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Accreditation

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process whereby a professional association or nongovernmental agency grants recognition to an institution or agency for demonstrated ability in a special area of practice

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Certification

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Process in which an individual or institution, agency, or educational program is evaluated and recognized as meeting certain predetermined standards.

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Diagnosis-related groups (DRGs)

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System that classifies patients by age, diagnoses, and surgical categories; used to predict the use of hospital resources, including the length of stay.

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Home Health care

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Services that enable individuals of all ages to remain in the comfort and security of their homes while receiving health care.

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Medicaid

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A federally funded, state-operated program of medical assistance to people with low income; authorized by Title XIX of the Social Security Act.

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Medicare

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A federally funded national health insurance for certain people older than 65 years of age. Title XVIII of the Social Security Act

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Discharge from the hospital

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patients most often receive referrals for home health services upon

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"Home bound"

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Unable to leave the home or requiring a great deal o effort to travel for appointments to see the health care provider.

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Twice daily and as seldom as monthly

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The frequency and length of home health visits occur sometime as often

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Community based care

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This led to an increased number of acutely ill home-care patients, changing demands on health care providers, and greater populations of the unserved and the underserved.

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Individual independence and integrity and keeps families together

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Home health care perserve

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Official viewed of home health care

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a component of comprehensive health care in which individuals and their families receive services in their place of residence for the purpose of promoting, maintaining, or restoring health, or of minimizing the effects illness and disability

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Patient viewed of home health care

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skilled and compassionate care provided on a one-to-one basis in the comforting and familiar surroundings of the home. providers base care on individual needs and personalized schedules and do so over a given period to enable adjustment, change, and learning to take place effectively

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Family viewed on home health care

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a means to keep the family together a s functioning, integrated unit. the goals are learning to adapt to change, preventing dysfunctional patterns from setting in, and attaining family wellness within the scope of an individual member's illness or disability. It provides needed emotional support and linkage with the larger community support systems.

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Provider viewed on home health care

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challenges all disciplines involved to provide excellent care in often less-than-excellent conditions and surroundings. Independence, creativity, communication, and excellent clinical skills are integral aspects of daily practice. It is an opportunity for nurses to demonstrate the best of their profession and themselves in cooperation with the health care team to patients and families with physical and psychological needs.

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New Testament of the Bible

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describes visiting the sick as a form of charity

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Important aspect of their work

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Sixth-century monks practiced home care as

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1617 by St. Vicent de Paul

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One of the earliest organized systems for home care, who organized the Sisterhood of the Dames de Charite to meet social welfare and visiting nursing needs.

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Primary caregivers

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in the 1700, families were the

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1796 as the Boston Dispensary

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The first home care program in the United States

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1859, William Rathbone of Liverpool, England

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established the Metropolitan Nursing Association, the first organized district nursing service, because of the outstanding home care his dying wife received. he believed that many people with long term illnesses had a better chance to receive the kind of care they desired in their own homes than in a hospital.

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Philadephia in 1886

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nurses provided care to all ages of people with both acute and chronic care needs in the first visiting nurse service in the United States

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Lillian Wald and Mary Brewster

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They developed a visiting nurse service for the poor in New York City in 1893 at the Nurses' Settlement House on Henry Street.

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late 1800s and early 1900s

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Formalization of visiting nurse associations, and public health departments became widespread.

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Metropolitan Life Insurance Company

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had a major effect on the growth and nature of home services when, in 1909, it began offering nursing services to its millions of industrial policyholders

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Social Security Act of 1935

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First provided governmental rather than local charitable funding for selected services such as maternal health, treatment for communicable disease, and the training of public health professionals. The act subsidized assistance for the poor and aged

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Amendments to the Act in 1950

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defined services and opened the door to direct payment for providers.

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When medicare became effective in 1966, it revolutionized home care

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1) changing it to a medical rather than nursing model of practice, 2) defining and limiting the services it reimbursed, and 3) changing the payment source and even changing the reason for providing home care

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The next major influence on home care came in 1983

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Congress enacted the prospective payment system (PPS) as a part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement.

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Balanced Budge Act (BBA) of 1997 called the interim Payment System

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in an effort to control home health expenditures, Congress imposed new limits on home health payments.

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Licensure by the state

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this gives legal permission to operate within that state only. regulations vary widely. not all states have much laws.

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Certification by the state certifying body that the federal government designates

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The federal government set the rules governing certification. Only certified agencies are permitted to receive Medicare payment. Many states piggyback medicaid reimbursement to certification, as do some insurers

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Certificate of need: Some states grant this according to rules and formulas that state regulators device.

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Cost of staring and running the agency, availability of personnel, and need for their services are generally considered in this process

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Accreditation by an outside agency that evaluates and judges how well the agency meets certain standards that the accrediting organization sets.

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An agency will sometimes obtain this accreditation from the National League for Nursing community Health Accreditation Program, The Joint Commission, or the National Homecaring Council. Other groups sometimes grant accreditation to special programs or specialized agencies. Some of these national accrediting agencies. Some of these national accrediting agencies are seeking "deemed status" from federal regulators, which will allow their accreditation to also serve as the required certification. This will eliminate the need for separate surveys for some agencies.

