NSG 411: EXAM 2 CHAPTER 32
32 Cards in this Set
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history and politics of home health
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•Care in the home by family members throughout history
•Latter half of 20th Century, hospitals making referrals for home care for nonacute patients
•Medicare Home Health Benefit: brief visits, temporary care; no reimbursement for health promotion or long-term care
•Balanced Budget Act …
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home health agencies:
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voluntary nonprofit
hospital based
for profit proprietary agencies
government and city agencies
noncertified agencies
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voluntary non profit
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•charitable; exempt from paying taxes; financed with nontax funds; VNAs
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hospital based
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•part of hospital as a separate department; nonprofit or generate revenue
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for profit proprietary agencies
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•individual owners, often part of large regional or national chain administered through corporate headquarters; pay taxes on profits
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noncertified agencies
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•private; funding from direct payment by the client or insurers; governed by individual owners or corporations
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most common diagnosis for home health patients
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: essential hypertension, heart failure, diabetes, chronic skin ulcers, osteoarthritis
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family members are..
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•informal caregivers: personal care to sophisticated skilled care
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primary caregiver:
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daily tasks of care
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secondary caregiver:
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intermittent responsibilities
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most clients admitted...
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after hospitlization
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home healthcare personnel
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•Nurses: RNs, LPNs
•Home care aides
•Physical therapy
•Occupational therapy
•Social work
•Administrative personnel
primary physician. Nurse is the leader though
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reimbursement for home healthcare
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•Corporate
–Insurance companies, HMOs, PPOs, case management programs
•Governmental third-party payers
–Medicare, Medicaid, military health system, Veterans administration
•Individual clients and families
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Medicare criteria and reimbursement
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•Criteria:
–Service type and frequency reasonable & necessary
–Client homebound
–Plan of care on Medicare forms
–Client in need of skilled service (observation, assessment, teaching, performing selected procedures)
–Service intermittent and part-time
•Episode of care: 60 days
•Admi…
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OASIS
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outcome and assessment information set.
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nursing practice during home visits
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•Locating and getting through the door (making the connection)
•Promoting self-management
•Detecting
•Collaborating, mobilizing resouces that can sustain the client after discharge, strengthening, teaching, solving problems (the wheel)
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home health nursing management
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•Case manager for each client
•Responsible for coordination of other professionals and paraprofessionals involved in the client’s care
•Case conferencing with team members (Medicare mandate—every 60 days)
•Supervising paraprofessionals
•Knowledge of reimbursement for services
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selected nursing challenges in the home
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•Infection control
–Clients
–Home health care team
•Medication safety
•Risk for falls (see Display 32.3)
•Technology at home
•Nurse safety (see Display 32.4)
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Future of care in the home
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•Community-based long-term care to address needs of the frail elderly or severely disabled for more prolonged care
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•New lines of business to meet changing needs and payment issues
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•Possible development of a national community-based long-term care benefit
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overview of hospice care
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Hospice movement to humanize end-of-life experience and provide palliative care (relief of suffering without curing underlying disease
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four major changes to end of life care
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–Care should attend to body, mind, and spirit.
–Death must not be a taboo topic.
–Medical technology should be used with discretion.
–Clients have a right to truthful discussion and involvement in treatment decisions.
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hospice care originated in
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England with St. Christopher’s Hospice (1967)
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first hospice in US?
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•established in 1974 by Florence Wald, Dean of the Yale School of Nursing
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est. of ? in 1982
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medicare hospice benefit
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movement of hospice from ? to ?
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charity to business
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hospice for?
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variety of end of life diseases not just cancer
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medicare hospice benefit:
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•prognosis of 6 months or less, sign up for comfort-focused hospice benefit, waive regular hospice benefit; acknowledgment of terminal prognosis; choosing comfort care instead of life-extending care
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four payment levels
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–Routine home care with intermittent visits
–Continuous home care when the patient’s condition is acute and death is near
–Inpatient hospital care for symptom relief
–Respite care in a nursing home to relieve family members
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Hospice nursing practice
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•RN as central to hospice interdisciplinary team
•Case manager; frequent visits
•Collaboration with physicians
•Rotation through 24-hour call 7 days/week to assure continuous availability by telephone and visits for emergent problems
•Competencies similar to home health nurses with ad…
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hospice nursing practice cont.
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•Sustaining oneself
•Connecting, speaking truth, and encouraging choice
•Collaborating
•Strengthening the family
•Comforting (palliative care, pain management, see Display 32.6 and Display 32.7)
•Spiritual practice and letting go
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ethical challenges
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•Ethical implications of interventions
–Respect or disregard for client autonomy
–Relief or disregard for client suffering
–Avoidance of killing at the very end of life
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•Hospice nurse: advocate for the client and family
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future of home health and hospice
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•Transformation into a community-based long-term care system; cost containment
•Change in the model for service provision to address those living with disabling and terminal illness
•Extinction of Medicare definitions for homebound, medical necessity, and skilled nursing
•Change in foc…
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NSG 411: EXAM 2 CHAPTER 32