Nursing Assistant Unit 1 Chapter 1: The Health Care System Unit 1 Chapter 1: The Health Care System

Unit Objectives:  Identify changes that have occurred in how health care is delivered  Describe the different types of health care organizations  Briefly explain the structure of health care organizations  List some of the government and private agencies that provide oversight of the health care system  Describe how the survey process is used to monitor the quality of care given by health care organizations  Discuss how health care is paid for  Identify changes that have occurred in how health care is delivered  Describe the different types of health care organizations  Briefly explain the structure of health care organizations  List some of the government and private agencies that provide oversight of the health care system  Describe how the survey process is used to monitor the quality of care given by health care organizations  Discuss how health care is paid for

Health Care Delivery, Past and Present  In the U.S. during the 18 th, 19 th, and early part of the 20 th century  Mainly focused around the home and family  “Snake Oil”  “family doctor”  In the U.S. during the 18 th, 19 th, and early part of the 20 th century  Mainly focused around the home and family  “Snake Oil”  “family doctor”

Health Care Delivery, Past and Present  Present-day delivery of health care  Mandatory education and training  Required to care for those in need  Multiple care locations  Multiple specialties  Family Practice, Cardiovascular, GI, Endocrine, Neurology, Obstetrics, etc.  Attention to holistic approach  Present-day delivery of health care  Mandatory education and training  Required to care for those in need  Multiple care locations  Multiple specialties  Family Practice, Cardiovascular, GI, Endocrine, Neurology, Obstetrics, etc.  Attention to holistic approach

Health Care Organizations  Mission  Purpose of a health care organization  Can this vary based on the type of organization  Examples of different missions  To detect and treat disease  To promote health by teaching people about ways to achieve and maintain physical and mental fitness  To provide emergency care to people with life threatening illness or injuries  Mission  Purpose of a health care organization  Can this vary based on the type of organization  Examples of different missions  To detect and treat disease  To promote health by teaching people about ways to achieve and maintain physical and mental fitness  To provide emergency care to people with life threatening illness or injuries

Health Care Organizations  Types of Health Care Organizations  Hospitals  Severe illness or injury or requires a great deal of care and or close monitoring  Acute care  General Hospitals  Specialty Hospitals  Patients  Inpatient vs. Outpatient  Types of Health Care Organizations  Hospitals  Severe illness or injury or requires a great deal of care and or close monitoring  Acute care  General Hospitals  Specialty Hospitals  Patients  Inpatient vs. Outpatient

Health Care Organizations  Sub-acute Care Units (Skilled Nursing Units)  Either in hospitals or Long-Term Care Facilities (Nursing Homes)  Care focuses on rehabilitation  Transition period between acute-care and home  Sub-acute Care Units (Skilled Nursing Units)  Either in hospitals or Long-Term Care Facilities (Nursing Homes)  Care focuses on rehabilitation  Transition period between acute-care and home

Health Care Organizations  Long-Term Care Facilities (Nursing Homes)  People who cannot care for themselves  Do not need the acute-care of a hospital  Referred to as residents  May stay for rest of life for go home  Not always elderly  Special units for Alzheimer’s  Long-Term Care Facilities (Nursing Homes)  People who cannot care for themselves  Do not need the acute-care of a hospital  Referred to as residents  May stay for rest of life for go home  Not always elderly  Special units for Alzheimer’s

Health Care Organizations  Assisted-Living Facilities  Type of long-term care  Residents provide most of their own care  Limited assistance from staff  Medications  Transportation  Meals  Housekeeping  Assisted-Living Facilities  Type of long-term care  Residents provide most of their own care  Limited assistance from staff  Medications  Transportation  Meals  Housekeeping

Health Care Organizations  Home Health Care Agencies  Skilled Nursing care in person’s home  Person’s receiving care called clients  Available for all ages and medical needs  Home Health Care Agencies  Skilled Nursing care in person’s home  Person’s receiving care called clients  Available for all ages and medical needs

Structure of Health Care Organizations

 Each division responsible for one key aspect  Ensures knowledgeable leadership for each area  Health Care Team  Many different people with many different types of knowledge and skills  Patient, resident, or client is always the focus of the team  Each division responsible for one key aspect  Ensures knowledgeable leadership for each area  Health Care Team  Many different people with many different types of knowledge and skills  Patient, resident, or client is always the focus of the team

