TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.37 "Home Health Nursing " Flashcards
0
Q
Home health care services enable individuals of all ages to remain in the comfort and security of their homes while receiving health care. Family support, familiar surroundings, and participation in the care process contribute to feelings of worth and dignity. Possible services include skilled nursing, physical therapy, psychiatric therapy, pain education and management, speech language therapy, occupational therapy, social services, intravenous therapy, nutritional support, respiratory therapy, acquisition of medical supplies and equipment, and home health aide, homemaker, pet-care assistance, and companion care.
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B)false
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1
Q
Home Health Nursing
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2
Q
Patients most often receive referrals for home health services upon discharge from the hospital; however, it is also possible for the patient, the family, or the health care provider to request home health care at other times.
A)true
B)false
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3
Q
To qualify for coverage by Medicare, a health maintenance organization (HMO), or various types of insurance, it is necessary for the patient to be “homebound,” meaning unable to leave the home or requiring a great deal of effort to travel for appointments to see the health care provider. The patient also has to be in need of intermittent skilled nursing care.
A)true
B)false
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4
Q
Patients older than 65 years account for half of all home health patients. Patients of all ages with various diagnoses account for the other half.
A)true
B)false
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5
Q
Hospitals are most likely to discharge those patients to home health care with a stroke, chronic obstructive pulmonary disease, fractured hips needing surgical interventions, and joint replacement procedures.
A)true
B)false
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6
Q
Home health care includes services ranging from wound care to ostomy assistance, setting up oral medications, prefilling insulin syringes or administering injections of vitamin B12, assisting patients postoperatively after undergoing total hip and total knee replacements, and monitoring patients with heart failure, diabetes, and hypertension.
A)true
B)false
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7
Q
The visits occur sometimes as often as twice daily and as seldom as monthly.
A)true
B)false
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8
Q
Home health care is needed because Americans are living longer and thus have more disease conditions that require care. Also, hospital stays are, on the average, much shorter than in the past, so many patients still require nursing interventions on discharge from the hospital.
A)true
B)false
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9
Q
Home health care is also essential because an increasing number of women work outside the home. Women who traditionally provided health care for their families are no longer available to provide this service. There is an increased mobility in our society and an increase in single-parent families with female heads of households.
A)true
B)false
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10
Q
HOME HEALTH CARE DEFINED
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11
Q
Home health care preserves individual independence and integrity and keeps families together.
A)true
B)false
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12
Q
The following are definitions of home health care as viewed from four different perspectives:
- Official: A component of comprehensive health care in which individuals and their families receive services in their place of residence for the purpose of promoting, maintaining, or restoring health, or of minimizing the effects of illness and disability.
- Patient: Skilled and compassionate care provided on a one-to-one basis in the comforting and familiar surroundings of the home. Providers base care on individual needs and personalized schedules and do so over a given period to enable adjustment, change, and learning to take place effectively.
- Family: A means to keep the family together as a functioning, integrated unit. The goals are learning to adapt to change, preventing dysfunctional patterns from setting in, and attaining family wellness within the scope of an individual member’s illness or disability. It provides needed emotional support and linkage with the larger community support systems.
• Provider: Challenges all disciplines involved to provide excellent care in often less-than-excellent conditions and surroundings. Independence, creativity, communication, and excellent clinical skills are integral aspects of daily practice. It is an opportunity for nurses to demonstrate the best of their profession and themselves in cooperation with the health care team to patients and families with physical and psychological needs.
A)true
B)false
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13
Q
HISTORICAL OVERVIEW
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14
Q
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 have grown.
A)true
B)false
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15
Q
Roots of the concept go back to the New Testament of the Bible, which describes visiting the sick as a form of charity.
A)home care
B)false
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16
Q
Sixth-century monks practiced home care as an important aspect of their work in the community.
A)true
B)false
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17
Q
One of the earliest organized systems for home care was developed in 1617 by St. Vincent de Paul, who organized the Sisterhood of the Dames de Charite to meet social welfare and visiting nursing needs.
A)true
B)false
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18
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In the 1700s, families were the primary caregivers.
A)true
B)false
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19
Q
The poor were hospitalized, whereas those with financial means were cared for in their homes by visiting physicians
A)true
B)false
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20
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The first home care program in the United States came into being in 1796 as the Boston Dispensary
A)true
B)false
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21
Q
In 1859, William Rathbone of Liverpool, England, established the Metropolitan Nursing Association, the first organized district nursing service, because of the outstanding home care his dying wife received. He believed that many people with long-term illnesses had a better chance to receive the kind of care they desired in their own homes than in a hospital-a belief central to home care today
A)true
B)false
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22
Q
The Metropolitan Life Insurance Company had a major effect on the growth and nature of home serrvices when, in 1909, it began offering nursing services to its millions of industrial policy holders. This initiiated third-party payment for services. Payment until then had been primarily a matter of charity or the responsibility of the patient.
A)true
B)false
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23
Q
The Social Security Act of 1935 first provided governmental rather than local charitable funding for selected services such as maternal health, treatment for communicable diseases, and the training of public health professionals. The Act subsidized assistance for the poor and aged. Amendments to the Act in 1950 further defined services and opened the door to direct payment for providers
A)true
B)false
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24
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.
A)true
B)false
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25
Medicare provided direct federal monies for the health care of all citizens 65 and older (or disabled), regardless of socioeconomic status.
A)true
B)false
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The companion Medicaid bill covered the care needs of the poor and indigent of all ages.
A)true
B)false
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27
When Medicare became effective in 1966, it revolutionized home care by:
(1) changing it to a medical rather than nursing model of practice,
(2) defining and limiting the services it reimbursed,
(3) changing the payment source and even changing the reason for providing home care
True
28
The next major influence on home care came in 1983. Congress enacted the prospective payment system (PPS) as a 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 (DRGs), pays a set rate (according to diagnosis) for the hospitalized patient's 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.
A)true
B)false
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29
Discharge for such patients occurred earlier in their convalescence, and thus the patient required more nursing care. This created a challenge to home care in terms of volume of patients seen, of the need to provide more skilled nursing care over more intensive periods, and the evolution of highly technical procedures in the home.
A)true
B)false
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30
In an effort to control home health expenditures, Congress imposed new limits on home health payments through a provision of the Balanced Budget Act of 1997 (BBA) called the Interim Payment System (IPS). Until BBA, there were no limits on payment for covered home health services provided to qualifying patients as long as visit costs were within "reasonable
A)true
B)false
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31
To reduce the growth in home health, the IPS imposed lower per-visit limits and imposed a new agency-specific, aggregate per-beneficiary limit based on agencies' federal fiscal year spending in 1994.
