Healthcare

Healthcare

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Healthcare

Introduction

America has a highly developed health
care system, which is available to all people. Although it can be very
complex and frustrating at times it has come a long way from the health
care organizations of yesterday. Previously most health care facilities
were a place where the sick were housed and cared for until death. Physicians
rarely practiced in hospitals and only those who were fortunate could afford
proper care at home or in private clinics. Today the level of health care
has excelled tremendously. Presently the goal of our health care is to
have a continuum of care for the patient, one which is integrated on all
levels. Many hospitals offer a referral service or discharge plan to patients
who are being discharged. Plans for the patient are discussed with a discharge
planner. The discharge planner is a person who is trained in assessing
what the patient's requirements for health care will be after discharge
from the hospital. This enables the patient to continue their care at a
level which is most appropriate for them. Items reviewed for discharge
planning include but are not limited to therapies, medication needs, living
arrangements and identification of specific goals. A few of the options
that are available for persons being discharged from an acute care hospital
can include home health care, assisted living facilities, long term care
or hospice

Home Health Care

According to Growing Old in America (1996),

"Home health care is one of the fastest growing segments of the health
care industry" (p. 114). Alternatives for home care can meet both the medical
and non-medical needs of a patient. These services are provided to patients
and their families in their home or place of residence. Home care is a
method of delivering nursing care and other therapies as required by the
patient's needs. Numerous alternatives are available for persons seeking
health care at home. With transportable technologies such as durable medical
equipment, oxygen supply and intravenous fluids there are countless possibilities
for treatment within the home setting. As stated in The Continuum of Long

Term Care "Home health programs range from formal organizations providing
skilled nursing care to relatively informal networks that arrange housekeeping
for friends" (p. 185). This has allowed for home care to quickly become
an essential component of the health c! are delivery system in the United

States.

In a home health care situation the primary
care giver is usually not the physician. The physician is communicated
with by phone and with documentation from the caregivers. The primary caregivers
are usually the nurses and other team members who are involved directly
with the patient's care. Although, the original order to begin home care
must be initiated by the physician if skilled care is to be obtained. According
to the 1995 Guide to Health Insurance for People with Medicare "Medicare
pays the full cost of medically necessary home health visits by a Medicare-approved
home health agency" (p. 5). This coverage must meet specific criteria,
but it can be a relief to family members to know that their loved ones
can be taken care of at home without worrying about the expenses.

Unfortunately, if the care to be given
within the home is termed "not medically necessary" the expense is not
covered. This can include items such as meal and medication delivery, a
percentage of necessary durable medical equipment, personal care and homemaker
services. My employment within a home health care agency has allowed for
review of services that are not covered by Medicare and/or private insurance.

Health care services that are not included can become quite numerous. It
is often difficult for family members to understand why specific services
are not covered especially when they appear to be necessary for the care
of the patient. These costs can add up quite quickly and the impact of
the cost can become quite distressing for family members and patients on
a limited budget. In these cases a Social Worker is usually provided to
help the patient and family explore other avenues which may enable them
to cover their health care costs.

Assisted Living

Assisted living is an arrangement to residents
of a facility that enables them to complete certain daily activities while
remaining independent. The services provided enable the resident to achieve
maximum function of their activities of daily living. The services are
unskilled and non-specialized personnel provide the activities essential
to the care of the resident. These services help assist the aged, blind,
disabled, and other functionally limited individuals with necessary daily
activities which they require help with or are unable to perform on their
own. An example of some of the services which may be available are light
housekeeping, meal preparation, medication reminders and personal care.

The personal care does not include specific health oriented services which
would require the services of a certified or licensed professional. It
is stated well in Aging "Although the level of services provided may vary,
assisted living communities all share a common goal: e! nabling people
to live as active and independent a life as possible" (p. 212). The goal
of an assisted living facility is to have the residents feel independent
within their own home. According to the article Assisted Living's Future

In Michigan Debated "Assisted living facilities can offer consumers a great
opportunity to get personalized care in a comfortable setting" (p. 2).

Currently there is some controversy surrounding
the different types of assisted living facilities. In Michigan facilities
termed assisted living have no real legal meaning and are not required
to be licensed under this name. According to the article Assisted Living's

Future In Michigan Debated "Unlicensed facilities, unsubsidized care, untrained
staff, and unmet promises make some places seem more like un-assisted living"
(p. 1). Unfortunately many facilities are misleading as to what level of
care they are providing. Both the government and national organizations
are currently addressing this issue.

