managed care environment. This cost containment is accomplished through timely hospital discharges by providing nursing services in the home setting and supporting clients at home rather than in skilled facilities. Home care is also popular with consumers, who prefer to receive care in their own homes rather than in an institution. The increasing number of home health agencies indicates that these agencies are profitable endeavors and provide hospitals with an additional revenue source.

ANS: B, D, E Home care is less expensive than institutionalized care. Physicians rarely make home visits. Consumers cannot usually afford to personally pay for home care. The rapid growth of the home health market reflects the increasing proportion of people aged 65 years and older; the lower average cost of home health care compared with institutional costs; active insurer support; and Medicare promotion of home health care as an alternative to institutionalization.

ANS: B, C Nurses who work with the terminally ill seek to enhance the patient's quality of life by focusing on relieving suffering throughout the illness, supporting the patient and family through the dying process, and providing grief support to the family after the patient has died. When the patient becomes terminally ill, the focus shifts from cure to comfort care. Hospice and palliative nursing care is provided in a variety of settings including hospitals, nursing homes, residential homes, and palliative care clinics. Ideally, all nurses approach care holistically and are expert in pain management and both physical and psychosocial care.