Chapter 1 Introduction to Health Care Agencies
<ul><ul><li>The person is always the focus of care. </li></ul></ul><ul><ul><li>Staff members have special talents, knowled...
<ul><li>AGENCY PURPOSES </li></ul><ul><ul><li>The purposes of health care are: </li></ul></ul><ul><ul><ul><li>Health promo...
Get into your Groups! <ul><li>Health care is provided in a variety of settings.  </li></ul><ul><li>Describe the type of ca...
<ul><li>TYPES OF AGENCIES </li></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Rehabilitation and subacute care agen...
<ul><li>ORGANIZATION </li></ul><ul><ul><li>An agency has a governing body called the board of trustees or board of directo...
<ul><ul><li>Nursing service </li></ul></ul><ul><ul><ul><li>The director of nursing (DON) is an RN. </li></ul></ul></ul><ul...
<ul><li>THE NURSING TEAM </li></ul><ul><ul><li>The nursing team involves those who provide nursing care. </li></ul></ul><u...
<ul><li>NURSING CARE PATTERNS </li></ul><ul><ul><li>The pattern used depends on how many persons need care, the staff, and...
<ul><li>PAYING FOR HEALTH CARE </li></ul><ul><ul><li>Private insurance is bought by individuals and families. </li></ul></...
<ul><ul><li>Medicare is a federal health insurance program for persons 65 years of age or older. </li></ul></ul><ul><ul><u...
<ul><ul><li>Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid. </li></ul></ul><ul><ul>...
<ul><ul><li>Managed care </li></ul></ul><ul><ul><ul><li>Managed care deals with health care delivery and payment. </li></u...
<ul><li>MEETING STANDARDS </li></ul><ul><ul><li>Standards are set by: </li></ul></ul><ul><ul><ul><li>The federal and state...
<ul><ul><li>Surveys are done to see if the agency meets set standards. </li></ul></ul><ul><ul><li>If standards are met, th...
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Ch 1 ppp, v7 with groups