A)true
B)false
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32
BBA also provided the authority for development of a PPS for home health. Thus Medicare pays providers of home health services at fixed predetermined rates
for services and supplies to cover an episode of care during a specific period.
A)true
B)false
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33
The goal of PPS is to produce new incentives for the home health provider to be more efficient in the delivery of home health services
and still remain financially solvent.
A)true
B)false
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34
Home care visits and Medicare expenditures for home care quadrupled between 1980 and 1991. This was directly attributed to shorter hospitalizations, more seriously ill patients being discharged to home, and increased acceptance of the delivery of higher technology care in the home.
A)true
B)false
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Life Span Considerations
Older Adults
Home Care Services
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* The growing number of older adults has resulted in increased need for home health care services.
* Early-discharge policies have resulted in very ill older adults leaving the hospital. This increases the importance of patient teaching, early discharge planning, and appropriate referral to home health agencies by hospital staff nurses.
* Many older adults do not require total care but do require a limited amount of assistance. Home care reduces disruption of lifestyle and is more cost effective than institutional placement.
* Transfer to a hospital or nursing home even on a temporary basis increases the stress level of older people. Stress is decreased if they receive care in a familiar environment.
* It is crucial for caregivers to learn the importance of preserving the older adult's autonomy, and to make any modifications to the home environment with consideration of the older adult's physical strengths and remaining functional abilities, not just the patient's disabilities.
* A number of service agencies exist that are in a position to assist older adults in their communities. These include Meals-on-Wheels, home health aides, homemakers, and home-based physical therapy services. As a nurse, make sure you are familiar with home health services in your area, and help older people make arrangements for the appropriate services
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TYPES OF HOME CARE AGENCIES
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The agency typically has to comply with federal, state, and local laws and regulations via the following:
* Licensure by the state. This gives legal permission to operate within that state only. Regulations vary widely. Not all states have such laws.
* Certification by the state certifying body that the federal government designates. The federal government set the rules governing certification (a process in which the government evaluates and recognizes an individual, institution, or educational program as meeting certain predetermined standards). Only certified agencies are permitted to receive Medicare payment. Many states piggyback Medicaid reimbursement to certification, as do some insurers.
* Certificate of need: Some states grant this according to rules and formulas that state regulators devise. Cost of starting and running the agency, availability of personnel, and need for their services are generally considered in this process.
* Accreditation by an outside agency that evaluates and judges how well the agency meets certain standards that the accrediting organization sets. An agency will sometimes obtain this accreditation (a process whereby a professional association or nongovernmental agency grants recognition to a school or institution for demonstrated ability in a special area of practice or training) from the National League for Nursing Community Health Accreditation Program, The Joint Commission, or the National Homecaring Council. Other groups sometimes grant accreditation to special programs or specialized agencies. Some of these national accrediting agencies are seeking "deemed status" from federal regulators, which will allow their accreditation to also serve as the required certification. This will eliminate the need for separate surveys for some agencies
True
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Now agencies are classified according to
(1) tax status, for profit or not for profit;
(2) location, freestanding or institution based;
(3) governance, private or public.
True
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CHANGES IN HOME HEALTH CARE
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Changes are occurring in home health care. The Joint Commission (TJC) is looking for agencies to establish ethics committees to handle ethical issues that arise in the home.
A)true
B)false
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42
Medicare is reimbursing psychiatric nurse clinicians for home visits. Psychiatric patients are required to be under the care of a psychiatrist and have a psychiatric diagnosis.
A)true
B)false
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43
The psychiatric nurse clinician provides therapy and education, as well as counsels family members
A)true
B)false
A
44
Patients with acquired immunodeficiency syndrome (AIDS) represent a growing home health care population
A)true
B)false
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45
Social workers provide assistance with a patient's emotional, financial, and household problems, thus allowing the nurse more time to perform nursing interventions
A)true
B)false
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46
Most agencies are obtaining a separate Medjcare certification to provide hospice care. Medicare-certified hospices receive per diem payments rather than a fee for visit. This method of payment is more economkal for insurers and taxpayers.
A)true
B)false
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47
Pet-care programs are emerging to reduce stress for home health patients who are too iJI to care for their pets. A "durable power of attorney for pet care" allows a patient to make arrangements for pet care if he or she becomes hospitalized or dies. Some home health agencies provide special pet services, such as transporting pets to veterinarian appointments.
A)true
B)false
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48
Electronic home visits have evolved. A computerized system now has the capacity to call a patient on the telephone at home and ask recorded questions such as, "What is your blood pressure?" The patient is able to respond by using the phone's keypad. In this way the nurse is able to efficiently review the patient's progress without making a home visit.
A)true
B)false
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49
One of the most rapidly growing segments in home health is home infusion therapy; an increasing number of home health agencies are offering home infusion services in an effort to compete for patient referrals. Health care facilities are eager to have home health agencies provide this service, since home intravenous (IV) therapy fits right in with their cost-cutting strategies. A 30-day IV antibiotic regimen of one common cephalosporin, for example, costs about $5000 when the patient receives it in the hospital but just $1600 when the patient is at home.
A)true
B)false
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50
Antibiotics, hydration, and total parenteral nutrition (TPN) are three of the most common forms of home IV therapy, and the practitioner often orders them for patients at home without any prior hospital admission. Other less frequently used therapies include IV analgesic medications, chemotherapy, and dobutamine (Dobuhex); dobutarnine, whose administration once occurred only in the intensive care unit (ICU), now serves as palliative therapy for home care patients with severe refractory CHF and for those awaiting heart transplants.
A)true
B)false
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SERVICE COMPONENTS
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```
Primary services include the following:
• Skilled nursing
• Physical therapy
• Speech-language therapy
• Occupational therapy
• Medical social services
• Homemaker- home health aide
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True
53
Other therapy services (e.g., respiratory) or professional services (e.g., nutritional counseling, pharmacy, podiatry, dentistry, and psychiatric or mental health) are sometimes among an agency's offerings.
A)true
B)false
A
54
Medicare requires a plan of treatment signed by the physician, outlining all disciplines, treatment, frequency, and duration. These orders are necessary to recertify every 60 days
A)true
B)false
A
55
Health Promotion
| Home Care
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* The most common diagnoses for home care patients are diabetes mellitus, hypertension, heart failure, osteoarthritis, stroke, acute and chronic wounds, chronic obstructive pulmonary disease, heart disease, cancer, and psychiatric disorders.
* Commonly performed treatments in the home include administration of infusion therapy (i.e., antibiotic administration), patient-controlled analgesia for pain management, enteral feedings, parenteral nutrition, chemotherapy, hydration therapy, and psychiatric counseling and education.
