2. Learning Objectives
• Explain the primary purpose of ambulatory care
• Identify the features of nursing primary care
• Discuss the growth of home care
• Describe the role of the nurse in home care
• Identify interventions for which Medicare pay in home care
• State the purpose of OASIS in home care
• Compare and contrast the common types of long term care
settings
• Differentiate assisted-living from other types of long term
care
• Describe the term transitional care
3. Community Based Care
• Ambulatory Care
• Is community settings like physician offices, hospitals, or
freestanding outpatient clinics, freestanding surgicenters, HMO
(health maintenance organizations
• Purpose is health promotion, health protection (illness
prevention), short-term treatment (i.e surgery), and follow-up for
existing health problem
• Visits are Episodic or can be Periodic for chronic health condition
• RN role
– Client education
– Health screening
– Comprehensive Assessment
– Telephonic Case Management
4. Community Based Care
• Nursing Primary Care
• Takes place in ambulatory care settings
sometimes called community centers
• Sometimes affiliated with large university
schools of nursing
• Primary health care providers are nurse
practitioners, midwives, clinical nurse
specialist
5. Home Care
• Preferred health care setting
• Lowest cost setting
• Promote, maintain, or restore health or maximize the level of
independence while minimizing effects of disability and illness
• Continued shift
• Increased acceptance as viable alternative
• Baby boomers becoming more involved in decision making process
• Aging has increased need for health care
• Technology allow client to remain safely at home like apnea
monitors
• Lower cost
• Increased managed care that dictates lower cost
6. RN role in Home Care
• Draw on existing resources
• Create resources thru use of family and
community support system
• Adult health care (medical-surgical), pediatric
care, perinatal care, geriatric care, behavioral
health care
7. Medicare & Home Care
• Beneficiary meets one or more of qualifying
conditions:
• Confined to the home
• Service are provided under a plan of care and
approved by physician
• Client is under the care of a physician
• Client needs skilled nursing care on an
intermittent basis or needs
physical, speech, and or occupational services
8. Medicare & Home Care
• Medicare pays for any or all of the following skilled nursing
services:
• Observation & assessment of client’s condition
• Management and evaluation of a client care plan
• Teaching and training activities
• Administration of medications and IV fluids
• Nasopharyngeal and tracheostomy suctioning
• Urinary catheters
• Wound care
• Ostomy care
• Rehabilitation nursing
• Psychiatric evaluation, therapy and teaching
9. Outcomes and Home Care
• Regulations require Medicare-certified home care
agencies to track and report client outcomes
• The Research-based tool for outcome tracking is called
Outcome & Assessment Information Set (OAISIS) The
report card for performance
• These outcome measures are the crux of Outcome
Based Quality Improvement, a systematic approach
that home care agencies can implement & follow for
CQI
• Before OASIS was uniform data set to track their own
outcomes and compare them to similar agencies
10. Types of Long Term Care Settings
• Residential Facilities
• Assisted Living Facilities
• Nursing Homes
– Intermediate
– Skilled nursing care
– Chronic or Extended care
11. Transitional Care
• Transitional Care Units or Sub-acute Care
Units are designed for client who are too ill to
be discharged from the hospital to a
traditional nursing home or the client home
