Home Care Flashcards
Exam 2
Medicare Home Health Benefit:
Brief visits, temporary care; no reimbursement for health promotion or long-term care
Home Care Financing
Who pays?
Corporate
Private insurance
Governmental third-party payers
Medicare, Medicaid, military health system, Veterans Administration
Individual clients and families
Charitable care from home care agencies
Home Care Financing
What is HIPS?
HIPS-homebound, intermittent, part-time, skilled
Home Care Financing
What is Balanced Budget Act and Medicare Prospective Payment System:
Payment rates based on client characteristics and need for service led to the closure of many Medicare certified agencies
Home Care Financing
What- I don’t get it?
Cost and number of visits declined; rates of wound healing, incontinence and psychosocial problems increased
Home Care Financing
What is there an increase of? A decrease of?
Decreased patient contact; increased documentation
Home Health Agencies include:
Voluntary nonprofit
Hospital based
For profit proprietary agencies
Gov and city agencies
Noncertified agencies
Home Health Agencies:
Voluntary nonprofit: What are they? How are they financed?
charitable;
exempt from paying taxes;
financed with nontax funds; VNAs
Home Health Agencies:
Hospital-based: What are they? How are they financed?
part of hospital as a separate department;
nonprofit or generate revenue
Home health Agencies?;
For-profit proprietary agencies:
individual owners,
often part of large regional or national chain administered through corporate headquarters;
pay taxes on profits
Home health Agencies?;
Noncertified agencies: What are they? How are they funded?
private; funding from direct payment by the client or insurers;
governed by individual owners or corporations
Clients and Families:
Who are the clients?
Client as the individual and family (and significant others)
Clients and Families:
When are most clients admitted for home care?
Most clients admitted to home care after hospitalization
Clients and Families:
Most common diagnoses:
Essential hypertension,
heart failure,
diabetes,
chronic skin ulcers,
osteoarthritis
Caregivers
Who are informal caregivers? What kind of care do they give?
Family members as informal caregivers:
personal care to sophisticated skilled care
Caregivers
What is a primary caregiver?
Primary caregiver: daily tasks of care
Caregivers
What is a Secondary caregiver?
Secondary caregiver: intermittent responsibilities
Caregivers:
What kind of burdens do they assume?
Caregivers assuming enormous burdens: physical, psychological, economic
Medicare Criteria for Reimbursement:
What about service type?
Service type and frequency reasonable & necessary
Medicare Criteria for Reimbursement:
How is the client?
Client homebound
Medicare Criteria for Reimbursement:
What is on the Medicare forms?
“Plan of care” on Medicare forms
Medicare Criteria for Reimbursement:
What is the client in need of
Client in need of skilled service (observation, assessment, teaching, performing selected procedures)
Medicare Criteria for Reimbursement:
How is the service offered? How long is episode of care?
Service intermittent and reasonable
Episode of care: 60 days
Medicare Criteria for Reimbursement:
How is admission?
Admission: assessment using OASIS
Medicare Criteria for Reimbursement:
What is medicare documentation?
Medicare documentation: OASIS, Medicare Plan of Care
Skilled Nursing Services:
Who is it performed by?
Performed by either a registered nurse (RN) or a licensed practical nurse (LPN).
Skilled Nursing Services:
What are examples?
Examples: administering IV/IM medications, vaccines, tube feedings; changing dressings; and teaching about medications or diabetes care.
Skilled Nursing Services:
What is NOT skilled nursing care?
Any service that could be done safely by a non-medical person (or by patient) without the supervision of a nurse, is not skilled nursing care.
Intermittent and part-time service:
How is it defined by medicare?
Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances
Outcomes and Assessment Information Set (OASIS):
Any home health agency seeking Medicare certification is required to do what?
Any home health agency seeking Medicare certification is required to meet the Medicare Conditions of Participation (CoP) prior to certification.
