Diets 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 that 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 it 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 that is most appropriate
for them. Items reviewed for discharge
planning includes but is 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
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 care 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 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. Examples of some of the
services that may be available are light housekeeping, meal preparation,
medication reminders and personal care. The personal care does not include
specific health oriented services that 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:
enabling 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 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. State
licensure regulations, federal regulations and Joint Commission on Accreditation
of Health Care Organizations (JCAHO) regulate the long-term care facility. 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
available 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. 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 that 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.
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.