Basic Nursing:Foundations of Skills & Concepts Chapter 29

1. Basic Nursing:Foundations of Skills & Concepts Chapter 29 REHABILITATION, HOME HEALTH, LONG-TERM CARE, AND HOSPICE

2. Nonacute Health Care • There has been a strong emergence in the past decade of nonacute health care services.

3. Reasons for Growth in Nonacute Health Care • The number of Americans over the age of 65 has tripled in this century. As individuals age, the risk increases of acquiring a chronic disease requiring health care throughout life. • Lives are being saved that would have been lost a few years ago. Ongoing health care services become necessary in such cases. • Discharge from acute-care hospitals is occurring much earlier. • Cost of acute care has reached critical proportions necessitating new forms of care management.

4. Clients’ and FamilyRights in Home Care (i) • To be treated with dignity, consideration, and respect. • To have their property treated with respect. • To be fully informed on admission of care, cost, and how payment will be made. • To know in advance if they will be responsible for any payment. • To participate in planning care.

5. Clients’ and FamilyRights in Home Care (ii) • To be informed in advance of any changes in care. • To receive care from professionally trained personnel. • To refuse treatment and be told of consequences of this action. • To expect confidentiality. • To be informed of termination of service. • To know how to make a complaint.

6. Clients’ & FamilyResponsibilities in Home Care (i) • To remain under a doctor’s care while receiving services. • To provide the agency with a complete health history. • To provide the agency with all requested insurance and financial information. • To sign the require consents and releases for insurance billing. • To participate in care by asking questions, expressing concerns, stating whether information is understood or not.

7. Clients’ & FamilyResponsibilities in Home Care (ii) • To provide a safe home environment in which care is given. • To cooperate with the doctor, the staff, and other caregivers. • To accept responsibility for any refusal of treatment. • To abide by agency policies that restrict duties the staff may perform. • To advice agency administration of any dissatisfaction or problems with care.

8. Sources of Reimbursement • Medicare. • Medicaid. • Private insurance.

9. Licensure • A mandatory system of granting licenses according to specified standards. • Regulated by each state.

10. Certification • A voluntary process that establishes and evaluates standards of care. • Required for any provider who seeks reimbursement from government funds. • Standards generated by the federal government.

11. Accreditation • An additional confirmation of quality. • Generally indicates that the provider has gone above the minimum standards in the delivery of care and service.

12. Rehabilitation • A process designed to help individuals reach their optimal level of physical, mental, and psychosocial functioning.

13. Interdisciplinary Health Care Team Process • Admission • Assessment • Problem identification • Care Plan Conference • Evaluation • Reassessment

14. Role of the LP/VN • Rehabilitation nursing is a specialty practice and requires specialized knowledge, skills, and attitudes. • Prerequisite is a sound knowledge base in the anatomy and physiology of the neurological, musculoskeletal, gastrointestinal, and urinary systems. • The nurse must have excellent clinical skills in areas of therapeutic positioning, exercises, transfers, ambulation, and activities of daily living.

15. Rehabilitation Settings • Hospital Inpatient Program. • Skilled Nursing Facility. • Outpatient Rehabilitation. • Home Rehabilitation.

16. Home Health Care • Encompasses a number of services delivered to persons in their homes. • The fastest growing segment of health care delivery.

17. Role of LP/VN inHome Health Care • Clients and their family caregivers must know: • The disease process. • Medications. • Special skills (changing dressings, administering of insulin, etc.). • Documentation and communication (how to keep records; when and how to contact nurse/physician/emergency services).

18. Long-Term Care • Refers to a spectrum of services provided to individuals who have an ongoing need for health care. • Long-term care facility may be licensed for either intermediate care or skilled nursing care.

19. Subacute Care • Designed to provide services for clients who are out of the acute stage of their illnesses but who still require skilled nursing, monitoring, and ongoing treatments. • Intended to fill the gap between the acute care hospital and the traditional long-term care facility.

20. Continuing Care Retirement Communities • Designed to provide continuing levels of care as individual’s health care needs change. • Levels include: • Independent • Assisted living • Health care, either short-term or permanent.

21. Assisted Living • A combination of housing and services for people who need help with the activities of daily living. • Nursing care is not provided.

22. Adult Day Care • Provide a variety of services in a protective setting for adults who are unable to stay alone but who do not need 24-hour care.

23. Respite Care • May be offered by adult day care centers, long-term care facilities, or in private homes. • Intended to provide a break to caregivers and may be utilized a few hours a week, for an occasional weekend, or for longer vacations. • Planned activities, meals, and supervision included.

24. Foster Care • Some states are investigating the use of foster homes for individuals who cannot live independently but who do not require the services of a health care facility. • The legal structure is comparable to the foster home concept for children.

25. Hospice • Humane, compassionate care provided to clients who can no longer benefit from curative treatment and have 6 months or less to live. • Hospice care may be implemented in the client’s home, a special area of hospitals or nursing homes, or freestanding inpatient facilities.