1
Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
providers
people or organizations that provide health care, including
doctors, nurses, clinics, and agencies.
facilities
in medicine, places where health care is delivered or
administered, including hospitals, long-term care facilities,
and treatment centers.
payers
people or organizations paying for healthcare services.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
long-term care (LTC)
care given in long-term care facilities (LTCF) for people who
need 24-hour skilled care.
skilled care
medically-necessary care given by a skilled nurse or
therapist.
length of stay
the number of days a person stays in a healthcare facility.
terminal illness
a disease or condition that will eventually cause death.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
chronic illness
a disease or condition that is long-term or long-lasting and
requires management of symptoms.
home health care
care that takes place in a person’s home.
diagnoses
physicians’ determinations of an illness.
assisted living
residences for people who do not need skilled, 24-hour care,
but do require some help with daily care.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
dementia
the serious loss of mental abilities, such as thinking,
remembering, reasoning, and communicating.
adult day services
care for people who need some assistance or supervision
during certain hours, but who do not live in the facility where
care is given.
acute care
24-hour skilled care for short-term illnesses or injuries;
generally given in hospitals and ambulatory surgical centers.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
subacute care
care given in a hospital or in a long-term care facility for
people who need less care than for an acute illness, but more
care than for a chronic illness.
outpatient care
care given for less than 24 hours for people who have had
treatments or surgery and need short-term skilled care.
rehabilitation
care that is given by specialists to help restore or improve
function after an illness or injury.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
hospice care
holistic, compassionate care given to dying people and their
families.
health maintenance organizations (HMOs)
a method of health insurance in which a person has to use a
particular doctor or group of doctors except in case of
emergency.
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
Define the following terms:
preferred provider organizations (PPOs)
a network of providers that contract to provide health
services to a group of people.
managed care
a system or strategy of managing health care in a way that
controls costs.
1 Understanding Healthcare Settings
Transparency 1-1: Traditional Healthcare System
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Understanding Healthcare Settings
1. Discuss the structure of the healthcare system and describe
ways it is changing
The following major changes have a serious impact on how
health care is provided:
• Increased use of expensive technology
• Rising costs of health care
• New ways to control costs of care
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Understanding Healthcare Settings
2. Describe a typical long-term care facility
Define the following terms:
activities of daily living (ADLs)
daily personal care tasks, such as bathing; caring for skin,
nail, hair, and teeth; dressing; toileting; eating and drinking;
walking; and transferring.
catheter
a thin tube inserted into the body to drain fluids or inject
fluids.
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Understanding Healthcare Settings
2. Describe a typical long-term care facility
REMEMBER:
There are many different models of long-term care facilities,
including facilities for residents with dementia and facilities with
assisted living wings.
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Understanding Healthcare Settings
2. Describe a typical long-term care facility
Think about these questions:
What services do you think all long-term care facilities offer?
What services might some long-term care facilities offer for
residents with different needs?
1 Understanding Healthcare Settings
Transparency 1-2: Residents in Long-term Care Facilities
• 89% are over 65
• 54% are over 85
• 11% are younger than 65
• 70% are female
• More than 90% are white and non-Hispanic
• About 1/3 come from a private residence
• Over 50% come from a hospital
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
Think about this question:
Why is important for an NA to know what kinds of residents he
will likely be caring for?
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
REMEMBER:
Residents with different lengths of stay may have different care
needs.
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
Residents with a length of stay of six months or more
• Make up over 2/3 of residents
• Require 24-hour care
• Did not have caregivers able to give enough care at home
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
Residents with a length of stay of less than six months
• May be admitted for terminal care (will die in the facility)
• May be admitted for rehabilitation or temporary illness (will
recover and return to the community)
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
Think about this question:
How might care for a resident admitted for temporary care be
different from care for a resident who will live in the facility for
years?
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Understanding Healthcare Settings
3. Describe residents who live in long-term care facilities
REMEMBER:
Many residents in LTC lack outside support. This means it is very
important for NAs to care for the whole person - addressing
social and emotional needs as well as physical needs.
