nursing assistant unit 1 chapter 1: the health care system unit 1 chapter 1: the health care system

Nursing Assistant

Unit 1Chapter 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

Health Care Delivery, Past and Present

In the U.S. during the 18th, 19th, and early part of the 20th 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

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

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

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

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

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

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

Structure of Health Care Organizations

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

Structure of Health Care Organizations

Patient, Resident, Client

Physical Therapist

Housekeeping

Dietary

Nursing Assistant

Nurse

Physician

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

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

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. 1951 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

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

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

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

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

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