Hartman’s Nursing Assistant Care

Understanding Healthcare Settings 1. Discuss the structure of the healthcare system and describe ways it is changing Health care is a growing field. The healthcare system refers to the different kinds of providers, facilities, and payers involved in delivering medical care. Providers are people or organizations that provide health care, including doctors, nurses, clinics, and agencies. Facilities are places where care is delivered or administered, including hospitals, long-term care facilities, and treatment centers (such as for cancer). Payers are people or organizations paying for healthcare services. These include insurance companies, government programs like Medicare and Medicaid, and individual patients or clients. Together, these people, places, and organizations make up the healthcare system. This textbook will focus on two types of care: long-term care and home health care. Longterm care (LTC) is given in long-term care facilities for people who need 24-hour skilled care. Skilled care is medically necessary care given by a skilled nurse or therapist; it is available 24 hours a day. It is ordered by a doctor and involves a treatment plan. This type of care is given to people who need a high level of care for ongoing conditions. The term nursing homes was once widely used to refer to these facilities. Now they are often known as long-term care facilities, skilled nursing facilities, rehabilitation centers, or extended care facilities. People who live in long-term care facilities may be disabled. They are often elderly, but younger adults sometimes require long-term care, too. They may arrive from hospitals or other healthcare settings. Their length of stay (the number of days a person stays in a healthcare facility) may be short, such as a few days or months, or longer than six months. Some of these people will have a terminal illness, which means the illness will eventually cause death. Other people may recover and return to their homes or to other care facilities or situations. Most people who live in long-term care facilities have chronic conditions. This means the conditions last a long period of time, even a lifetime. Chronic conditions include physical disabilities, heart disease, and dementia. (Chapter 18 has more information about these disorders and diseases.) People who live in these facilities are usually referred to as residents because the facility is where they reside or live. These places are their homes for the duration of their stay (Fig. 1-1). Fig. 1-1. People who live in long-term care facilities are called residents because the facility is where they reside for the duration of their stay. Home health care, or home care, is provided in a person’s home (Fig. 1-2). This type of care is also generally given to people who are older and are chronically ill but who are able to and wish to remain at home. Home health care may also be needed when a person is weak after a recent hospital stay. Skilled assistance or monitoring may be required. People who receive home health care are usually referred to as clients. Fig. 1-2. Home health care is performed in a person’s home. People receiving home care are generally referred to as clients. In some ways, working as a home health aide is similar to working as a nursing assistant. Almost all care described in this textbook applies to both nursing assistants and home health aides. Most of the basic medical procedures and many of the personal care procedures are the same. Home health aides may also clean, shop for groceries, do laundry, and cook. Home health aides may have more contact with the client’s family than nursing assistants do. They also will work more independently, although a supervisor monitors their work. The advantage of home care is that clients do not have to leave home. They may have lived there for many years, and staying at home can be comforting. People who need long-term care or home health care will have different diagnoses, or medical conditions determined by a doctor. The stages of illness or disease affect how sick people are and how much care they will need. The jobs of nursing assistants will also vary. This is due to each person’s different symptoms, abilities, and needs. Other healthcare settings include the following: Assisted living facilities are residences for people who need some help with daily care, such as showering, meals, and dressing. Help with medications may also be given. People who live in these facilities do not need 24-hour skilled care. Assisted living facilities allow for more independent living in a homelike environment. A resident can live in a single room or an apartment; however, some residents have roommates. An assisted living facility may be attached to a long-term care facility, or it may stand alone. Some assisted living facilities have memory care units for people who have mild dementia. These people are unable to live alone but are still fairly independent. Dementia is defined as the serious loss of mental abili ties, such as thinking, remembering, reason ing, and communicating. There is more information about dementia in Chapter 19. Adult day services are for people who need some assistance and supervision during certain hours, but who do not live in the facility where care is provided. Generally, adult day services are for people who need some help but are not seriously ill or disabled. Adult day services can also provide a break for spouses, family members, and friends. Acute care is 24-hour skilled care given in hospitals and ambulatory surgical centers for people who require short-term, immediate care for illnesses or injuries (Fig. 1-3). People are also admitted for short stays for