My own experience with an assisted living
facility has been quite good. Formerly my grandmother was a resident of
an assisted living facility. The facility was specifically built for seniors
and was that of an apartment like structure. The facility provided social
and recreational activities on a continual basis. There was also transportation
service available for residents who wished to use it. My grandmother thoroughly
enjoyed living in an assisted living facility where she had the opportunity
to make numerous friends, participate in activities and remain independent.

Long Term Care

Long-term care patients are categorized
by having a chronic condition and/or disease. The long-term care facility
can be either hospital-based or freestanding. It consists of an organized
medical staff, which provides continuous nursing services under professional
nurse direction. The patient's status is reviewed on a regular basis to
determine if they meet criteria to remain at the facility.

The long-term care facility is regulated
by state licensure regulations, federal regulations and Joint Commission
on Accreditation of Health Care Organizations (JCAHO). State licensure
is mandatory, Federal regulation is only necessary if the facility participates
with Medicare and Medicaid, and JCAHO standards are voluntary.

Long term-care is very expensive and it
often becomes a financial catastrophe for the elderly person and their
family. Private insurance is unlikely to cover the full cost of care and

Medicare only pays for a limited amount. The person usually must eliminate
a substantial amount of their assets to become eligible for Medicaid which
covers long term care. According to Growing Old In America "In order for
elderly persons to qualify for nursing home care under Medicaid, they usually
must reduce their personal financial status to the poverty level (p. 119-120).

Regretfully, the cost is not the only disturbing
factor of a long-term care facility. A family decision to place my grandfather
who was suffering from Alzheimer's disease into a nursing home was a very
difficult and emotional experience for everyone involved. Regular visits
by all family members continually raised concerns about the quality of
care that he was receiving. Staffing was also a concern for our family.

It seemed there was not enough staff to meet the needs of the patients
within the facility. Although licensing agencies regulated these aspects,
this was not comforting to our concerns. Fortunately, we were able to move
my grandfather to a different facility. The nursing home was newer and
better staffed and all family members felt more comfortable about the care
he was receiving. The experience of placing a loved one into a long term
care facility is one I would prefer to not experience again. It is comforting
to know that there are good facilities availab! le and caregivers that
really care about the patient's needs. These aspects are very important
for families to understand before making a final decision when they must
place a loved one into a facility.

Hospice

Unfortunately the last resort for some
patients may be hospice care. Hospice is an organized program that offers
dying persons and their families an alternative to traditional care for
terminal illness. As stated in Aging "Hospice care is exclusively for dying
people. It therefore brings expertise to helping patients and their families
face issues specific to death and dying" (p. 180). Hospice enables the
patient to receive palliative medical care, while meeting the psychosocial
and spiritual needs of the patient, their family and friends. Hospice programs
also offer bereavement services for 13 months (or beyond if required) following
the patient's death for any family members or friends who wish to receive
the service.

The article The Continuum of Long term

Care emphasizes "The philosophy of hospice is that terminally ill individuals
should be allowed to maintain life during their final days in as natural
and comfortable a setting as possible" (p. 198). The quality of life of
the terminally ill patients relies heavily on the psychosocial skills of
their health care team. The health care team consists of a physician, nurse,
social worker, chaplain, home health aide and volunteers. The team develops
an individual care plan which will provide an appropriate support system
for the patient and their family up to and beyond the patient's death.

Weekly meetings allow the team to focus on the changing needs of the patient
and make adjustments to their plan.

Hospice care can be received in a variety
of organizational settings. The most preferred setting is of course within
the patient's own home, but nursing homes, hospitals and long term care
facilities are a few who can also provide hospice care. Hospice care is
a covered benefit under Medicare and most private insurance companies.

The regulating agencies that set the standards for hospices are Medicare,
the National Hospice Organization, Joint Commission on Accreditation of

Health Care Organizations (JCAHO) and state hospice agencies.

I have found that the medical record content
in a hospice program contains an extensive amount of identifying information
in regards to the patient and their primary caregiver(s). All aspects of
patient care are well documented and assure well-coordinated, continuous
care. The medical record acts as a communication tool between the different
team members and is used on a continuous basis throughout the patient's
care.

Conclusion

Although there are many options other
than those listed for health care after discharge from a hospital, The
most important aspect for a person is to be well informed and knowledgeable
about the variety of options available. It can be very confusing, especially
to an elderly person when talk of finances, regulations and covered and
non-covered items are discussed. It is our responsibility as future health
care administrators to provide adequate information to the person who is
opting for alternatives to health care.

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