Test 3 Review Flashcards
what organization regulates nursing homes?
the office of long term care (OLTC)
what % of those over 65 live in a nursing home?
5%
does medicare pay for short term rehab?
yes, but a lifetime max of 30 days
inpatient rehab facilities are also called?
acute care
what is an inpatient rehab facility
provides comprehensive rehab and medical management for conditions such as joint surgery, stroke, TBI
what requirement does someone need to meet to stay in an inpatient rehab facility?
they have to meet certain established progressive goals
physiatrist
rehab physician, leads an inpatient rehab facility
residential housing
either independent or assisted living facility
independent living facilities are usually?
upscale retirement homes
assisted living facilities
adults that need supervision but not a skilled nursing facility or around-the-clock care (RTC)
-the care is contracted by the individual, and must meet certain requirements (ex-in AR you must be able to independently use the toilet)
MD vs DO
MD-medical doctor, uses allopathic medicine, focused on diagnosis and treatment of disease
DO-doctor of osteopathic medicine, uses holistic approach, has a more preventive emphasis
urgent care clinics
designed for non life threatening situations (minor injuries/illness, routine care, simple testing and imaging)
-sometimes called “doc in a box” b/c they are usually doctors that want to get away from a hospital or a normal clinic
minute clinics
type of urgent care clinic, gaining traction for convenience (CVS, Walgreens, Walmart)
free/charitable clinics
usually locally funded and serve the underserved and low income populations
ex-Jonesboro Church Health Clinic
county health unit
run independently by each county with state oversight from the Department of Health
-serve the underserved with immunizations, WIC, TB surveillance, control diseases
federally qualified health centers are also called?
community health centers
federally qualified health centers do what?
provide low cost care to underserved and low income populations
-provide primary care, lab testing, OB/GYN services, and dental services
durable medical equipment
DME
must be pre-approved for purchase by a physician to get it, ranges from wheelchairs, beds, diabetic shoes, etc
outpatient services
care delivered outside a hospital that shortens hospital stays and after care
- most diagnostic services and treatments are outpatient
- increases profit margin because they see more people quicker and use less resources
managed care
the way insurance companies manage their enrollees
outside laboratories
walk-in labs where testing is done (ex-drug screening for jobs)
- decreases length of stay, add convenience, decrease cost
- blood donation, HIV screens, at home test kits (pregnancy, etc)
outpatient surgery
simple procedures and tests with lower risks of complications performed outside the hospital, no 24-hr care provided and can be specialized
audiologist
deals with hearing loss and hearing related problems
speech pathology
work with patients that have reduced ability to speak
-can come from congenital defects, developmental defects, defects acquired through injury, and defects acquired through chronic disease
pain management clinics
handle acute or chronic pain, and palliative care physicians handle EOL care
primary care medical home
PCMH
team based approach that offers comprehensive and coordinated outpatient care
-improves access to care, quality, and safety
-physicians are paid capitation
what is the biggest problem in elder care?
failure to plan
-they don’t plan out what they want at the end of life, and no one knows what they want
covered service
a service that Medicare covers only if it is deemed reasonable and necessary
home health requirements for medicare
- must have a doctor
- must be under a plan of care and reviewed regularly
- must be homebound
- must have a skilled need
- the agency must be approved
homebound
leaving isn’t recommended, conditions prevent them from leaving without help, or leaving takes taxing effort
-required to receive home healthcare
episode of care
60-day covered service by medicare, goal is to reduce cost
skilled need
intermittent care, PT, OT, speech pathology, etc that a patient must need one or more of in order to be considered for home healthcare
skilled nursing care
intermittent care by an RN or LPN given to a medicare patient if they are homebound
-IV drugs, tube feedings, wound care
aide services
services such as laundry, bathing, cleaning, etc that are only provided if skilled nursing care is present and it is needed
medical and social services
they take care of social and emotional concerns (such as counseling, reported abuse and neglect, etc)
home health plan of care
must meet certain needs and be certified by a doctor, an assessment determines the number of weekly visits and the care plan
what does medicare NOT cover?