• The nurse and a rehabilitation team member will at times also provide medical equipment in the home to facilitate medical treatment and safety, such as electrical beds, wheelchairs,
commodes, walkers, and other assistive devices.
True
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SKILLED NURSING
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Service Goals
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Skilled nursing services revolve around four major goals:
1. Restorative: The return to a previous level of functioning as appropriate and realistic
2. lmprovernent: Achieving better health and a higher level of functioning than at admission
3. Maintenance: Preserving functional capacities and independence by maintaining current level of health
4. Promotion: Teaching healthy lifestyles that keep the effect of illness or disability to a minimum and prevent the recurrence of illness
True
60
Provider Attributes
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61
Nurses practicing in the home setting are caregivers, teachers, counselors, case managers, and advocates.
A)true
B)false
A
62
To be a home health nurse, you need to be technically proficient and self-motivated, have expert organizational skills, be innovative, be an independent decision maker, and respond to problems promptly. Common sense, flexibility, compassion, empathy, patience, honesty, and dependability are essential.
A)true
B)false
A
63
You will generally provide services in the patient's home; hence you will need to feel comfortable with the unknown, as well as accept differences in etluuc cultures and value systems.
A)true
B)false .
A
64
Nurses who depend on the security of the institutional setting, immediate medical direction, and frequent peer support find the independence of home care practice difficult.
A)true
B)false
A
65
lf you are a home health nurse, it is necessary that you keep in mind the dominant role the patient and the family play. Unlike the hospital situation, home health nursing requires that nurses and other providers adapt to the patient, family, and home environment. You will be a visitor in the patient's home.
The patient's and family's cultural values and beliefs are very important for you to acknowledge and respect.
You will often encounter the use of home remedies and complementary and alternative therapies and have the responsibility to carefully guide the patient and family in their safe and effective use
True
66
Strong communication skills are essential for teaching, counseling, interviewing, and listening. A high energy level, cheerfulness, and a positive attitude are valuable attributes, because you will often be called on to work with patients and families who are under stress.
A)true
B)false
A
67
Respect for the patient's dignity, privacy, and need of autonomy is an integral part of providing efffective nursing services. Commitment to professional standards of practice, ongoing continuing education, and skills updates are important.
A)true
B)false
A
68
ROLE OF THE LPN/LVN
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69
An RN has to supervise LPNs/LVNs. Although . LPNs/LVNs are not empowered to make detailed patient assessments or clinical judgments, their observations, reporting, documentation, teaclting, and technical care capabilities are important to home care.
A)true
B)false
A
70
Provider Attributes
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71
Personal and professional attributes described for RNs also apply to the LPN /LVN.:
Independent practice is not allowed, but self direction, motivation, creativity, clinical proficiency, flexibility, compassion, empathy, and patience are all essential attributes. Good commu. nkation skills-both written and spoken-are necessary. The ability to work alone, follow directions, recognize important changes in condition, and assist in patient teaching is needed. Evaluation of care interrventions and recommendations for alteration of the plan of care constitute a part of the role.
A)true
B)false
A
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Functions
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Depending on the agency, agency policies, and state practice acts, the LPN / LVN will sometimes provide the following services in the home as directed and supervised by the RN:
* Catheter care and teaching
* Ostomy care and teaching
* Wound care and sterile dressing changes
* Obtaining specimens for cultures
* Injection administration
* Prefilling insulin syringes
* Fingersticks for blood glucose readings
* Monitoring physical status (such as lung sounds, bowel sounds, pulses, edema, and weight)
* Teaching, monitoring, or setting up medications, including IV medications
* Nutrition; assessment of nutrition and hydration status; teaching about prescribed diet; administration of nasogastric, gastrostomy, and jejunostomy tube feedings, and teaching families about tube feedings
* Specimen collection
* Therapeutic diet teaching or reinforcement
* Respiratory care, management of oxygen therapy, mechanical ventilation, and physiotherapy
* Tracheostomy care, including suctioning
* Enemas for special conditions
* Insertion of urinary catheter, irrigation, and observation for infections
* Bowel and bladder training
* Pain management
* Emotional support
* Preventive health measures
* Patient and family teaching
* Vi tal signs
True
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Safety Alert!
| Home Oxygen Use
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MASK OR CANNULA
• Ensure that the straps are not too tight
• Remove straps two or three times/day to wash, dry, and stimulate skin
• Pad any pressure points
• Observe tops of ears for skin impairment from pressure points
ORAL AND NASAL MUCOUS MEMBRANES
• Assess oral and nasal mucous membranes two or three times/day
• Use water-based gel on lips and nasal mucosa
• Provide frequent oral hygiene
• Provide humidification via humidifier or nebulizing device
DECREASING RISK FOR INFECTION
• Remove mask or collar and cleanse with water two or three times/day
• Cleanse skin carefully at this time and observe for cuts, scratches, and ecchymosis
• Change disposable equipment frequently
• Remove secretions that are expectorated
DECREASING RISK OF FIRE INJURIES
• Post "No Smoking" warning signs in home where they are clearly visible
• Do not allow open flames, wool blankets, or mineral oils in the area where oxygen is in use
• Do not allow smoking in the home
True
76
PHYSICAL THERAPY
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The goals of treatment have to be restorative for Medicare reimbursement but will in some cases be for maintenance or prevention for other payer sources.
A)true
B)false
A
78
The therapist completes a detailed assessment of the patient and then determines treatment, education, and assistive devices needed for rehabilitation. These are included as a part of the physician approved plan of treatment. Treatments range from muscle strengthening to transcutaneous nerve stimulation and ultrasound treatments.
A)true
B)false
A
79
Patients who have orthopedic conditions, such as repair of a fractured hip, a total hip or total knee replacement, and those with neuromuscular diseases such as stroke, multiple sclerosis, or amyotrophk lateral sclerosis receive referral to a physical therapist
A)TURE
B)false
A
80
The therapist actively teaches the patient and the family the rehabilitaation plan to promote self-care and independence. Communication with the physician and the RN promotes continuity of care.
A)true
B)false
A
81
SPEECH-LANGUAGE THERAPY
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Independent functioning and maximum rehabilitation of speech and language abilities are primary treatment goals. Often the provision of services occurs after stroke or surgery.
A)true
B)false
A
83
Possible therapies range from language relearning to working with eating or swallowing disorders or teaching lipreading to those with hearing disorders.
A)speech therapy
B)false
Aa
84
Pathologists work closely with the patient and family for rehabilitation or adjushnent to a new disability.