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Ch 1 ppp, v7 with groups

  1. 1. Chapter 1 Introduction to Health Care Agencies
  2. 2. <ul><ul><li>The person is always the focus of care. </li></ul></ul><ul><ul><li>Staff members have special talents, knowledge, and skills. </li></ul></ul><ul><ul><ul><li>All work to meet the person’s needs. </li></ul></ul></ul>
  3. 3. <ul><li>AGENCY PURPOSES </li></ul><ul><ul><li>The purposes of health care are: </li></ul></ul><ul><ul><ul><li>Health promotion </li></ul></ul></ul><ul><ul><ul><ul><li>The goal is to reduce the risk of illnesses. </li></ul></ul></ul></ul><ul><ul><ul><li>Disease prevention </li></ul></ul></ul><ul><ul><ul><li>Detection and treatment of disease </li></ul></ul></ul><ul><ul><ul><li>Rehabilitation and restorative care </li></ul></ul></ul><ul><ul><li>Many agencies are learning sites for students. </li></ul></ul><ul><ul><ul><li>The students assist in the purposes of health care. </li></ul></ul></ul>
  4. 4. Get into your Groups! <ul><li>Health care is provided in a variety of settings. </li></ul><ul><li>Describe the type of care provided in: </li></ul><ul><ul><li>hospitals </li></ul></ul><ul><ul><li>rehabilitation and subacute care agencies </li></ul></ul><ul><ul><li>long-term care centers </li></ul></ul><ul><ul><li>mental health centers </li></ul></ul><ul><ul><li>home care agencies </li></ul></ul><ul><ul><li>hospices. </li></ul></ul><ul><li>You have 5 minutes…Be ready to share with the entire class! </li></ul>
  5. 5. <ul><li>TYPES OF AGENCIES </li></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Rehabilitation and subacute care agencies </li></ul></ul><ul><ul><li>Long-term care centers (nursing homes, nursing facilities, nursing centers) </li></ul></ul><ul><ul><ul><li>Skilled nursing facilities (SNFs) </li></ul></ul></ul><ul><ul><li>Assisted living residences </li></ul></ul><ul><ul><li>Mental health centers </li></ul></ul><ul><ul><li>Home care agencies </li></ul></ul><ul><ul><li>Hospices </li></ul></ul><ul><ul><li>Health care systems </li></ul></ul>
  6. 6. <ul><li>ORGANIZATION </li></ul><ul><ul><li>An agency has a governing body called the board of trustees or board of directors. </li></ul></ul><ul><ul><ul><li>The board makes policies. </li></ul></ul></ul><ul><ul><ul><li>An administrator manages the agency. </li></ul></ul></ul><ul><ul><ul><li>Directors or department heads manage certain areas. </li></ul></ul></ul><ul><ul><li>The health team (interdisciplinary health care team) involves the many health care workers whose skills and knowledge focus on the person’s total care. </li></ul></ul><ul><ul><ul><li>The goal is to provide quality care. </li></ul></ul></ul><ul><ul><ul><li>The person is the focus of care. </li></ul></ul></ul>
  7. 7. <ul><ul><li>Nursing service </li></ul></ul><ul><ul><ul><li>The director of nursing (DON) is an RN. </li></ul></ul></ul><ul><ul><ul><ul><li>The DON is responsible for the entire nursing staff. </li></ul></ul></ul></ul><ul><ul><ul><li>Nurse managers assist the DON. </li></ul></ul></ul><ul><ul><ul><li>Nursing areas usually have charge nurses for each shift. </li></ul></ul></ul><ul><ul><ul><li>Staff RNs report to the charge nurse. </li></ul></ul></ul><ul><ul><ul><li>LPNs/LVNs report to staff RNs or to the charge nurse. </li></ul></ul></ul><ul><ul><ul><li>You report to the nurse supervising your work. </li></ul></ul></ul><ul><ul><ul><li>Nursing education (staff development) is part of nursing service. </li></ul></ul></ul>
  8. 8. <ul><li>THE NURSING TEAM </li></ul><ul><ul><li>The nursing team involves those who provide nursing care. </li></ul></ul><ul><ul><ul><li>Registered nurses </li></ul></ul></ul><ul><ul><ul><li>Licensed practical nurses and licensed vocational nurses </li></ul></ul></ul><ul><ul><ul><li>Nursing assistants </li></ul></ul></ul>
  9. 9. <ul><li>NURSING CARE PATTERNS </li></ul><ul><ul><li>The pattern used depends on how many persons need care, the staff, and the cost. </li></ul></ul><ul><ul><li>Functional nursing focuses on tasks and jobs. </li></ul></ul><ul><ul><li>Team nursing involves a team of nursing staff led by an RN. </li></ul></ul><ul><ul><li>Primary nursing involves total care. </li></ul></ul><ul><ul><li>Case management is like primary nursing. </li></ul></ul><ul><ul><ul><li>A case manager (an RN) coordinates a person’s care. </li></ul></ul></ul><ul><ul><li>Patient-focused care is when services are moved from departments to the bedside. </li></ul></ul>
  10. 10. <ul><li>PAYING FOR HEALTH CARE </li></ul><ul><ul><li>Private insurance is bought by individuals and families. </li></ul></ul><ul><ul><li>Group insurance is bought by groups or organizations for individuals. </li></ul></ul>
  11. 11. <ul><ul><li>Medicare is a federal health insurance program for persons 65 years of age or older. </li></ul></ul><ul><ul><ul><li>Some younger people with certain disabilities are covered. </li></ul></ul></ul><ul><ul><ul><li>Part A </li></ul></ul></ul><ul><ul><ul><li>Part B </li></ul></ul></ul><ul><ul><li>Medicaid is a health care payment program sponsored by the federal government and operated by the states. </li></ul></ul>
  12. 12. <ul><ul><li>Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid. </li></ul></ul><ul><ul><ul><li>Diagnosis-Related Groups (DRGs) are for hospital costs. </li></ul></ul></ul><ul><ul><ul><li>Resource Utilization Groups (RUGs) are for SNF payments. </li></ul></ul></ul><ul><ul><ul><li>Case Mix Groups (CMGs) are used for rehabilitation centers. </li></ul></ul></ul><ul><ul><ul><li>Home Health Resource Groups (HHRGs) are used for home health care. </li></ul></ul></ul>
  13. 13. <ul><ul><li>Managed care </li></ul></ul><ul><ul><ul><li>Managed care deals with health care delivery and payment. </li></ul></ul></ul><ul><ul><ul><li>Managed care limits: </li></ul></ul></ul><ul><ul><ul><ul><li>The choice of where to go for health care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>The care that doctors provide </li></ul></ul></ul></ul>
  14. 14. <ul><li>MEETING STANDARDS </li></ul><ul><ul><li>Standards are set by: </li></ul></ul><ul><ul><ul><li>The federal and state governments </li></ul></ul></ul><ul><ul><ul><li>Accrediting agencies </li></ul></ul></ul><ul><ul><li>An agency must meet standards for: </li></ul></ul><ul><ul><ul><li>Licensure </li></ul></ul></ul><ul><ul><ul><li>Certification </li></ul></ul></ul><ul><ul><ul><li>Accreditation </li></ul></ul></ul>
  15. 15. <ul><ul><li>Surveys are done to see if the agency meets set standards. </li></ul></ul><ul><ul><li>If standards are met, the agency receives a license, certification, or accreditation. </li></ul></ul><ul><ul><li>When problems (deficiencies) are found: </li></ul></ul><ul><ul><ul><li>The agency is given time to correct them. </li></ul></ul></ul><ul><ul><ul><li>The agency can be fined for uncorrected or serious deficiencies. </li></ul></ul></ul><ul><ul><ul><li>The agency can lose its license, certification, or accreditation. </li></ul></ul></ul>

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