Understanding Healthcare Settings CHAPTER 1 Learning Objectives Discuss

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

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

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

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

Meet a few residents Mr. Chase Mrs. Albert • 40 year old • 70 year old male female • Developmental • Early dementia ly disabled • Admitted from • Admitted at home Long-term care age 22 Mr. Brown Mrs. Dooring • 75 year old • 68 year old male female • Aggressive • Admitted for Cancer rehab following hip • Admitted from replacement hospital 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 Surveys Citations Tips • State • Federal • Conducted by state agencies • Interviews, observations, chart reviews • Issued if a problem is found • Tell the truth when asked questions • Do NOT guess if you are unsure

Medicare & Medicaid

Culture Change & Person-Directed Care • Culture Change • 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