Outcomes and Assessment Information Set (OASIS):
Any home health agency seeking Medicare certification is required to meet the Medicare Conditions of Participation (CoP) prior to certification.
What does this include?
This includes compliance with the OASIS collection and transmission requirements
Outcomes and Assessment Information Set (OASIS):
What does it measure?
Measures outcomes for quality improvement and client satisfaction with care
Outcomes and Assessment Information Set (OASIS):
What is it considered?
Cost-effective, quality care
Outcomes and Assessment Information Set (OASIS):
A collection of data items that encompass
sociodemographic
environmental
support system
health status
functional status attributes of adult patients
Types of OASIS Assessments:
When can OASIS assessments be completed and turned in?
OASIS assessments to be completed and turned in within 48 hours of visit
Types of OASIS Assessments:
OASIS assessments to be completed and turned in within 48 hours of visit and occur at:
Start or Resumption of Care
Recertification (60 days)
Discharge from Agency
Transfer to Inpatient Facility
Death or Discharge from Agency
Nursing Diagnosis:
What is it?
A clinical judgment about individual, family, or community responses to actual or potential health problems/life processes
Nursing Diagnosis:
What does it provide the basis for?
Provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable
Nursing Diagnosis:
What does it do in a consistent manner?
Describe, document, and quantify daily practice in a consistent manner
OMAHA System: What is it?
A comprehensive, orderly, nonexclusive, mutually exclusive taxonomy designed to identify diverse clients’ health-related concerns
One of the best approaches to nursing diagnosis in home care
OMAHA System
OMAHA System:
What was it developed for?
Developed for home care practice, not for inpatient care
Goals of the OMAHA System:
To develop what?
To develop a structured and comprehensive system that could be both understood and used by members of various disciplines and foster collaborative practice
Goals of the OMAHA System:
What is it?
Guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agency-wide, multidisciplinary clinical information management system capable of meeting the needs of practitioners, managers, and administrators
OMAHA System includes:
Problem Classification Scheme
Intervention Scheme
Problem Rating Scale for Desired Outcomes
Client Goals includes what?
Include health promotion, maintenance, and restoration
Client Goals:
To help clients do what?
Help clients function at the highest possible level by maximizing the level of independence and self-care abilities
Client Goals:
To prevent what?
Prevent complications in chronically ill persons and help minimize the effects of disability and illness
Telehealth:
What is it?
Telehealth is a form of electronic communication used to deliver
Telehealth:
What does it include?
Acute care and specialty consultations
Home telenursing
Electronic referrals to specialists in expert health facilities
Home Care Visit:
Includes:
Initiating the visit
The actual visit
Termination of the visit
Post-visit planning
Home Care Visit:
Initiating the visit- what should be included
Preparation
Equipment
Directions
Personal safety
Home Care Visit:
Actual visit- what should be included
Assessing for risk of medication errors
Assessing for risk of falls
Assessing for risk of abuse and neglect
Home Health Nursing Case Management:
What does each client receive?
Case manager for each client
Home Health Nursing Case Management:
What is the case manager responsible for?
Responsible for coordination of other professionals and paraprofessionals involved in the client’s care
Home Health Nursing Case Management:
What does the case manager do?
Case conferencing with team members (Medicare mandate — every 60 days)
Supervising paraprofessionals
Home Health Nursing Case Management:
What must they be knowledgable for?
Knowledge of reimbursement for service
Caregivers as Partners:
Who is included in the home health care team?
Caregivers are often family members and friends. They must be considered members of the home care team and offered appropriate support if their commitment to care for a loved one at home is to be successful.
Type of services
Home Care Services
Private Care Services
Hospice and Palliative Care
Community Programs
Research Center
Medicaid Long-term Care - MLTC
Future of Home Care:
What are they going to address?
Community-based long-term care to address needs of the frail elderly or severely disabled for extended home care
New lines of business to meet changing needs and payment issues
Future of Home Care
What is there a possible development of?
Possible development of a national community-based long-term care benefit