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Understanding Healthcare Settings
4. Explain policies and procedures
Define the following terms:
policy
a course of action that should be taken every time a certain
situation occurs.
procedure
a method, or way, of doing something.
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Understanding Healthcare Settings
4. Explain policies and procedures
The following are common policies and procedures in long-term
care facilities:
• All resident information is confidential.
• Resident’s care plan must be followed.
• NAs only perform tasks in job descriptions.
• NAs report to a nurse.
• NAs should not discuss personal problems with residents or
families.
• NAs should not accept gifts and money from residents or
families.
• NAs must be dependable.
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Understanding Healthcare Settings
4. Explain policies and procedures
REMEMBER:
It is very important for NAs to ask questions about policies and
procedures or review the procedure manual when they are
unsure about care.
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Understanding Healthcare Settings
5. Describe the long-term care survey process
Define the following terms:
cite
in a long-term care facility, to find a problem through a
survey.
Joint Commission
an independent, not-for-profit organization that evaluates
and accredits healthcare organizations.
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Understanding Healthcare Settings
5. Describe the long-term care survey process
Surveyors use these methods to study residents’ care and
determine how their needs are being met:
• Interview residents and their families
• Observe staff interactions with residents and care given
• Review residents’ charts
• Observe residents’ meals
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Understanding Healthcare Settings
5. Describe the long-term care survey process
Think about these questions:
Why is it very important for NAs to tell the truth when asked
questions by surveyors?
What should an NA do if she doesn’t know the answer to a
surveyor’s question?
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Understanding Healthcare Settings
5. Describe the long-term care survey process
REMEMBER:
Surveys conducted to the Joint Commission are not affiliated with
state inspections. Facilities participate in Joint Commission
surveys on a voluntary basis.
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Understanding Healthcare Settings
6. Explain Medicare and Medicaid
Define the following terms:
Centers for Medicare & Medicaid Services (CMS)
a federal agency within the U.S. Department of Health and
Human Services that is responsible for Medicare and
Medicaid, among many other responsibilities.
Medicare
a federal health insurance program for people who are 65 or
older, are disabled, or are ill and cannot work.
Medicaid
a medical assistance program for low-income people.
1 Understanding Healthcare Settings
Transparency 1-3: Facts About Medicare and Medicaid
Medicare
• Medicare is for people 65 or older and people under 65 who
are disabled and cannot work.
• Part A helps pay for care in a hospital or skilled nursing
facility or for care from a home health agency or hospice.
• Part B helps pay for doctor services and other medical
services and equipment.
• Part C allows private health insurance companies to provide
Medicare benefits.
• Part D helps pay for medications prescribed for treatment.
Medicaid
• Medicaid is a medical assistance program for low-income
people.
• People qualify based on income and special circumstances.
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Understanding Healthcare Settings
7. Discuss the terms culture change and person-directed care
and describe Pioneer Network and The Eden Alternative
Define the following terms:
culture change
a term given to the process of transforming services for
elders so that they are based on the values and practices of
the person receiving care; core values include choice, dignity,
respect, self-determination, and purposeful living.
person-directed care
a type of care that places the emphasis on the person
needing care and his or her individuality and capabilities.
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Understanding Healthcare Settings
7. Discuss the terms culture change and person-directed care
and describe Pioneer Network and The Eden Alternative
These are the core values of culture change:
• Choice
• Dignity
• Respect
• Self-determination
• Purposeful living
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Understanding Healthcare Settings
7. Discuss the terms culture change and person-directed care
and describe Pioneer Network and The Eden Alternative
The Pioneer Network
• Was formed in 1997 by a small group of people in LTC
• Advocates for person-directed care
• Called for change in how elders are treated everywhere in the
community
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Understanding Healthcare Settings
7. Discuss the terms culture change and person-directed care
and describe Pioneer Network and The Eden Alternative
The Eden Alternative
• Was founded in 1991 by Dr. William Thomas
• Seeks to improve the lives of elders and their caregivers
• Creates environments that support growth and development
and eliminate loneliness, helplessness, and boredom
• Offers education, resources, and consulting services