A)true
B)false
A
85
OCCUPATIONAL THERAPY
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86
Based on a complete evaluation of functional level, the therapist will choose and teach therapeutic activities designed to restore functional levels. Services include the following:
1. Techniques to increase independence
2. Analysis of activities as they relate to patients' skin, their environment, their families, and their routines
3. Expanding the disease management approach into a lifestyle management approach
4. Design, fabrication, and fitting of orthotic or self help devices
5. Assessment for vocational training
True
87
Occupational therapists assist patients to improve in their performance of activities of daily living (ADLs), as well as their sensory-motor, cognitive, and neuromuscular functioning .
A)true
B)false
A
88
MEDICAL SOCIAL SERVICES
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Their focus is on the emotional and social aspects of illness. The patient, the family, or other support systems undergo evaluation for social, emotional, and environmental factors. The care plan includes education, counseLing, payment source identifica tion, and referrals.
A)MEDICAL SOCIAL SERVICES
b)false
A
90
Coping with stress and crisis intervention are also part of social worker services. Social services in home health are generally short term.
A)true
B)false
A
91
HOMEMAKER-HOME HEALTH AIDE
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92
These workers are an integral part of the home health care team. They provide the basic support services that sometimes enable an elderly individual, disabled adult, or dependent child to remain at home.
A)HOMEMAKER-HOME HEALTH AIDE
B)social service
A
93
Most home aide services fall into one of three categories:
(1) personal care, or assistance with bathing, oral hygiene, eating, dressing, and toileting
(2) physical assistance with transfers, medications, and ambulation
(3) household chores, or cookking, light housekeeping, shopping, and laundry . Medicare will not cover visits made solely for the third reason.
True
94
Medicare and Medicaid require on-site supervision -of the aide every 2 weeks, principally by an RN. Supervision by a licensed physical therapist is acceptable if skilled nursing is not involved. Private payers, however, often do not have such requirements. Aide services are sometimes provided in blocks of time ranging from 1 to 2 hours for Medicare to 8 to 24 hours for private or other payment sources.
A)true
B)false
A
95
Coordinated Care
Delegation
PATIENT BATHING
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96
Skills of bathing are often acceptable to delegate to assistive personnel (AP); however, skin and range-of-motion (ROM) assessment require the critical thinking and knowledge application unique to the nurse. As a nurse, do the following:
* Instruct the care provider what type of bath (complete, partial assist, tub, shower) is appropriate to the patient's diagnosis, needs, and ability.
* Remind the care provider to notify you of any skin integrity problems so you will make sure to inspect areas of impairment or potential impairment.
* Remind the care provider to use an organized approach and reassuring tone of voice so the patient feels safe and comfortable during bathing.
* Instruct the care provider to encourage the patient to report any concerns or discomfort during the bath.
* Instruct the care provider to encourage as much independence in the patient's self-care skills as appropriate and to provide positive feedback.
True
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THE TYPICAL HOME HEALTH PROCESS
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REFERRAL
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99
The entry point to the home health care system is by referral. This comes from the patient, the family, a social service agency, the hospital, the physician, or another agency.
A)true
B)false
A
100
Agencies have a variety of methods of intake for referrals, ranging from a formalized hospital discharge planning process with a central agency intake coordinator to a direct call from the patient's physician to the agency staff.
A)true
B)false
A
101
ADMISSION
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102
An RN makes the initial evaluation and admission visit within 24 to 48 hours of the referral. Sometimes an RN will complete this in a formal role as admission nurse, and at other times a staff nurse who will serve as the primary nurse on the case will do so.
A)true
B)false
A
103
The evaluation and admission process generally includes at least the following:
1. Complete patient evaluation, including physiical and psychosocial factors
2. Environmental assessment relating specifically to safety and ability to provide services effectively in the home
3. Identification of primary functional impairments
4. Identification of the impact of the disease or disability on the patient and the family
5. Assessment of the support system of the family or the significant other
6. Determination of knowledge and adherence to treatments and medications
7. Determination of desire for care and services
8. Involvement of the patient and the family in the development of the plan of care and goals
9. Notification to the patient of rights as a patient, along with information on costs, payment sources, and billing practices
10. Explanation of the patient's right to self-determination, including information and implementation policies for advanced directives
11. Provision of initial nursing interventions (it is necessary for the nurse to obtain an initial set of orders from the health care provider and proceed with providing the specific interventions ordered)
True
104
The admission process typically takes a minimum of 1 hour. It will take Longer if the patient is disoriented or in need of nursing interventions
A)true
B)false
A
105
CARE PLAN
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106
Agency staff drafts a treatment plan cooperatively with the physician. This plan describes the current physical status of the patient, medications, treatments, the disciplines needed to provide care, the frequency and the duration of services, the goals and outcomes, and the time frame for implementation.
A)true
B)false
A
107
The physician is required to sign the plan of treatment, which serves as the traditional physician orders. The treatment plan is possible to alter at any time (based on patient needs) through additional written, signed orders, and it is obligatory to review and renew it on a regular schedule for Medicare and Medicaid patients. It is possible to write separate care plans that are discipline specific, such as nursing and physical therapy. A separate, detailed home health aide care plan is always required.
A)true
B)false
A
108
VISITS
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109
Visits for interventions by the disciplines made in the orders serve to meet the patient-centered goals and make progress toward identified outcomes.
A)true
B)false
A
110
Skilled nursing visits typically take 30 to 45 minutes but duration potentially increases to several hours for complex procedures.
A)true
B)false
A
111
Therapy visits range from 30 minutes to 1 hour. With increasing federal pressure to decrease home care and hospice costs, and with the current Medicare PPS, clinical efficiency is critically necessary within the industry.
A)true
B)false
A
112
Telemonitored patients are "seen" daily, thereby allowing agencies to plan home visits not for regular patient assessment (such as vital signs), but to provide hands-on intervention or face-to-face teaching when necessary.
A)true
B)false
A
113
The purpose of telemonitoring is not to replace nurses, but to generate data that professional caregivers need to make critically important clinical decisions, allowing them to use their time and talents more effectively and efficiently
A)true
B)false
A
114
Aide visits average 1 to 2 hours but sometimes will be longer, depending on needs and payment source.
A)true
B)false
A
115
Revisions to the plan of care and referrals to other agencies occur during this period. Patients receive visits as infrequently as once a month for diabetic monitoring to several times a day over a short period to provide complex care.
A)true
B)false
A
116
DOCUMENTATION
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117
Throughout the care process, concise and complete documentation is essential. This documentation is sometimes handwritten and sometimes dictated or entered into a computer. A number of agencies use the problem-oriented record system-many in combination with the nursing diagnosis system.