surgery. Fig. 1-3. Acute care is performed in hospitals for illnesses or injuries that require immediate care. Subacute care is care given in hospitals or long-term care facilities. It is used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness. Treatment usually ends when the condition has stabilized or after the predetermined time period for treatment has been completed. The cost is usually less than for acute care but more than for long-term care. Subacute care is covered in Chapter 22. Outpatient care is usually given to people who have had treatments, procedures, or surgeries and need short-term skilled care. They do not require an overnight stay in a hospital or other care facility. Rehabilitation is care given by specialists. Physical, occupational, and speech therapists help restore or improve function after an illness or injury. Information about rehabilitation and related care is located in Chapter 21. Hospice care is given in facilities or homes for people who have approximately six months or less to live. Hospice workers give physical and emotional care and comfort until a person dies, while also supporting families during this process. There is more information about hospice care in Chapter 23. Often payers control the amount and type of healthcare services people receive. The kind of care a person receives and where he receives it may depend, in part, on who is paying for it. In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. This law is commonly referred to as the Affordable Care Act. Its goals include increasing the quality of health insurance, expanding insurance coverage (both public and private), and reducing healthcare costs. The Affordable Care Act has been controversial and, like any law, it may be changed by elected officials. Public health insurance programs include Medicare and Medicaid, the Children’s Health Insurance Program (CHIP), military health benefits from TRICARE and the Veterans Health Administration, and the Indian Health Service. Private health insurance plans may be purchased by a person’s employer, and costs are paid for by the employer or the employee, or shared by both. An individual may also purchase private health insurance directly. Coverage of medical services varies from plan to plan. The healthcare system is constantly changing, and with these changes come new costs. New technologies and medications are being created, and better ways of caring for people in a wide variety of healthcare settings are being developed. Better health care helps people live longer, which leads to a larger elderly population that may need additional health care. New discoveries and expensive equipment have also increased healthcare costs (Fig. 1-4). Fig. 1-4. Technology makes it possible to offer better health care, but equipment can be expensive. Many health insurance plans employ cost-control strategies called managed care. Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are examples of managed care. Managed care seeks to control costs by limiting plan members’ choice of healthcare providers and facilities. There is an increasing emphasis within managed care on promoting wellness as a means of reducing the need for healthcare services (and, as a result, reducing costs). In the past, the goal of health care was simply to make sick people well. Today things are more complicated. Cost control is a consideration, as is the coordination of the many types of care a person might receive. While in many cases a person who is seriously ill will still be admitted to a hospital, hospital stays are often shorter now due to cost-control measures. After release from the hospital, many people need continuing care. This care may be provided in a long-term care facility, a rehabilitation hospital, or by a home health agency, depending on the needs of the patient or client. 2. Describe a typical long-term care facility Long-term care facilities are businesses that provide skilled nursing care 24 hours a day. These facilities may offer assisted living housing, dementia care, or subacute care. Some facilities offer specialized care, while others care for all types of residents. The typical long-term care facility offers personal care for all residents and focused care for residents with special needs. Personal care includes bathing; skin, nail, and hair care; mouth care; and assistance with walking, eating and drinking, dressing, transferring, and elimination. All of these daily personal care tasks are called activities of daily living, or ADLs. Other common services offered at these facilities include the following: • Physical, occupational, and speech therapy • Wound care • Care of different types of tubes, including catheters (thin tubes inserted into the body to drain or inject fluids) • Nutrition therapy • Management of chronic diseases, such as Alzheimer’s disease, acquired immune deficiency syndrome (AIDS), diabetes, chronic obstructive pulmonary disease (COPD), cancer, and congestive heart failure (CHF) When specialized care is offered at long-term care facilities, the employees must have special training. Residents with similar needs may be placed in units together. Nonprofit companies or for-profit companies can own long-term care facilities. 3. Describe residents who live in long-term care facilities There are some general statements that can be made about residents in long-term care facilities. While it is helpful to understand the entire population, it is more important for nursing assistants to understand each individual for whom they will care. Residents’ care should be based on their specific needs, illnesses, and preferences. According to a survey conducted in 2013–2014 by the National Center for Health Statistics (