24-hour care, meal delivery, homemaker services, and personal care
homemaker services
“sitter” services such as shopping, cleaning, and laundry if unrelated to the diagnosis medicare does not cover it
personal care
bathing, dressing, etc if unrelated to diagnosis medicare does not cover it
home health advance beneficiary notice
HHABN
gives the patient the right to continue treatment knowing they will have to pay for it
hospice
care and support for people that are terminally ill and their families, and the main focus is comfort
- IDT meetings are required with all staff input
- a nurse and doctor are on call 24/7
respite care
short term inpatient care that gives the caregiver a break, can be up to 5 days at a time
hospice benefit
care paid by Medicare on a per diem (day) basis, no deductible to patient
-when you switch to hospice benefit you revoke medicare, and you can choose to go back to medicare but must revoke hospice benefit
benefit periods for hospice
two 90-day periods followed by unlimited 60-day periods, have to be re-certified by a doctor
how many physicians must certify you for hospice before you are admitted?
2
what is the fastest growing job industry?
in home elderly care
basic research
pure quest for knowledge, can end up with no practical application
applied research
science with a direct goal in mind
translational research
type of applied research that focuses on applying science to illness
clinical research
scientific research involving human subjects
epidemiology
using statistics about a population to investigate relationship between exposure and disease
biostatistics
design, data collection, and analysis of studies on living organisms
health services research
focuses on effectiveness of health systems
academic institutions and funding research
universities and medical colleges employ a large % of research scientists, and they will fund 20% of research
IRB
institutional review board-peer review and approve protocols and consent forms to protect human subjects
4 Phases of Drug Trials
- small group of healthy volunteers to test safety
- small group of people with the target disease to test if it works
- larger population of people with disease against people with a placebo to test effectiveness
- post approval monitoring of side effects
intellectual property
protection given to new drugs such as patents and data exclusivity
formulary
list of prescription drugs approved for use in healthcare institutions
clinical guidelines
reference guide for what the best available evidence says the provider should do in a given situation
advance care planning
discussing the options for end of life treatment, or treatment in case you are unable to speak for yourself
advance directive
legal document noting what treatment you want that only goes into effect once you are unable to speak for yourself
who is Kubla Ross?
they invented the 5 stages of death
5 Stages of Death
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Hill-Burton Act of 1946
established community hospitals and provided the first access to care
why is the average person not prepared for high-level decision making?
low health literacy
healthcare proxy/surrogate
person who speaks for you when you are unable to
POLST
physician ordered life sustaining treatment
-document signed by the patient and doctor that gives patients more control over what life sustaining treatments they want, also helps prevent unwanted and ineffective treatments
what is the definition of EOL care?
assisting and providing support to someone in end-stage disease process
diseases other than cancer that are used to admit to hospice?
end stage cardiovascular disease, kidney or liver failure, COPD, failure to thrive, etc
who does hospice extend to beyond the patient?
family system and primary caregiver
family system
anyone that a client identifies as important or supportive
primary caregiver
one person designated by the patient, usually a health professional (case manager) but can be someone else
hospice settings
home, long term inpatient, acute care, hospital, standalone facility
which setting is the principal setting in the U.S. for hospice care?
the home
disciplines involved in hospice
nurses, social workers, doctors, chaplains, volunteers, PTs, etc
common symptoms observed in hospice patients besides chronic pain
nausea and vomiting, decubitus ulcers, skin breakdown, respiratory problems
ABCDE of Palliative Care
A-Advance Prep B-Build therapeutic environment C-Communicate well D-Deal with patient and family reactions E-Encourage and validate their emotions
what did the Dying in America Report find?
improving quality and availability of medical and social services for patients and families can enhance quality of life and improve the care system
by 2020, how many people will be living with at least 1 chronic illness?
157 million
how many people could benefit from palliative care?
6 million
how many people die from chronic disease?
7/10
what was the first insurance?
Western Clinic in Tacoma, WA during civil war (1910-1929) that offered coverage to mill owners and employees for 50 cents a month
health maintenance organization
HMO
provides managed care and acts as liaison with providers on a capitation basis
accountable care organization
ACO
groups of doctors, hospitals, etc that come together to give coordinated care to medicare patients, and they share the savings
general principle of health insurance?
spread risks over a large population and the population pays enough to fund the group overall
health savings account
HSA
separate account where employer and employee can contribute certain amount per year
employer mandate of ACA
business with 100+ employees must offer care, and if the employee qualifies for a subsidy through the market, the employer must pay $2000 on each employee over 30 employees
nursing homes are also called?
skilled nursing facility (SNF)
how is care in a nursing home different than in a hospital?
a nursing home has a higher nurse to patient ratio and is able to provide more comprehensive RTC care