A)true
B)false
A
118
Documentation that follows the nursing process model provides an accmate picture of the type and the quality of care. It reflects the effectiveness of the plan of care and progress toward goals and outcomes, or it reflects the nature of and the reasons for lack of progress or deterioration and includes alternative interventions. It is also necessary to document communications with the home care team and referral sources.
A)true
B)false
A
119
Staff need to recognize the record as a legal docwnent subject to close scrutiny at any time. Professional standards, accountability, and quality of care are closely linked to legal implications, as well as to internal evaluation purposes.
A)true
B)false
A
120
Reimbursement sources have a major influence on documentation requirements by setting forth specific forms and formats that are necessary to follow. Medicare requires extensive paperwork.
A)true
B)false
A
121
Selected Nursing Diagnoses for Home Health Care
,
122
Risk for infection, related to:
• Inadequate primary or secondary defenses
• Inadequate acquired immunity
• Malnutrition
Deficient knowledge related to:
• Lack of experience
• Cognition limitation
Imbalanced nutrition, less than body requirements, related to:
• Inability to ingest or digest food
• Inability to absorb nutrients
• Economic deprivation
```
Bathing/hygiene self-care deficit, related to:
• Pain
• Musculoskeletal impairment
• Decreased endurance
• Neurologic impairment
```
```
Impaired skin integrity, related to:
• Physical immobility
• Radiation
• Impaired circulation (pressure)
• Inadequate nutrition
```
Pain, related to:
• Chronic illness (e.g., rheumatoid arthritis)
• Terminal cancer
True
123
QUALITY ASSURANCE, ASSESSMENT, AND IMPROVEMENT
,
124
Assessing quality involves evaluating all aspects of the agency operation. Three major elements . are included:
1. Structural criteria: The agency's overall organization, philosophy, policies, procedures, bylaws, personnel practices, supervision, orientation, contracts, and physical facilities
2. Process criteria: Evaluation of care delivery. Authorities scrutinize the activities of the health professionals and paraprofessionals and support in the management of patient care, documentation, and patient care conferences.
3. Outcome criteria: Measurement of change in patient behavior, the results of patient care in terms of changes, health indicators, and satisfaction. Care standards and expected outcomes are an integral part of this area.
True
125
There is a move by a national accreditation body (TJC) and many businesses to redefine quality assessment activities in terms of quality improvement. Terms such as total quality management, continuous quality improvement, and quality improvement (for home care) relate to an agency-wide commitment to excellence that covers clinical and nonclinical functions.
A)true
B)false
True
126
The following major principles are involved:
* Quality of patient care and desired outcomes are possible to improve by assessing and improving governance, management, and clinical and support processes that affect patient outcomes.
* Processes are carried out by individuals (managers, clinicians, support) and jointly by these groups.
* It is necessary to coordinate and integrate processes.
* Employees of an organization are motivated and competent to carry out processes and it is appropriate to give them opportunities to continuously improve through continuing education and also cardiopulmonary resuscitation (CPR) certification
True
127
REIMBURSEMENT SOURCES
,
128
Reimbursement for home health services comes from a variety of sources, and covered services and disciplines vary. Medicare and Medicaid are major sources of income for the majority of agencies, but reliance on these sources for reimbursement has decreased in recent years.
A)true
B)false
A
129
MEDICARE
,
130
Medicare is a federal program that requires agencies to be certified as meeting the federal conditions of participation, which set forth specific requirements for orrganization, staffing, training, types of services covered, and agency evaluation.
A)Medicare
B)Medicaid
A
131
Regulations further mandate eligibility requirements. Beneficiaries of services are required to be 65 or older, disabled, or have end-stage renal disease. In addition, they have to be (1) under the care of a licensed physician, (2) homebound, and (3) in need of skilled nursing or therapy services on an intermittent basis.
A)Medicare
B)Medicaid
A
132
MEDICAID
,
133
The Medicaid program pays for home care services to indigent and low-income people of all ages. The state administers it, but both state and federal funding subsidizes it.
A)true
B)false
A
134
THIRD PARTY
,
135
Third-party insures pay for limited home care services. Coverage, requirements, and payment rates vary. Reimbursement is often tied to posthospitalization recoveries. A few progressive companies are paying for nursing and aide services for new mothers who return home within 24 hours of delivery.
A)true
B)false
A
136
A case manager (commonly a nurse or soda! worker) will determine and arrange for a mix of home care, therapy services, counseling, supplies, and equipment for a patient. The availability of these combined, paid-for services often allows earlier discharges and provides a planned approach to rehabilitation.
A)true
B)false
A
137
PRIVATE PAY
,
138
Individuals sometimes also pay directly for home health services. Possible charges range from the standard full change to scaled-down rates based on the -ability of the patient to pay.
A)true
B)false
A
139
OTHER SOURCES
,
140
Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) have negotiated contracts with home health agencies to provide services to their patients. Both organizations are prepaid health plans operated independently or through employer groups.
A)true
B)false
A
141
CULTURAL CONSIDERATIONS
,
142
Culture is present in the lives of patients, families, and health care providers and is especially apparent in the home environment. Frustration occurs when values conflict, thus increasing the complexity involved in nursing interventions.
A)true
B)false
A
143
As a nurse, you need to anticipate potential cultural problems and identify your own and other's values. Cultural health practices are acceptable to incorporate with traditional medical care in the home environment, provided it does not conflict with the prescribed treatment.
A)true
B)false
A
144
Cultural Considerations
| Breaking through Cultural Barriers to Communication
,
145
Step 1: Assess your attitudes about people from other cultures.
• Review your personal beliefs and past experiences.
• Set aside any attitudes, values, and biases that are judgmental.
Step 2: Assess communications variables from a cultural perspective.
• Learn as much as possible about the patient's cultural customs and beliefs.
• Encourage the patient to reveal cultural interpretation of health, illness, and health care.
• Be sensitive to the uniqueness of the patient.
• Identify sources of discrepancy between the patient's and your own conceptions of health and illness.
• Communicate at the patient's level of functioning.
• Assess cultural factors that have the potential to affect your relationship with the patient, and respond appropriately.
Step 3: Modify communication to meet cultural needs.
• Be attentive to signs of fear, anxiety, and confusion in the patient. Be alert for feedback that the patient is not understanding.
• Respond in a reassuring manner in keeping with the patient's cultural orientation.
• Be alert to words the patient seems to understand, and use them frequently.
• Keep messages simple, and repeat them frequently.
• Avoid using medical terms and abbreviations that the patient perhaps does not understand.
• Be aware that in some cultural groups discussion with others concerning the patient will possibly cause offense and impede nursing practices.