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Visiting nurse associations, nursing divisions of state or local health departments, and hospitals

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Before Medicare, the provision of home health care was primarily the task of

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Agencies are classified according to

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1) tax status, for profit or not for profit; 2) location, freestanding or institution based 3) governance, private or public

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Voluntary

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-public; nonprofit; freestanding -community-based board of directors -tax deductible contributions; grants; fees from all sources -community health; public health; home health -RN; LVN/LPN; aide; homemaker; social worker; therapists - 1/2 -8 hour

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Official

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-public; nonprofit; freestanding -State, country, city, or other local unit of government and volunteer board representative of the area -State local, or country revenues; grants; fees from limited sources; charitable contributions -Community health; public health; home health - RN;LVN/LPN; aide; homemaker;social worker; therapists -1/2 - 8 hour

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combination

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-Public; nonprofit; freestanding -Jointly operated by the 2 types of agencies above under a combined board of directors -State, local, or country revenues; grants; fees from limited sources; charitable contributions -Community health; public health; home health -RN; LVN/LPN; aide; homemaker; social worker; therapists -1/2 - 4 hour

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Hospital

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-Private; nonprofit or for profit; institution based; hospital - Hospital board of directors -Fees from all sources -Home health; community health (limited) -RN; LPN/LVN; aide; social worker; therapists -1/2 - 4 hours

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Proprietary

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-Private; for profit; freestanding -Governed and owned by individual, corporation, or other organization; many paid boards of directors appointed by owner -Fees from most sources; some do and some do not participate in Medicare-Medicaid -Some offer limited home health; private duty; homemaker -RN; LPN/LVN; aide - 1 - 24 hours

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Private not for profit

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-Private; nonprofit; freestanding -Governed and owned by individual, corporation, or other organizational structure; board appointed by owner -Fees from most sources; some do and some do not participate in Medicare-Medicaid -Some offer limited home health services; private duty; homemaker -RN;LPN/LVN; aide - 1/2 - 24 hour

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Other home health agencies

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- Private; for profit or nonprofit; institution based - Based within formalized institution; governed by that board or designated board -Fees from all sources -Home health services; limited homemaker -RN; LPN/LVN; aide; therapists; may have homemaker; social worker - 1/2 - 8 hr

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Ethical issues that arise in the home

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The Joint Commission is looking for agencies to establish ethics committees to handle

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Therapy and education, as well as counsels family members

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The psychiatric nurse clinician provide

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Emotional, financial, and household problems

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Social workers are taking a more active role in home health care. Social workers provide assistance with a patient's

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Per Diem payment rather than a fee for visit

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Most agencies are obtaining a separate Medicare certification to provide hospice care. Medicare-certified hospice receive:

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"durable power of attorney for pet care"

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Allows patient to make arrangement for pet care if he or she becomes hospitalized or dies

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The phone's keypad

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A computerized system call a patient on the telephone at home and ask recorded question, the patient then respond by

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70%

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With the help of telemonitoring such as standard vital sign measurement and though the various peripheral technologies available, patients have ___ reduced rehospitalization and emergency department

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One of the most rapidly growing segments in home health is home infusion therapy

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an increasing number of home health agencies are offering home infusion services in an effort to compete for patient referrals

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Antibiotics, hydration, and total parenteral nutrition

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Three of the most common forms of home IV therapy, and the practitioner often orders them for patients at home without any prior orders hospital admission

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60 days

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Medicare requires a plan of treatment signed by the physician, outline all disciplines, treatment, frequency, and duration, and these orders are necessary to recertify every how many days

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Skilled nursing services revolve around four major goals

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1. Restorative - the return to a previous level of functioning as appropriate and realistic 2. Improvement - achieving better health 3. Maintenance - preserving functional capacities and independence 4. Promotion - teaching healthy lifestyle

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Assessment and teaching skills

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What is crucial in caring for patients in their homes as well as in structured facilities.

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Strong communication skills

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This is essential for teaching, counseling, interviewing, and listening.

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Respect for the patient's dignity, privacy, and need of autonomy

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This is an integral part of providing effective home health nursing services

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LPN/LVN will sometimes provide the following services in the home as directed and supervised by the RN

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-Catheter care and teaching -Ostomy care and teaching -wound care and sterile dressing changes -obtaining specimens for cultures -injection administration -prefilling insulin syringes -fingersticks for blood glucose readings -monitoring physical status -teaching, monitoring, or setting up medications, including IV medications -nutrition -specimen collection -therapeutic diet teaching or reinforcement -respiratory care, management of oxygen therapy, mechanical ventilation, and physiotherapy -tracheostomy care, including suctioning -enemas for special conditions -insertion of urinary catheter, irrigation, and observation for infections -bowel and bladder training -pain management -emotional support -preventive health measures -patient and family teaching -vital signs

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Determines treatment,education, and assistive devices needed for rehabilitation

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The therapist completes a detailed assessment of the patient and then

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Promote self-care and independence

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The therapist actively teaches the patient and the family the rehabilitation plan to

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To be reimburse by Medicare

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A master's prepared clinician who has been certified by the American Speech and Hearing Association is required to provide speech services. Other insurers sometimes accept a practitioner prepared at the bachelor's level.

