Community Health Care

Essential Question:
What are the main differences between long term healthcare facilities and short term healthcare
facilities?

Word Wall/Vocabulary
1. Patient focused care
2. DRG
3. JCAHO
4. acute illness
5. chronic illness
6. Medicaid
7. Medicare
8. Hospice
9. Quality Assurance
10. Skilled Care Facility

Lecture Outline
 5 Basic Functions of healthcare facilities
o Provide services for the ill and injured
o Preventing disease
o Promoting individual and community health
o Educating health care workers
o Promoting research in medicine and nursing
(What are some examples of facilities that specialize in these functions?)

 Patient focused care

o Based on the fact that each patient is a unique individual and has different needs
o Must pay attention to the physical, mental, and emotional aspects of the person if
they are to have a fulfilling and satisfying life
o Quality of life is important
 Why is this important?
 People are living longer
 Want to create and maintain an environment that humanizes and
individualizes each patient
 In what cases would you want to preserve the quality of live vs. extending
the length or duration of the life?

 Health care is an ever-changing entity. What do you think are some of the reasons that
healthcare must change?
o People are living longer. The longer that people live, their need for health care
increases; therefore more services are needed. As the population gets older, more
services are needed for patients with illness and disability.
 o Advanced technology allows more lives to be saved. However, these individuals
need continuing health care
o The cost of health care has increased because of the demand for services and
advances in technology.
o Science has created many ethical (moral) questions that must be answered by
healthcare providers and health care consumers.
 What are some ways that we can decrease healthcare cost?
o Discharge patients earlier from the hospital—Is this safe?
o Home health care and outpatient facilities
o Surgicenters and urgent care facilities vs. ER visits and hospital OR’s
o If you thought you had strep throat would it be more cost effective to go to the
hospital ER or to the urgent care facility?
 Managed Care—these are methods used by insurance companies to reduce health care
costs
o Some of the methods used include:
 Approving procedures and diagnostic tests prior to the procedures or tests
 Negotiate with physicians, hospitals, and pharmacies to provide services at
a lower cost to the company’s members
 Approve only a certain number of days of hospitalization for a specific
diagnosis Ex) 48 hours after a vaginal birth and 72 hours after a C/S
 Require that specific procedures be done on an outpatient basis rather than
having the patient admitted to the hospital

NEEDS OF THE COMMUNITY

 A community is people who live in a common area and share common health needs.
 The class is a community. What are some of this communities health care need?
o Provisions for disposal of wastes
o Safe drinking water
o Availability of healthful foods
o Protection from disease
o General health care
o Public health laws regulate these services and are enforced by government
agencies.
 Different types of healthcare are needed at various stages of life
o Preventative care- wellness needs
 Infants and children—well baby checkups and immunizations
 Prenatal care—care of the mother during her pregnancy
 Physical exams all throughout life
 Health education to help prevent disease and injury
o Emergency care
 Short term care for a sudden injury or illness
o Surgery
 Repair an injured body part or remove a diseased organ
 o Rehab
 Help patients regain abilities after illness or injury
o Long term care facilities
 For patients who have chronic or incurable conditions
o Hospice care
 For patients who are dying and their families
 The people who receive health care are called the health care consumers. There are
more specific names for the health care consumer based on the services they need.
o Patient is a term for a person in an acute care facility
o Client is a term for a person receiving care in their own home
o Resident is usually a term for those people who are in long term skilled care
facilities
COMMUNITY HEALTH CARE SERVICES