• Use an appropriate language dictionary. A Spanish-English equivalency chart will help in some cases.
True
146
Step 4: Respect the patient and his or her communicated needs.
• Use a kind and attentive approach to convey respect.
• Learn how people signal that they are listening in the patient's culture; then use appropriate active listening techniques.
• Adopt an attitude of flexibility, respect, and interest to help bridge barriers imposed by culture.
• Be considerate of reluctance to talk when the subject involves sexual matters; be aware that in some cultures, people do not discuss sexual matters freely with members of the opposite sex.
Step 5: Communicate in a nonthreatening manner.
• Use a caring tone of voice and facial expression to help alleviate the patient's fears.
• Speak slowly and distinctly, but not loudly.
• Conduct the interview in an unhurried manner.
• Follow acceptable social and cultural amenities.
• Ask general questions during the information-gathering stage.
• Be patient when the respondent gives information that seems unrelated to the patient's health problem.
• Develop a trusting relationship by listening carefully, allowing time, and giving the patient your full attention.
• Use gestures and pictures to help the patient understand.
• Repeat the message in different ways if necessary.
Step 6: Use interpreters to improve communication.
• Ask the interpreter to translate the message, not just the individual words.
• Obtain feedback to confirm understanding.
• Use an interpreter who is culturally sensitive.
True
147
Nursing Diagnosis
,
148
```
Possible nursing diagnoses related to the home health patient and family include the following:
• Interrupted family processes
• Impaired parenting
• Anxiety
• Caregiver role strain
• Constipation
• Impaired physical mobility
• Imbalanced nutrition: less than body requirements
• Acute confusion
• Ineffective airway clearance
• Risk for impaired skin integrity
• Compromised family coping
• Disabled family coping
• Fatigue
• Ineffective coping
• Ineffective management of therapeutic regimen
• Deficient knowledge
• Acute/Chronic pain
• Impaired home maintenance
• Risk for infection
• Social isolation
• Risk for caregiver role strain
• Risk for injury
```
True
149
CONCLUSION
,
150
Current trends support the growth of home care as an economic, humane, preferred health delivery system for many types of care.
A)true
B)false
A
151
Medical management and control rather than cure are the standard of care for many illnesses. This has increased the number of potentially debilitating chronic illnesses. Dependency and disability are more prevalent in all age-groups.
A)true
B)false
A
152
Home care provides the assessment and evaluation of chronic illnesses necessary to prevent acute episodes. Aides and homemakers have the capacity to provide necessary support in ADLs to enable the patient to remain in the home
A)true
B)false
A
153
Key Points
,
154
* Home health care allows individuals to maintain personal control and to participate in the direction of their own care.
* Families are an important part of the success of home care services as health care workers provide care, supervision, assistance, and support in attaining the care plan goals.
* A number of different professional and paraprofessional disciplines provide home care services based on a coordinated plan of care approved by a physician. Teamwork is an essential component of the concept.
* Skilled nursing care is the most frequently provided service. RNs and LPNs/LVNs under the supervision of RNs provide direct care of different levels of complexity.
* Providers of care in the home need to possess special qualities to effectively practice in this nontraditional environment.
* Home health care agencies strive to provide the highest quality of services economically. Success is evaluated through quality assurance plans.
* Home health services are reimbursed by federal, state, local, group, and private sources.
* Congress imposed new limits on home health payments through a provision of the Balanced Budget Act of 1997 (BBA) called the Interim Payment System (IPS).
* Quality assessment of safe and effective care in the home is of great significance.
* The acuity levels of patients requiring care in their homes continues to rise, and the technologic aspects of care, including use of mechanical equipment and invasive procedures such as intravenous therapies, are increasing in home care. These factors, when combined with shorter hospital stays, require extensive discharge planning to prepare patients and family for home health care.
True
155
NCLEX PREP
,
156
```
9-year-old patient recently fractured her hip and had a hemiarthroplasty (bipolar) hip repair. Her daughter works during the day but provides care in the evening. The most appropriate service agency to provide for this
patient's daily care is a/an:
1. private duty agency.
2. home health care agency.
3. nursing home facility.
4. outpatient rehabilitation agency.
```
2
157
2. A student nurse asks her nurse educator why there is an increased demand for home health care. The most accurate response by the educator is that:
1. more family members want to care for their ill members at home.
2. there is a shortage of nurses who want to work in acute hospital care settings.
3. there is an increase in the number of older patients with chronic illnesses.
4. there is increased technology in hospitals, which provokes anxiety in many patients.
3
158
3. The nurse is assigned to home health care for an 83-year-old patient with a stroke who has right-sided hemiplegia, difficulty swallowing, and speech impairment. He is receiving care in his home from his wife
and retired daughter. It is necessary for the nurse involved in administering care in their home to provide a:
1. strict regimen and care plan.
2. holistic, nonjudgmental philosophy.
3. teaching plan for all family members.
4. means of transporting the patient to his physician.
2
159
4. Nurses are aware that evolving future health care trends point to:
1. decreased reimbursement for home health care services.
2. keeping patients in the hospital longer because of the severity of their illnesses.
3. increased high-technology procedures in the home setting.
4. slowed growth in number of agencies involved in home care.
3
160
5. A 68-year-old patient is recovering from an abdominoperineal resection with a permanent colostomy. Her physician has ordered home health care nursing upon her discharge. A primary goal for home health care nursing for this patient will be to:
1. return the patient to previous lifestyle.
2. avoid dependency on medication therapy.
3. establish self-care and independence.
4. maintain a friendly relationship with family members.
3
161
6. It is necessary for a nursing supervisor for home health care to always be concerned with patient care and:
1) location of the home.
2) quality assurance.
3) method of payment.
4) number of children in the home.
2
162
7. When the home health care nurse makes arrangements for the patient to receive home care, data are collected from the:
1) home care agency.
2) patient and family members.
3) insurance company.
4. community volunteer agencies.
2
163
So Which services does a home health agency generally provide? (Select all that apply.)
1) Skilled nursing
2) Nutritional support
3) Home health aide
4) Recreational therapy
1 2 3
164
9.A major influence on home health care began in 1983. This system, based on major diagnostic categories and diagnosis-related groups, paid a set rate for the hospitalized patient's care rather than the "cost," or
charges traditionally billed by institutions. Such patients were discharged earlier in their convalescence and thus required more home nursing care. This system is called:
1.prospective payment system (PPS).
2. Medicaid.
3.Medicare.
4.Older American Act.
