Chapter 9: Organization of Care
Health Care Services
Clinical health care services include prevention of disease, maintenance of good health, curing disease, rehabilitation, and palliation. The first level in the continuum of health care begins with healthy people. There are multiple prevention service levels. Primary prevention focuses on education to prevent illness. Handwashing signs, immunization programs, weight loss programs, and workplace safety programs all aim to reduce disease by influencing behavior. Secondary prevention focuses early detection and screenings. Routine tests are meant to catch diseases even while the patient is still unaware of the condition. Patients that are already experiencing symptoms benefit from tertiary
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Acute care is short-term care centered around diagnosing and treating illness or injury. Acute curative services respond to life-threatening emergencies, acute episodes of chronic illnesses, and any health problem that requires immediate, time-sensitive response. Acute care can include emergency care, trauma care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization (Yarbrough & Erwin, 2015).
Long-term care meets the non-medical care needs of people that need assistance with activities of daily living due to a medical condition. Activities of daily living may include bathing, dressing, eating, housework, or meal prep (Yarbrough & Erwin, 2015). Nursing homes or institutions are providers of long-term care, but Medicare will not pay for custodial care. Medicare only pays for medical care. Medicare will not pay for help with taking medication, using the toilet, or everyday tasks that someone is unable to accomplish due to chronic illness (Long-term care,
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The Patient-Centered Medical Home seeks to improve health system delivery through respect, coordination, and involvement of caregivers. The Patient-Centered Medical Home (PCMH) involves a team of nurses, legal consultants, pharmacists, therapists, insurance consultants, medical assistants, and physicians working together at one location to provide expert care in the health issues they are specialized to address. Team-based care is designed to make primary care meet the needs of patients by providing collaboration among medical professionals. Patient-centered care can potentially improve both clinical outcomes and satisfaction rates while improving quality of care and reducing costs (Rickert, 2012). A large portion of this cost reduction is due to a dramatic decrease in Emergency Medicine Department visits (Masterson,
Patient-centered care refers to the view that patients and their family members are partners in developing a care plan. This stems from the belief that the patient is in control and that the care provided is rooted in respect that addresses the patient’s personal needs and values (Barnsteiner & Sherwood, 2012). Creating a partnership with a patient that allows them to grasp the goals and methods of their plan of care and includes them in the decision-making process can prevent errors from occurring. This gives the patient the opportunity to correct any
Coordinating Primary Care/Team Effort: “patient Centered Medical Home” Geisinger calls it “Personal Health Navigator” aims to help patients manage all the complexities of their care in one setting. Focus on putting patients/families at the center of care. Doctors, nurses, technicians and case managers (who coordinates it all). Constantly
Issues with long term care services include employee turnover, regulation, employee communication and especially payment for services. Legal concerns associated with long-term care are the rise of population who will eventually need it. The demand for long-term care services are going to explode as the population ages and more people are living longer with chronic conditions. But the main questions still remains, who will pay for these services and how will they be delivered? When I say this I’m referring to the actually facilities themselves, will there be space for patients when the time
Drug and health plans are major resources to long-term care. Medicare does not cover most of long-term care services, but it may pay a portion depending on selected coverage. Medicaid may step in and help pay as well. “The Medicare Plan Finder tool provides one central point to view and compare all available drug and health plan
Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.
The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People
One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.
Medicare doesn’t pay the largest part of Long Term Care services or personal care. Medicare will pay for a short stay at a Skilled Nursing Facility, hospice care, or home health if an individual meets these conditions:
Long term or chronic care includes a much broader range of services than acute care, emphasizing social as care well as medical services. While acute care is usually confined to specialty providers, the providers of long term care are more wide ranging. They include traditional medical providers such as physicians and hospitals, formal community caregivers such as home care agencies, facility providers such as nursing homes and assisted living facilities, and informal caregivers such as friends or family members.
Drug and Alcohol Treatment in America has been based on the Medical Model of Treatment. According to Wikipedia, the medical model of addiction is rooted in the philosophy that addiction is a disease and has biological, neurological, genetic, and environmental sources of origin. Treatment includes potential detox with a 28 day or more stay at a residential treatment facility. The continuum of care can include an additional 28 days at the partial hospitalization level, followed by another 6 weeks of Intensive Outpatient.
Patient centered care is defined as “the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient, which includes listening to, informing and involving patients in their care” (Grenier and Knebel, 2003). Five challenges presented in patient centered care are patient obstacles, physician and practice obstacles, facility obstacles, community obstacles, and health literacy.
Patient and family centered care is a vital component in the delivery of health care. It is not only nurses who influence the delivery of patient and family centered care; in fact, there is a wide range of health care disciplines that are involved in the process. Some of these disciplines include physicians, respiratory therapists, occupational therapists, physical therapists, pharmacy, and case managers. Two vital attributes that contribute to patient and family centered care among the health care team are collaboration and leadership. Each member of the health care profession plays an equal role in providing patient and family centered care to patients during their hospitalization or visit to a health care setting. This paper will seek to further identify the meaning of patient and family centered care, examine the views of a respiratory therapist on the issue, and identify different leadership techniques that allow for appropriate collaboration among the interprofessional team.
Usually Medicare does not pay for long-term care; it will only pay for medically necessary skilled nursing facilities or home health care. With Medicare certain criteria has to be met for certain conditions for Medicare to pick up the cost. Medicare also does not pay for any kind of long-term care that helps assist with activities of daily living. This kind of care includes dressing, bathing, and using the bathroom. Medicare Advantage plans can offer limited skilled nursing facility and home care coverage if the patient’s long-term care is medically necessary. Medicaid offers coverage for both medical and non-medical associated long-term care, but the person will only qualify if they have less than $2000 in assets and income that is inadequate to pay for the cost of their care. If a veteran is at least 70% service connected disabled the Veterans Administration will pay the costs of long-term care for life. Long-term care that is not provided by the government is usually paid out-of –pocket by family members. Most people choose the option of home health care because long-term care is too costly.
Long-term care can be defined as a broad set of paid and unpaid services for people who are mentally or physically disabled, or whose chronic illness places them in need of medical or personal assistance for long periods of time. “It is estimated that there are more than twelve million Americans of all ages whose mix of serious disability and chronic illness places them at the high risk for functional decline, hospitalization, or nursing home placement.” (Benjamin) Several different populations require long-term care services, and the needs of these populations vary. In addition to the elderly, many of the long-term care users are younger persons with physical disabilities; persons with developmental disabilities; and persons with chronic
This paper will explain the components of the Home Health Care delivery system of continuum. The reader will be able to understand some of the services provided by the home health care system and how they fit into the continuum of care. It will give details on how the entity does or does not contribute to the overall management of healthcare resources.