Community Health VN144 Flashcards
Home health key points
Home health care services enable individuals of all ages to remain in the comfort and security of their homes while receiving health care.
To qualify for coverage key point
By Medicare, a health maintenance organization (HMO), or various types of insurance, it is necessary for the patient to be “home bound”, meaning unable to leave the home or requiring a great deal of effort to travel for appointments to see the health care provider.
Key point
Recently there has been a shift to community based care. This has led to an increased number of acutely ill home care patients, changing demands on health care providers, and greater populations of the unserved and the underserved.
Historical key point
The former definition of home care was simply providing physical care to the sick in their homes, but the scope and the complexity of the concept and practice has grown.
Test point
Nurses provided care to all ages of people with both acute and chronic care needs in the first visiting nurse service in the United States, formed in Philadelphia in 1886.
Lillian Wald and Mary Brewster developed a visiting nurse service in 1893 the Nurses Settlement House on Henry St.
Test point
A revolution, however, occurred in 1965 with the enactment of Title XVIII (known as Medicare) and Title XIX (known as Medicaid) amendments to the Social Security Act. Medicare provided direct federal monies for the health care of all citizens 65 and older (or disabled), regardless of socioeconomic status. The companion Medicaid bill covered the care needs of the poor and indigent of all ages.
Medicare key point
When Medicare became effective in 1966, it revolutionized home care by (1) changing it to a medical rather than nursing model of practice.
DRG’s test point
The next major influence on home care came in 1983. Congress enacted the prospective system (PPS) as part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement. This system, based on major diagnostic categories and diagnosis-related groups (DRG’s), pays a set rate (according to diagnosis) for the hospitalized patients care rather than the “cost”, or charges an institution traditionally bills according to its own schedule of fees. The net effect of the change was a major shift of patients out of hospitals and into their homes, extended-care facilities, or skilled nursing facilities. Discharge for such patients occurred earlier in their convalescence, and thus the patient required more nursing care.
