Реферат: Health Care Essay Research Paper America has

Health Care Essay, Research Paper

America has a highly developed health care

system, which is available to all people. Although it can be

very complex and frustrating at times it has come a long

way from the health care organizations of yesterday.

Previously most health care facilities were a place where

the sick were housed and cared for until death. Physicians

rarely practiced in hospitals and only those who were

fortunate could afford proper care at home or in private

clinics. Today the level of health care has excelled

tremendously. Presently the goal of our health care is to

have a continuum of care for the patient, one which is

integrated on all levels. Many hospitals offer a referral

service or discharge plan to patients who are being

discharged. Plans for the patient are discussed with a

discharge planner. The discharge planner is a person who is

trained in assessing what the patient’s requirements for

health care will be after discharge from the hospital. This

enables the patient to continue! their care at a level which

is most appropriate for them. Items reviewed for discharge

planning include but are not limited to therapies, medication

needs, living arrangements and identification of specific

goals. A few of the options that are available for persons

being discharged from an acute care hospital can include

home health care, assisted living facilities, long term care or

hospice Home Health Care According to Growing Old in

America (1996), «Home health care is one of the fastest

growing segments of the health care industry» (p. 114).

Alternatives for home care can meet both the medical and

non-medical needs of a patient. These services are

provided to patients and their families in their home or

place of residence. Home care is a method of delivering

nursing care and other therapies as required by the patient’s

needs. Numerous alternatives are available for persons

seeking health care at home. With transportable

technologies such as durable medical equipment, oxygen

supply and intravenous fluids there are countless

possibilities for treatment within the home setting. As stated

in The Continuum of Long Term Care «Home health

programs range from formal organizations providing skilled

nursing care to relatively informal networks that arrange

housekeeping for friends» (p. 185). This has allowed for

home care to quickly become an essential component of

the health c! are delivery system in the United States. In a

home health care situation the primary care giver is usually

not the physician. The physician is communicated with by

phone and with documentation from the caregivers. The

primary caregivers are usually the nurses and other team

members who are involved directly with the patient’s care.

Although, the original order to begin home care must be

initiated by the physician if skilled care is to be obtained.

According to the 1995 Guide to Health Insurance for

People with Medicare «Medicare pays the full cost of

medically necessary home health visits by a

Medicare-approved home health agency» (p. 5). This

coverage must meet specific criteria, but it can be a relief to

family members to know that their loved ones can be taken

care of at home without worrying about the expenses.

Unfortunately, if the care to be given within the home is

termed «not medically necessary» the expense is not

covered. This can include items such as meal and

medication delivery, a percentage of necessary durable

medical equipment, personal care and homemaker

services. My employment within a home health care agency

has allowed for review of services that are not covered by

Medicare and/or private insurance. Health care services

that are not included can become quite numerous. It is

often difficult for family members to understand why

specific services are not covered especially when they

appear to be necessary for the care of the patient. These

costs can add up quite quickly and the impact of the cost

can become quite distressing for family members and

patients on a limited budget. In these cases a Social

Worker is usually provided to help the patient and family

explore other avenues which may enable them to cover

their health care costs. Assisted Living Assisted living is an

arrangement to residents of a facility that enables them to

complete certain daily activities while remaining

independent. The services provided enable the resident to

achieve maximum function of their activities of daily living.

The services are unskilled and non-specialized personnel

provide the activities essential to the care of the resident.

These services help assist the aged, blind, disabled, and

other functionally limited individuals with necessary daily

activities which they require help with or are unable to

perform on their own. An example of some of the services

which may be available are light housekeeping, meal

preparation, medication reminders and personal care. The

personal care does not include specific health oriented

services which would require the services of a certified or

licensed professional. It is stated well in Aging «Although

the level of services provided may vary, assisted living

communities all share a common goal: e! nabling people to

live as active and independent a life as possible» (p. 212).

The goal of an assisted living facility is to have the residents

feel independent within their own home. According to the

article Assisted Living’s Future In Michigan Debated

«Assisted living facilities can offer consumers a great

opportunity to get personalized care in a comfortable

setting» (p. 2). Currently there is some controversy

surrounding the different types of assisted living facilities. In

Michigan facilities termed assisted living have no real legal

meaning and are not required to be licensed under this

name. According to the article Assisted Living’s Future In

Michigan Debated «Unlicensed facilities, unsubsidized care,

untrained staff, and unmet promises make some places

seem more like un-assisted living» (p. 1). Unfortunately

many facilities are misleading as to what level of care they

are providing. Both the government and national

organizations are currently addressing this issue. My own

experience with an assisted living facility has been quite

good. Formerly my grandmother was a resident of an

assisted living facility. The facility was specifically built for

seniors and was that of an apartment like structure. The

facility provided social and recreational activities on a

continual basis. There was also transportation service

available for residents who wished to use it. My

grandmother thoroughly enjoyed living in an assisted living

facility where she had the opportunity to make numerous

friends, participate in activities and remain independent.