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Physical, emotional, and social impact

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Therapy goals include reducing to a minimum communication disorders and

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National Occupational Therapy Association

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Therapists have bachelor's level preparation and have the opportunity to ear the occupational therapist, registered designation if they meet the registration requirements of

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OTR

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The certified occupational therapy assistant is permitted to provide some services under the supervision of the

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OTR service include

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- techniques to increase independence -analysis of activities as they relate to patients' skin, their environment, their families, and their routines -expanding the disease management approach into a lifestyle management approach -design, fabrication, and fitting of orthotic or self-help devices -assessment for vocational training

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Sensory-motor, cognitive, and neuromusculr functioning

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Occupation therapists assist patients to improve in their performance of ADLs as well as their

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Social worker with a master's degree

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Workers with bachelor's degrees are permitted to provide services under the supervision of a

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Emotional and social aspects of illness

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Social workers focus is on

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Homemaker-home health aide; home health aide

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They provide the basic support services that sometimes enable an elder individual, disabled adult, or dependent child to remain at home

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Primary skilled or therapy service (speech or physical)

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Before HHA services are arrange, Medicare requires what to provided first.

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Most aide services fall into one of three categories:

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1) personal care, or assistance with bathing, oral hygiene, eating, dressing, and toileting 2) physical assistance with transfer, medications, and ambulation 3) household cores, or cooking, light housekeeping, shopping, and laundry

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Third reason

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Medicare will not cover visits made solely for what reason

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Assistive personnel

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Skills of bathing are often acceptable to delegate to

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2 weeks, by an RN (sometime by a licensed physical therapist if skilled nursing is not involved)

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Medicare and Medicaid require on-site supervision every

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1 to 2 hours for Medicare to 8 to 24 hours for private or other payment sources

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Aide services are sometime provided in blocks of time ranging from

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Referral

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The entry point to the home health care system is by

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24 to 48 hours of the referral

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An RN makes the initial evaluation and admission visit within - The physician will often give general orders before this visit, but agencies sometimes make an evaluation visit without orders if agency policy permits.

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1 hour

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The admission process typically takes a minimum of

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Physician for specific orders

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If the agency is to admit the patient, it is necessary to contact who before delivery of care.

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Additional written, signed orders, and it is obligatory to review and renew it on a regular schedule for Medicare and Medicaid patients

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The treatment plan is possible to alter at any time

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30 to 45 minutes

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Skilled nursing visits typically take

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30 minutes to 1 hours

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Therapy visit range from

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Daily

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Telemonitored patient are "seen"

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Generate data that professional caregivers need to make critically important clinical decisions

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The purpose of telemonitor is not to replace nurses, but to

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1 to 2 hours

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Aide visits average

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60 to 90 days

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Patients will sometimes remain on the caseload for

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Communications with the home care team and referral sources

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It is also necessary to document

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Professional standards, accountability, quality of care, and internal evaluation purpose

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They are linked to legal implication

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Admission

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Discharge planning for home care begins with

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Track patient progress

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Many agencies follow up on a postdischarge basis to

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Promote continuity of care in the patient's home

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The purpose of discharge planning is to

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Quality assessment programs

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Provide documentation for outside organizations and for internal measures for improvements and refinements of policies and procedures

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Structural criteria, process criteria, outcome criteria

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Assessing quality involves evaluating all aspects of the agency operation, which include three major elements

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Structural criteria

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The agency's overall organization, philosophy, policies, procedures, bylaws, personnel practices, supervision, orientation, contacts, and physical facilities

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Process criteria

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Evaluation of care delivery. Authorities scrutinize the activities of the health professionals and paraprofessionals and support in the management of patient care, documentation, and patient care conferences.

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Outcome criteria

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Measurement o change in patient behavior, the results of patient care in terms of changes, health indicators, and satisfaction.

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Total quality management, continuous quality improvement, and quality improvement

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National accreditation body and many businesses has redefine quality assessment activities in terms of quality improvement. Terms such as

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Qualification for Medicare

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-65 years or older -disable -end stage renal disease In addition, they have to be -under the care of a licensed physician -homebound -in need of skilled nursing or therapy services on an intermittent bases

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24 hours of delivery

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Third party insurers sometime pay nursing and aide services for new mothers who return home within

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Pre-paid health plans

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Health maintenance organization (HMOs) and preferred provider organizations (PPOs) are

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Prospective payment system (PPS)

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A major influence on home health care began in 1983. This system, based on major diagnostic categories and diagnosis-related groups, paid a set rate for the hospitalized patient's care rather than the "cost," or charges traditionally billed by institutions. Such patients were discharged earlier in their convalescence and thus required more home nursing care. This system is called

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Balanced Budge Act (BBA)

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In 1997, Congress imposed new limits on home health payments through a provision of the

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Decreasing the number of patients served by home health

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The effects of the 1997 Congressional provision affected home health by

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A new payment system for home health agencies

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In 2000, the Health Care Financing Administration (HCFA) instituted

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