copyright © 2008 delmar learning. all rights reserved. unit 1 community health care

Copyright © 2008 Delmar Learning. All rights reserved.

Unit 1

Community Health Care


Objectives

• Spell and define terms.• List the five basic functions of health

care facilities.• Describe four changes that have taken

place in health care in the last few years.

• Describe the differences between acute care and long-term care.


Objectives

• Name the departments within a hospital.• Describe the functions of the

departments within a hospital.• Explain three ways by which health care

costs are paid.• State the purpose of health care facility

surveys.


Introduction

• Health care facilities have five basic functions:– Provide services for the ill and injured– Prevent disease– Promote individual and community health– Educate health care workers– Promote research in medicine and nursing


Overview of Health Care

• Health care emphasizes patient-focused care

• Many changes have occurred in health care in the last few years



• There are several reasons for these changes– People are living longer– Technology is becoming more advanced– Health care costs have increased– Many ethical questions that must be

answered by health care providers and consumers



• Managed care means the insurance company will:– Not permit certain procedures or diagnostic

tests until they have been approved by the insurer.



• Managed care means the insurance company will:– Negotiate with specific physicians,

hospitals, pharmacies, and other care providers to render services at a lower cost to the company’s members.



• Managed care means the insurance company will:– Approve only a certain number of days of

hospitalization for specific diagnoses.– Require that specific procedures be done

on an outpatient basis rather than having the patient admitted to the hospital.


Needs of the Community

• Health care is needed throughout life• Short-term or long-term care includes:

– Preventive – Emergency – Surgery– Rehabilitation – Hospice care


Preventive Care

• Prenatal care – Care of mother during pregnancy

• Well-baby checkups and immunizations• Health education to teach individuals

how to avoid disease and injury• Physical examinations throughout life


Emergency Care

• Short-term care given for sudden illness or injury

• Surgery– To repair an injured body or remove a

diseased organ


Rehabilitation

• To help a patient regain abilities after an illness or injury

• Long-term care– For persons who have chronic or incurable

conditions


Hospice Care

• For patients who are dying and their families



• People receiving health care are called health care consumers – Identified by type of care they need



• Patient – Persons in acute care facilities, such as

hospitals

• Client – Persons receiving care in their own homes

• Resident– Persons in long-term skilled care facilities


Types of Health Care Facilities

Short-Term Care Long-Term CareHospitals Skilled care facilities

Urgent care facilities Adult day care

Surgicenters Assisted living facilities

Rehabilitation centers

Psychiatric hospitals

Outpatient clinics Respite care

Psychiatric hospitals

Physician’s offices Home care


Long-term Acute Care Hospitals

• Fully licensed hospitals in which a lengthy stay is anticipated

• Provide a higher level of care than other chronic care settings


Long-term Acute Care Hospitals

• Patients must have a medically-complex condition– Need acute care services– Have a good chance of improvement


Magnet Hospitals

• Magnet Program for Excellence in Nursing Services – Based on quality indicators and nursing

practice standards


Magnet Hospitals

• Program is voluntary and recognizes hospitals for nursing excellence

• Hospitals who have been awarded magnet status are usually progressive– Desirable places to work


Community Health Care Services

• Hospitals– Most hospitals are licensed to care for

patients of all ages and with a variety of problems

– Some hospitals take care of patients with special conditions or care for specific age groups



• Pediatric hospitals– Care for children from birth to 18 years

• Psychiatric hospitals– Provide care for persons with mental illness

• Rehabilitation hospitals– Provide restorative services to patients

following disease, illness, or injury



• Hospital organization – Provide the most efficient delivery of

service– Major departments established within each

facility • Care for patients with specific conditions• 24 hours a day, 7 days a week



• Hospital organization– Surgical department

• Cares for patients before, during, and after surgery

– Pediatric department• Cares for sick and injured children



• Hospital organization– Obstetric department

• Cares for newborns and their mothers

– Emergency department• Cares for victims of trauma, natural disasters,

or medical emergencies



• Hospital organization– Critical care department

• Cares for seriously ill patients who require constant monitoring and care



• Hospital organization– Medical department

• Cares for patients with medical conditions such as pneumonia or heart disease



• Hospital organization– Larger hospitals – Many specialized units staffed by nurses

and therapists • Trained to care for persons with specific

problems


Specialized Services

• Dietary • Pharmacy • Diagnostic

– Pathology (study of disease)– Diagnostic imaging and radiology– Laboratory



• Rehabilitation services– Physical therapy– Occupational therapy– Speech therapy– Respiratory therapy– Social services



• Environmental services– Housekeeping– Maintenance– Laundry



• Business services• Medical records department• Volunteer services• Pastoral services


Financing Health Care

• Health care is paid for by:– Insurance– Out-of-pocket payments– Medicaid

• State and federal government program• Pays for persons of any age who do not have

financial resources for health care



• Medicare is a federal government program– Pays a portion of health care costs for

persons 65 years and older

• For younger persons permanently disabled and qualify for benefit



• Medicare payment is based on:– Diagnosis related groups (DRGs)

• Actual cost of care is not considered



• Rather, Medicare set the payment rates:– Based on data from studies that

determined the average length of stay– Required for various medical diagnoses,

procedures, and treatments


Regulatory Agencies

• Joint Commission for Accreditation of Healthcare Organizations (JCAHO)– Inspects and accredits health care agencies– Participation is voluntary – Hospitals are not eligible to receive

Medicare payment unless they are JCAHO accredited


Regulatory Agencies

• Occupational Safety and Health Administration (OSHA)– Surveys health care facilities– Protects health and safety of employees


Quality Assurance

• All health care facilities have a program called quality assurance (QA)– Identifies problems and finds solutions for

improvement

copyright © 2008 delmar learning. all rights reserved. unit 1 community health care

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