Long Term Care Long-term care patients are categorized

by having a chronic condition and/or disease. The

long-term care facility can be either hospital-based or

freestanding. It consists of an organized medical staff,

which provides continuous nursing services under

professional nurse direction. The patient’s status is

reviewed on a regular basis to determine if they meet

criteria to remain at the facility. The long-term care facility

is regulated by state licensure regulations, federal

regulations and Joint Commission on Accreditation of

Health Care Organizations (JCAHO). State licensure is

mandatory, Federal regulation is only necessary if the

facility participates with Medicare and Medicaid, and

JCAHO standards are voluntary. Long term-care is very

expensive and it often becomes a financial catastrophe for

the elderly person and their family. Private insurance is

unlikely to cover the full cost of care and Medicare only

pays for a limited amount. The person usually must

eliminate a substantial amount of their assets to become

eligible for Medicaid which covers long term care.

According to Growing Old In America «In order for elderly

persons to qualify for nursing home care under Medicaid,

they usually must reduce their personal financial status to

the poverty level (p. 119-120). Regretfully, the cost is not

the only disturbing factor of a long-term care facility. A

family decision to place my grandfather who was suffering

from Alzheimer’s disease into a nursing home was a very

difficult and emotional experience for everyone involved.

Regular visits by all family members continually raised

concerns about the quality of care that he was receiving.

Staffing was also a concern for our family. It seemed there

was not enough staff to meet the needs of the patients

within the facility. Although licensing agencies regulated

these aspects, this was not comforting to our concerns.

Fortunately, we were able to move my grandfather to a

different facility. The nursing home was newer and better

staffed and all family members felt more comfortable about

the care he was receiving. The experience of placing a

loved one into a long term care facility is one I would prefer

to not experience again. It is comforting to know that there

are good facilities availab! le and caregivers that really care

about the patient’s needs. These aspects are very important

for families to understand before making a final decision

when they must place a loved one into a facility. Hospice

Unfortunately the last resort for some patients may be

hospice care. Hospice is an organized program that offers

dying persons and their families an alternative to traditional

care for terminal illness. As stated in Aging „Hospice care is

exclusively for dying people. It therefore brings expertise to

helping patients and their families face issues specific to

death and dying“ (p. 180). Hospice enables the patient to

receive palliative medical care, while meeting the

psychosocial and spiritual needs of the patient, their family

and friends. Hospice programs also offer bereavement

services for 13 months (or beyond if required) following the

patient’s death for any family members or friends who wish

to receive the service. The article The Continuum of Long

term Care emphasizes „The philosophy of hospice is that

terminally ill individuals should be allowed to maintain life

during their final days in as natural and comfortable a setting

as possible“ (p. 198). The quality of life of the terminally ill

patients relies heavily on the psychosocial skills of their

health care team. The health care team consists of a

physician, nurse, social worker, chaplain, home health aide

and volunteers. The team develops an individual care plan

which will provide an appropriate support system for the

patient and their family up to and beyond the patient’s

death. Weekly meetings allow the team to focus on the

changing needs of the patient and make adjustments to their

plan. Hospice care can be received in a variety of

organizational settings. The most preferred setting is of

course within the patient’s own home, but nursing homes,

hospitals and long term care facilities are a few who can

also provide hospice care. Hospice care is a covered

benefit under Medicare and most private insurance

companies. The regulating agencies that set the standards

for hospices are Medicare, the National Hospice

Organization, Joint Commission on Accreditation of Health

Care Organizations (JCAHO) and state hospice agencies. I

have found that the medical record content in a hospice

program contains an extensive amount of identifying

information in regards to the patient and their primary

caregiver(s). All aspects of patient care are well

documented and assure well-coordinated, continuous care.

The medical record acts as a communication tool between

the different team members and is used on a continuous

basis throughout the patient’s care. Conclusion Although

there are many options other than those listed for health

care after discharge from a hospital, The most important

aspect for a person is to be well informed and

knowledgeable about the variety of options available. It can

be very confusing, especially to an elderly person when talk

of finances, regulations and covered and non-covered items

are discussed. It is our responsibility as future health care

administrators to provide adequate information to the

person who is opting for alternatives to health care.

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