Chapter 1

1. Chapter 1 Introduction to Health Care Agencies

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.

3. AGENCY PURPOSES • The purposes of health care are: • Health promotion • The goal is to reduce the risk of illnesses. • Disease prevention • Detection and treatment of disease • Rehabilitation and restorative care • Many agencies are learning sites for students. • The students assist in the purposes of health care.

4. TYPES OF AGENCIES • Hospitals • Rehabilitation and subacute care agencies • Long-term care centers (nursing homes, nursing facilities, nursing centers) • Skilled nursing facilities (SNFs) • Assisted living residences • Mental health centers • Home care agencies • Hospices • Health care systems

5. ORGANIZATION • An agency has a governing body called the board of trustees or board of directors. • The board makes policies. • An administrator manages the agency. • 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 person is the focus of care.

6. Nursing service • The director of nursing (DON) is an RN. • The DON is responsible for the entire nursing staff. • Nurse managers assist the DON. • Nursing areas usually have charge nurses for each shift. • Staff RNs report to the charge nurse. • LPNs/LVNs report to staff RNs or to the charge nurse. • You report to the nurse supervising your work. • Nursing education (staff development) is part of nursing service.

7. THE NURSING TEAM • The nursing team involves those who provide nursing care. • Registered nurses • Licensed practical nurses and licensed vocational nurses • Nursing assistants

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. • Patient-focused care is when services are moved from departments to the bedside.

9. PAYING FOR HEALTH CARE • Private insurance is bought by individuals and families. • Group insurance is bought by groups or organizations for individuals.

10. Medicare is a federal health insurance program for persons 65 years of age or older. • Some younger people with certain disabilities are covered. • Part A • Part B • Medicaid is a health care payment program sponsored by the federal government and operated by the states.

11. Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid. • Diagnosis-Related Groups (DRGs) are for hospital costs. • Resource Utilization Groups (RUGs) are for SNF payments. • Case Mix Groups (CMGs) are used for rehabilitation centers. • Home Health Resource Groups (HHRGs) are used for home health care.

12. Managed care • Managed care deals with health care delivery and payment. • Managed care limits: • The choice of where to go for health care • The care that doctors provide

13. MEETING STANDARDS • Standards are set by: • The federal and state governments • Accrediting agencies • An agency must meet standards for: • Licensure • Certification • Accreditation

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 can be fined for uncorrected or serious deficiencies. • The agency can lose its license, certification, or accreditation.