1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 1 Introduction to Health Care Agencies

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  The person is always the focus of care.  Staff members have special talents, knowledge, and skills. All work to meet the person’s needs. All work to meet the person’s needs.

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  AGENCY PURPOSES  The purposes of health care are: Health promotion Health promotion  The goal is to reduce the risk of illnesses. Disease prevention Disease prevention Detection and treatment of disease Detection and treatment of disease Rehabilitation and restorative care Rehabilitation and restorative care  Many agencies are learning sites for students. The students assist in the purposes of health care. The students assist in the purposes of health care.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  TYPES OF AGENCIES  Hospitals  Rehabilitation and subacute care agencies  Long-term care centers (nursing homes, nursing facilities, nursing centers) Skilled nursing facilities (SNFs) Skilled nursing facilities (SNFs)  Assisted living residences  Mental health centers  Home care agencies  Hospices  Health care systems

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  ORGANIZATION  An agency has a governing body called the board of trustees or board of directors. The board makes policies. The board makes policies. An administrator manages the agency. An administrator manages the agency. Directors or department heads manage certain areas. Directors or department heads manage certain areas.  The health team (interdisciplinary health care team) involves the many health care workers whose skills and knowledge focus on the person’s total care. The goal is to provide quality care. The goal is to provide quality care. The person is the focus of care. The person is the focus of care.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Nursing service The director of nursing (DON) is an RN. The director of nursing (DON) is an RN.  The DON is responsible for the entire nursing staff. Nurse managers assist the DON. Nurse managers assist the DON. Nursing areas usually have charge nurses for each shift. Nursing areas usually have charge nurses for each shift. Staff RNs report to the charge nurse. Staff RNs report to the charge nurse. LPNs/LVNs report to staff RNs or to the charge nurse. LPNs/LVNs report to staff RNs or to the charge nurse. You report to the nurse supervising your work. You report to the nurse supervising your work. Nursing education (staff development) is part of nursing service. Nursing education (staff development) is part of nursing service.

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  THE NURSING TEAM  The nursing team involves those who provide nursing care. Registered nurses Registered nurses Licensed practical nurses and licensed vocational nurses Licensed practical nurses and licensed vocational nurses Nursing assistants Nursing assistants

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  NURSING CARE PATTERNS  The pattern used depends on how many persons need care, the staff, and the cost.  Functional nursing focuses on tasks and jobs.  Team nursing involves a team of nursing staff led by an RN.  Primary nursing involves total care.  Case management is like primary nursing. A case manager (an RN) coordinates a person’s care. A case manager (an RN) coordinates a person’s care.  Patient-focused care is when services are moved from departments to the bedside.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  PAYING FOR HEALTH CARE  Private insurance is bought by individuals and families.  Group insurance is bought by groups or organizations for individuals.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Medicare is a federal health insurance program for persons 65 years of age or older. Some younger people with certain disabilities are covered. Some younger people with certain disabilities are covered. Part A Part A Part B Part B  Medicaid is a health care payment program sponsored by the federal government and operated by the states.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid. Diagnosis-Related Groups (DRGs) are for hospital costs. Diagnosis-Related Groups (DRGs) are for hospital costs. Resource Utilization Groups (RUGs) are for SNF payments. Resource Utilization Groups (RUGs) are for SNF payments. Case Mix Groups (CMGs) are used for rehabilitation centers. Case Mix Groups (CMGs) are used for rehabilitation centers. Home Health Resource Groups (HHRGs) are used for home health care. Home Health Resource Groups (HHRGs) are used for home health care.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Managed care Managed care deals with health care delivery and payment. Managed care deals with health care delivery and payment. Managed care limits: Managed care limits:  The choice of where to go for health care  The care that doctors provide

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  MEETING STANDARDS  Standards are set by: The federal and state governments The federal and state governments Accrediting agencies Accrediting agencies  An agency must meet standards for: Licensure Licensure Certification Certification Accreditation Accreditation

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  Surveys are done to see if the agency meets set standards.  If standards are met, the agency receives a license, certification, or accreditation.  When problems (deficiencies) are found: The agency is given time to correct them. The agency is given time to correct them. The agency can be fined for uncorrected or serious deficiencies. The agency can be fined for uncorrected or serious deficiencies. The agency can lose its license, certification, or accreditation. The agency can lose its license, certification, or accreditation.