Understanding Healthcare Settings Chapter 1

Learning Objectives Discuss the structure of the healthcare system and describe ways it’s changing Describe a typical long-term care facility Describe residents who live in long-term care facilities Explain policies and procedures Describe the long-term care survey process Explain Medicare and Medicaid Discuss the terms culture change and person-directed care

Providers Facilities Payers Healthcare Structure Who provides the healthcare Doctors, nurses, clinics, agencies Providers Where healthcare is delivered Hospitals, long-term care facilities, treatment centers Facilities Who pay for healthcare Insurance companies, government programs, individuals Payers

Changing Healthcare Increased use of expensive technology Rising healthcare costs New ways to control costs of care Managed Care HMOs Health maintenance organization PPOs Preferred provider organization

Typical Long-Term Care Facility 24-hour skilled nursing care Personal care for all residents Activities of Daily Living (ADLs) Focused care for residents with special needs IV therapy, wound care, management of chronic diseases, etc. Most conditions are chronic

Meet a few residents Long-term care Short-term care Mr. Chase 40 year old male Developmentally disabled Admitted at age 22 Mrs. Albert 70 year old female Early dementia Admitted from home Mr. Brown 75 year old male Aggressive Cancer Admitted from hospital Mrs. Dooring 68 year old female Admitted for rehab following hip replacement Long-term care Short-term care

Policies and Procedures Policy Course of action that should be taken every time a certain situation occurs Resident information is confidential Procedure Method, or way, of doing something Reporting information about residents specific to that facility

Long-Term Care Survey Regulations State Federal Surveys Conducted by state agencies Interviews, observations, chart reviews Citations Issued if a problem is found Tips Tell the truth when asked questions Do NOT guess if you are unsure

Medicare & Medicaid

Culture Change & Person-Directed Care Choice Dignity Respect Self-determination Purposeful living Pioneer Network Advocates for person-directed care (emphasizing individuality) Eden Alternative Focus on improving the lives of elders and their caregivers

Review Structure of healthcare Long-term care facility Residents who live in LTC facilities Policies and procedures Survey process Medicare and Medicaid Culture change and person-directed care