 Two main types of healthcare

o Long term and short term
 Short term care is for minor problems (UTI).
o Name some short term care facilities.
o Examples of short term healthcare
 Hospitals
 Urgent care facilities
 Surgicenters
 Outpatient clinics
 Psychiatric hospitals
 Physician’s offices
 Hospitals can be places for short term care for acute illnesses.
o An acute illness is one that comes on suddenly and requires intense and
immediate treatment.
o Examples of acute illnesses: heart attacks, burns, strokes, uncontrolled diabetes.
 Long term care is necessary for people who have chronic conditions
 Chronic illnesses are treatable but not curable and are expected to require lifelong care.
 What are some examples of common chronic illnesses?
o Cardiovascular disease
o Alzheimer’s disease
o MS
o Parkinson’s disease
o Diabetes
o Examples of long term healthcare
 Skilled care facilities
 Adult day care
 Assisted living facilities
 Rehab centers
 Psychiatric hospitals
  Respite care
 Home health
 Hospitals are often broken down by units that care for specific populations
o Pediatrics- for children from birth to 18 years
o Psychiatric- for people with mental illness
o Rehabilitation- provides restorative care to patients following disease, illness,
and injury. They are designed to help the patient regain the ability to function at
the highest level possible, considering the illness or injury.
o Medical Units (Medical-Surgical Units)- cares for medical conditions
(pneumonia, heart disease)
o Surgical Department- care for patients before, during, and after surgery.
 Pre-Op Area
 Surgical Suites/ Operating Rooms
 PACU (Post Anesthesia Care Units) –post anesthesia recovery(PAR)—
patients are closely monitored after surgery and remain here until they are
stable enough to leave the surgical department.
o Obstetric Department
 Labor and Delivery- where mothers deliver their babies
 Postpartum Unit- for mothers who have recently given birth
 Nursery- for newborn babies
 Antepartum- unit to monitor women who are still pregnant that are high
risk or experiencing complications.
o Emergency Department
 Victims of trauma or natural disasters
 Medical emergencies
o Critical Care Departments
 Care for people who are seriously ill and need continuous monitoring and
care.
 Ex) ICU
 Many hospitals include more than nursing units. There are specialized service
departments that factor into a patient’s care.
o Dietary Service
 Not just delivery of trays
 A registered dietician will review meal orders and decide what foods are
appropriate for the patient based on their condition and the orders and
diagnosis from the physician
 Food service prepares the food and delivers it to the units
o Pharmacy Service
 Prepare and provide all medications and IV therapy solutions
 Monitor the physicians orders for mistakes or clarifications
 Monitor for drug interactions
o Diagnostic Services
 Pathology dept.- perform tests on specimens taken from body tissue to
help the doctor make a diagnosis
  Diagnostic imaging and radiology- take xrays and do other specialized
procedures to help make a diagnosis
 Laboratory- perform diagnostic tests and investigative procedures.
• Specimen are sent to the lab for analysis
• Blood, Urine, Sputum, etc.
 Rehabilitation Services
• Physical therapy- assists patients to regain mobility skills
• Occupational therapy- helps patients to regain self care skills
• Speech therapy- helps patients to regain the ability to
communicate and works with patients who have swallowing
disorders
• Respiratory therapy- provides care for patients who have disorders
of the cardiopulmonary system, respiratory system, and sleep
disorders that affect the patient’s breathing.
 Social Services
• Counseling services for patients and their families
• Financial assistance
• Plan for discharge
• Arrange for transfers from one facility to another
 Environmental services
• Housekeeping- responsible for the overall cleaning of the hospital
• Maintenance- cares for and repairs equipment
• Laundry services- provide and clean all hospital laundry
 Business services
• Responsible for billing, employee payroll, and other financial
concerns
 Medical Records transcribes and catalogs all patient records.
 Volunteers
 Pastoral Care
• Helps patients meet their religious and spiritual needs
• Provides counseling

FINANCING HEALTH CARE

 Who pays for healthcare?
o Insurance
 Insurance via a plan paid for by employer or individual insurance
 Employers may pay all or a portion of the costs of a group insurance plan.
 HMO health maintenance organization is a type of prepaid insurance
o Out of pocket
 Can be people who have no insurance at all
 Could be the amount of the bill that insurance will not cover
o Medicare
 Federal government program
 Pays for a portion of healthcare costs for people 65 years and over
Also covers younger people who are permanently disabled and who
qualify for the benefit
 Payments are based on DRG’s (diagnosis related groups)
• Research was done to see how long a patient needed to stay in the
hospital for a certain diagnosis, the amount of money a specific
procedure should cost, cost of treatments, etc.
• They set payment rates for specific diagnoses based on their
research findings
• Medicare pays only the fixed rate that they deemed appropriate for
a service.
o Medicaid
 State and Federal Government program
 Pays healthcare cost for people of any age who do not have financial
resources for healthcare.

REGULATORY AGENCIES
 External agencies regulate healthcare facilities (some state and federal, many private
organizations)
 Hospitals must meet quality standards to operate. (Health and safety regulations)
 Surveys are conducted to ensure that hospitals are maintaining acceptable standards of
practice.
 Must have a state license to operate, must hold certification to be eligible to collect
Medicaid and Medicare
 JCAHO (Joint Commission for Accreditation of Healthcare Organizations)
o Inspects and accredits hospitals, nursing homes, home care providers, medical
suppliers, ambulance services and other health care agencies
o Must be JCAHO accredited to collect Medicare. (Hospitals could not survive with
out Medicare revenue.
o Sets high standards and stops by periodically to evaluate facility
o JCAHO requirements
 Employees must be assigned to care for patients based on patient needs,
caregiver qualifications, training, and experience
 Employees must be competent to carry out their responsibilies.
• Must maintain a list of staff education and annual competencies
• Staff must participate in ongoing education
• Must document how their competencies are evaluated
• When surveyors show up they may ask an employee to perform an
appropriate task or demonstrate the use of a certain piece of
equipment.
 Once the survey is complete if there are any areas that are lacking or not
up to standards then the facility has a chance to correct and improve these
issues before accreditation is granted or denied.
 OSHA Surveys
 o Monitors and protects the health and safety of the employee.
o Review infection control policies, isolation practices, PPD, material safety data
sheets (MSDS).
o Interview employees and tour facilities
o Will make recommendations to improve employee safety.
o OSHA can give a citation if they note dangerous or unsafe conditions
 Citations are for violations of OSHA rules
 Must be posted in the area where the violation occurred for three days or
until the unsafe condition is corrected.

QUALITY ASSURANCE
 Purpose is to conduct internal reviews to identify problems and find solutions for
improvement
 Evaluated care provided and practices in the facility
 Committee members review practices and report back on ways to improve care
 Identify problems and correct them
 Improves the quality of care given to the patients.