Structure of Health Care Organizations Patient, Resident, Client Physical Therapist HousekeepingDietary Nursing Assistant NursePhysician Social Services Lab, Pharmacy, X- Ray

Oversight of the Health Care System  Ensuring Quality Health Care  Proper training and competency  Standards of cleanliness and quality  Safe delivery of care  Availability to everyone  Ensuring Quality Health Care  Proper training and competency  Standards of cleanliness and quality  Safe delivery of care  Availability to everyone

Oversight of the Health Care System  Ensuring Quality Health Care Cont.  United States Department of Health and Human Services (DHHS)  Primary agency responsible for protecting this nation’s health  Umbrella of DHHS  Ensuring Quality Health Care Cont.  United States Department of Health and Human Services (DHHS)  Primary agency responsible for protecting this nation’s health  Umbrella of DHHS

Oversight of the Health Care System DHHS NIH (National Institute of Health) FDA (Food and Drug Administration) Agency for Health Care Research and Quality (AHRQ) Center for Disease Control (CDC) Centers for Medicare and Medicaid Services (CMS)

Oversight of the Health Care System  The Joint Commission  Joint Commission on Accreditation of Health Care Organizations (JCAHO) “jay-co”  Est  Standards for all types of health care organizations  Inspections  Voluntary  Organizations must pay for inspections  The Joint Commission  Joint Commission on Accreditation of Health Care Organizations (JCAHO) “jay-co”  Est  Standards for all types of health care organizations  Inspections  Voluntary  Organizations must pay for inspections

Oversight of the Health Care System  They Survey Process  Actual inspection  Written report presented  Opportunity to respond to deficiencies  Failure to fix could result in:  Loss of accreditation  Fines  Inability to qualify for Medicare or Medicaid payments  Admission ban  Closure  They Survey Process  Actual inspection  Written report presented  Opportunity to respond to deficiencies  Failure to fix could result in:  Loss of accreditation  Fines  Inability to qualify for Medicare or Medicaid payments  Admission ban  Closure

Oversight of the Health Care System  What do I do during a survey?  Always act within your scope of practice  Always behave like the professional you are  Make sure that your conversations are appropriate  Be mindful of privacy  Maintain a neat, clean working environment  Always put patient’s needs first  Answer questions honestly and to the best of your ability  What do I do during a survey?  Always act within your scope of practice  Always behave like the professional you are  Make sure that your conversations are appropriate  Be mindful of privacy  Maintain a neat, clean working environment  Always put patient’s needs first  Answer questions honestly and to the best of your ability

Protecting Health Care Workers  Occupational Safety and Health Administration (OSHA)  Government agency  Part of the Department of Labor  Created in response to public concern over increasing number of on-the-job injuries and deaths  Can impose very large fines  Occupational Safety and Health Administration (OSHA)  Government agency  Part of the Department of Labor  Created in response to public concern over increasing number of on-the-job injuries and deaths  Can impose very large fines

Paying for Health Care  Private and Group Insurance  Group insurance is purchased by and group or employer at a group rate  Employee may pay certain percentage  Precertification process  Health care provider must prove that patient needs services provided  Managed Care System  Contracts with doctors and organizations  PPO  HMO  Private and Group Insurance  Group insurance is purchased by and group or employer at a group rate  Employee may pay certain percentage  Precertification process  Health care provider must prove that patient needs services provided  Managed Care System  Contracts with doctors and organizations  PPO  HMO

Paying for Health Care  Medicare  Federal program  65 and older  Younger if disabled  Minimum Data Set (qualifying for long-term care)  Diagnostic Related Groups (DRG’s)  Adopted by insurance companies as well  Medicare  Federal program  65 and older  Younger if disabled  Minimum Data Set (qualifying for long-term care)  Diagnostic Related Groups (DRG’s)  Adopted by insurance companies as well

Paying for Health Care  Medicaid  Federally funded  STATE REGULATED  Low income  May have with Medicare if financially eligible  Not all facilities required to accept Medicaid  Medicaid  Federally funded  STATE REGULATED  Low income  May have with Medicare if financially eligible  Not all facilities required to accept Medicaid