1
165
10. In 1997, Congress imposed new limits on home health payments through a provision of the:
1. Social Security Administration.
2. National Institutes of Health (NIH).
3. Balanced Budget Act (BBA).
4. Human and Health Services (HHS).
3
166
11. The effects of the 1997 congressional provision affected home health by:
1. increasing the number of patients served by home health.
2. decreasing the number of patients served by home health.
2
167
12. In 2000, the Health Care Financing Administration (HCFA) instituted:
1. a new payment system for home health agencies.
2. Medicare-certified agencies.
3. The Joint Commission.
4. rules governing certification of home health agencies.
1
168
13. Two major nursing considerations crucial for patients in their homes as well as in structured facilities are:
1. need for security and immediate medical direction.
2. assessment and teaching.
3. frequent peer support and independence.
4. need for administrators' and managers' availability and casual documentation.
2
169
14. The environment for home health care nursing is controlled by the:
1. physician.
2. home health nurse.
3. physical therapist.
4. patient and the family.
4
170
15.Over the past several years, technology advances have helped increase the adoption of _______________to monitor the patient's vital signs, oxygen saturation, and weight in the home for the home health agency.
A)telemornitoring
B)false
A
171
16. To qualify for coverage for home health services by Medicare, an HMO, or other insurance, it is necessary to meet which criteria? (Select all that apply.)
1. The patient needs wound care.
2. The patient has to be homebound.
3. The patient has to need intermittent skilled nursing care.
4. The patient needs to receive a vitamin B12 injection every month.
2, 3
172
STUDY GUIDE
,
173
Medicare–enacted by Title XVIII of the Social Security Act, provided direct fed- eral money for health care of all citizens 65 and older (or disabled) regardless of socioeconomic status.
A)true
B)false
A
174
Medicaid–enacted by Title XIX of the Social Security Act, provided for health care needs of the poor and indigent of all ages.
A)true
B)false
A
175
For the older adult, the nurse is aware that there is an increased need for services, they are leaving the hospital earlier and sicker, stress is reduced if care is received in a familiar environment (home), and there are a variety of services that may meet the needs of this population
A)true
B)false
A
176
Voluntary–public, nonprofit, such as a visiting nurse association, governed by a community-based board of directors
A)true
B)false
A
177
Official–public, nonprofit, such as a state or county health department, governed by the state or local unit of government and a volunteer board of area representatives
A)true
B)false
A
178
Proprietary–private, for profit, such as “Home Care of XXX,” governed and owned by an individual or corporation
A)true
B)false
A
179
Regulations that must be followed, depending on the status of the agency, are licensure or certification by the state, certificate of need, and/or accreditation by an outside agency.
A)true
B)false
A
180
Changes occurring in home health care include the establishment of ethics committees, social workers taking a more active role, employment of nurse pain specialists, separate Medicare certification for hospice services, pet care programs, electronic home visits (com- puters), more patients with AIDS, and expan- sion of home infusion therapy.
A)true
B)false
A
181
Factors that have increased the need for home health care are advances in medical treatment that allow patients to survive serious problems and live longer, the extent of chronic disease, the growing aged population, rising cost of acute care services, deinstitutionalization of technology-dependent children and adults, and the emphasis on health promotion.
A)true
B)false
A
182
Telemonitoring in home care includes computerized systems that can access such measurements as standard vital signs, blood values, and ECGs through the use of digital cameras and video phones.
A)true
B)false
A
183
The types of services typically offered by home health care agencies include skilled nursing, physical therapy, speech-language therapy, occupational therapy, social services, homemaker/home health aides, and other supportive services.
A)true
B)false
A
184
Skilled nursing care is provided and directed by licensed registered nurses.
A)true
B)false
A
185
The role of the LPN/LVN in home care is to work under the supervision of the RN and provide observations, reports, documentation, teaching, technical care (catheter care, wound care, injections, and so on).
A)true
B)false
A
186
Home health care referrals usually come from the patient, family, social service agency, hospital, physician, or another agency. Hospitals may have formal discharge planning processes.
A)true
B)false
A
187
Once the patient is referred, the process is admission, development of the care plan, scheduling of visits, documentation, and discharge.
A)true
B)false
A
188
Admission to the home health care agency includes a complete patient evaluation, environmental assessment, identification of primary problems, family/support person assessment, determination of level of knowledge about care, involvement of the patient in the plan, notification of patient rights, costs, billing, and information on advance directives.
A)true
B)false
A
189
The documentation that is used frequently in home care is a problem-oriented record system that follows the nursing process. Documentation may be done by hand, dictation, or entered into a computer.
A)true
B)false
A
190
The major principles of total quality management (TQM) or quality improvement (QI) are improvement in the quality of patient care and desired outcomes by assessing and improving processes that affect these outcomes, processes are carried out by individuals and groups, processes must be coordinated and integrated, and employees are motivated and competent to carry out the processes.
A)true
B)false
A
191
The steps used to break through cultural barriers to communication are:
* Assessing your attitudes about people from other cultures
* Assessing communication variables using a cultural perspective
* Planning care based on the communicated needs and cultural background
* Modifying communication to meet cultural needs
* Respecting the patient and the communicated needs
* Communicating in a nonthreatening manner
* Using interpreters to improve communication
True
192
Delegation of interventions to assistive personnel in the home can include: provision of hygienic care and assistance with other activities of daily living, measurement of vital signs, glucose monitoring, and medication administration/supervision.
A)true
B)false
True a
193
In 1997, the Balanced Budget Act was passed that put into effect the Interim Payment System (IPS) that imposed lower per-visit limits and per-beneficiary limits on home health care (based on 1994 spending). This created a massive reduction in costs, but also resulted in the closure of thousands of home health agencies that could not afford to repay the government for overpayments.
A prospective payment system was also put into place for implementation in October 2000, which will have an effect on the approach to delivery of home care because of the cost-based reimbursement system.
A)true
B)false
A
194
Medicare and Medicaid require that the plan of treatment is signed by the physician and outlines all of the disciplines, treatments, and the frequency and duration of care.
A)true
B)false
A
195
The service goals of home health nursing are;
- restorative
- improvement
- maintenance
- promotion
True
196
The home health nurse will refer the patient who requires promotion of independence with the use of self help device to the
A) Social worker
B) Occupational therapist
C) Physical therapist
B
197
Home health nurse should provide safety information to the patient and family members for home oxygen use. That information should include:(Select all that apply)
A) No smoking signs should be posted on the front and back doors
B) Frequent oral hygiene is necessary owing to the drying of mucus membranes
C)Only rule blankets should be used by the patient
A B
198
Key terms
,
199
Accreditation-Process where by a professional association or nongovernmental agency grants recognition to a institute or an agency for demonstrated ability in a special area of practice
A)true
B)false
A
200
Certification-Process in which an individual or institution, agency, or educational program is evaluated and recognized as meeting certain predetermined standards
A)true
B)false
A
201
Diagnose related groups-System that classifies patients by age, diagnosis, and surgical categories, used to predict the use of hospital resources, including the length of stay
A)true
B)false
A
202
Home healthcare-Services that enable individuals of all ages to remain in the comfort and security of their homes while receiving healthcare
A)true
B)false
A
203
EXTRA INFORMATION
,
204
In 1983, the system of Medicare reimbursement played a major role in that increased me for home healthcare in the United States
A) Diagnosis related groups
B) Balance budget act
A
205
The speech- language therapist works with the home care patient on task including
A) Swallowing issues
B) Feeding oneself
A
206
This method of reimbursement is available to individuals who are disabled or of low income
A) Medicaid
B) Medicare
A
207
So that the patient can plan accordingly, the nurse tells the home health patient that a skilled nursing visit typically last
A)30-45 mins
B)1-2 hours
A
208
The most important benefit of home health care is that
A) It preserves individual independence and integrity and keep families together
B)false
A
209
Who sets the rules for governing of certification of home health care agencies
A) The federal government
B) Third-party payers insurance
A
210
The goal of restorative care is to assist the patient
A) Returning to the level of functioning prior to the present illness
B)false
A
211
Home health care is viewed from different perspectives. Which perspective is defined as skilled and compassionate care provided on a one-to-one basis, based on individual needs and personalized schedules?
A) Official
B) Patient
B
212
IV therapy is a growing segment of home health. Three of the most common forms of home IV therapy include:
A)Antibiotics
B)Hydration
C)Total parental nutrition (TPN)
A B C
213
In the home care setting, which type of service is most frequently provided?
A)Skilled nursing
B)Physical therapy
A
214
The main reason an increased number of debilitating chronic illnesses are now seen in home health care settings is:
A)More illnesses are being managed than cured.
B)Home health provides better services.
A
215
Which of the following diagnoses is seen most commonly in home care patients?
A)Diabetes mellitus
B)Renal failure
A
216
A nurse is in the home setting caring for a patient with COPD who is on 2 liters of oxygen continuously. Which of the following statements by the patient indicates a need for further education?
A)I wash my face before I go to be at night.
This statement warrants further teaching. The patient should remove the tubing and wash and dry the skin 2 to 3 times a day to stimulate circulation to those skin areas.
B)I am to use water-based gel on my lips."
A
217
When a patient has been referred for home health services, the first step completed by the nurse is to:
A)Perform an initial assessment for admission
B)Receive payment approval
A
218
A growing number of older adults need home care services. When the admission nurse is developing an older patient's plan of care, it is important for the nurse to:
A)Consider the physical strength and functional abilities when making modifications to the home environment.
B)Focus only on the older patient's disabilities and reasons for needing home care.
A
219
The two major skills needed for a nurse working in the home care setting are:
A)Assessment and teaching
B)Communication and documentation
A
220
A nurse working in the home care setting understands that the integral parts of providing effective nursing services include respecting the patient's privacy, understanding the need for autonomy, and:
A)Respecting the patient's dignity
B)Understanding the patient's concerns
A
221
Home health nursing -Family support, familiar surroundings, and participation in the care process contribute to feelings of work and dignity
A)true
B)false
A
222
Official-Services are provided to individuals and their families in their place of residence for the purpose of promoting, maintaining, or restoring health or minimizing the effects of illness and disability
A)true
B)false
A
223
Diagnosis related groups-Congress enacted this prospective payment system in 1983 as a part of the tax equity and fiscal responsibility act for hospitals receiving Medicare reimbursement
Based on major diagnostic categories, a set rate is paid for the hospitalized patient care rather than the cost or charges traditionally billed by institutions
A)true
B)false
A
224
One of the most rapid growing segments in home health is home infusion therapy
A)true
B)false
A
225
Skilled nursing-This is provided and directed by currently licensed registered nurse. Basic nursing services may be provided by the LVN under the supervision of the RN.
SERVICE GOALS
Restorative, improvement, maintenance, promotion
Nurses practicing in the home health setting must be technically proficient, self-motivated, innovative, and independent decision-makers
True Skilled nursing
226
Speech language therapy-Independent functioning a maximum rehabilitation of speech and language abilities are primary treatment goals
A)true
B)false
A
227
Occupational therapy-Services deal with life's practical task.
SERVICES INCLUDE
Techniques to increase independence, design, fabrication, and fitting of orthotic or self-help devices, and assessment of vocational training
Trye
228
Home health aide-The aid provides the basic support services that can enable an elderly individual, disabled adult, or dependent child to remain at home.
Most aide services fall into one of three categories;
1. Personal care
2. Physical assistance
3. Household chores
True
229
Referral-Entry point into the home health care system. Can come from the patient, family, social service agency, hospital, physician, or another agency
A)true
B)false
A
230
The evaluation and admission process generally include at least of the following;
- Complete patient evaluation
- Environmental assessment
- Identification of primary functional impairments
- Assessment of the family or significant other support system
- Determination of knowledge and adherence to treatment and medication
True
231
Documentation-It provides an accurate picture of the type and quality of care and reflect the effectiveness of the plan of care and progress towards goals and outcomes or the reason for lack of progress
A)true
B)false
A
232
Discharge planning- Planning begins with a mission. The purpose of discharge planning is to promote continuity of care in the patient's home
A)true
B)false
A
233
Quality assessment plans reflect standards, objectives, and measure outcomes and include plans for remediation or improvement as integral part of the process
A)true
B)false
A
234
Medicare- Beneficiaries of service must be 65 or older, disabled, or have end-stage renal disease
A)true
B)false
A
235
A case manager will determine and arrange for a mix of home care, therapy services, counseling, supplies, and equipment for a patient
A)true
B)false
A
236
Skilled nursing and therapy of rehabilitation and prevention of deterioration, as well as methods to cope with physical changes
A)true
B)false
A
237
Home health nursing -Family support, familiar surroundings, and participation in the care process contribute to feelings of work and dignity
A)true
B)false
A
238
Official-Services are provided to individuals and their families in their place of residence for the purpose of promoting, maintaining, or restoring health or minimizing the effects of illness and disability
A)true
B)false
A
239
A case manager will determine and arrange for a mix of home care, therapy services, counseling, supplies, and equipment for a patient
A)true
B)false
A
240
Skilled nursing and therapy of rehabilitation and prevention of deterioration, as well as methods to cope with physical changes
A)true
B)false
A
