Introduction to Healthcare
and Public Health in the US
Delivering Healthcare (Part 1)
Lecture d
This material (Comp1_Unit2d) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Delivering Healthcare (Part 1)
Learning Objectives
•
•
•
•
Describe the organization of healthcare at the
federal, state and local levels (Lecture a)
Describe the organization of the VA system and
Military Health System (Lecture b)
Describe the structure and function of hospital
clinical and administrative units (Lecture c)
Describe different types of long term care
facilities, with an emphasis on their function
(Lecture d)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
2
Delivering Healthcare (part 1)
Learning Objectives
• Describe a variety of healthcare settings, with emphasis
on their function, including:
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–
–
–
–
–
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School-based health centers
Home healthcare
Group living
Assisted living, retirement communities, nursing homes
Hospice care (end-of-life care)
Long term, psychiatric, and specialty hospitals
Community mental health centers
• Discuss important healthcare issues for older adults
– Increasing need for assistance with daily activities
– Financial, legal, ethical issues
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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School-Based Health Centers
• Children can and should receive physical and
behavioral healthcare in school
– Providers are nurses, physicians, social workers,
substance abuse counselors, other providers
– Further medical or hospital services are arranged as
needed
– Parental consent is required
• Healthcare may be periodic (for example, mobile
health center) or off-site (health center serving
more than one school)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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The Aging Population
1.5 Chart: (http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm, ND)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Difficulty with ADLs
(Activities of Daily Living) by Age
Percentage
of adults
1.6 Chart: (http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf , 2007)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Long term care Facilities
and Services
Help with
ADLs
Help with other
services
Help with
care needs
Range of costs
Community-based services
Yes
Yes
No
Low to medium
Home healthcare
Yes
Yes
Yes
Low to high
In-law apartments
Yes
Yes
Yes
Low to high
Housing for aging and
disabled individuals
Yes
Yes
No
Low to high
Board and care homes
Yes
Yes
Yes
Low to high
Assisted living
Yes
Yes
Yes
Medium to high
Continuing care retirement
communities
Yes
Yes
Yes
High
Nursing homes
Yes
Yes
Yes
High
Service or facility
1.7 Chart: (http://www.medicare.gov/longtermcare/static/TypesOverview.asp, ND)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Financial and Quality Issues
• Centers for Medicare and Medicaid Services (CMS)
– Provides health insurance for older adults, disabled, poor
– Covers 25% of US population; 94% of people age 65 or older
– Reimburses qualifying healthcare facilities
• Joint Commission (JC) certifies quality, safety
– Independent nonprofit agency
– Examines hospitals, nursing homes, home care organizations,
mental health programs, etc.
– Healthcare facilities volunteer for JC certification
– JC accreditation is a major factor in CMS approval for
reimbursement
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Home Healthcare
• Home healthcare is assistance with ADLs and chores
inside the home
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–
–
–
Family, friends, volunteers may help
Community services may be available
Skilled nursing is needed for medical issues
May be reimbursed by Medicare
• Home healthcare agency is another option
– Professional service
– May be reimbursed by Medicare
– Includes hospice care (end-of-life care)
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Board and Care Homes
(Group Homes)
• Group living arrangements for people who
cannot live alone and need help with ADLs
– Residents may have physical or mental disability,
cognitive impairment, substance abuse
– Residents may be elderly, but not necessarily
– Meals are provided, but medical care is not
– Services, quality, and fees vary widely
– May be paid in part by private insurance,
Medicare/Medicaid, other assistance
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Assisted Living
• Person has own room or apartment in a large complex
• Receives assistance with ADLs, 24-hour care
• Offers group dining, social/recreational activities,
housekeeping/laundry
• Medical services may be available on site
• Service plan for each resident evolves over time
• Facilities are licensed in most states
• Billing is monthly rent plus fees for extra services
• Insurance may cover some costs; Medicare does not
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
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Continuing Care
Retirement Communities
• Offer different types of housing, depending on
the level of assistance needed
– Separate homes/apartments for independent living
– Assisted living facility for help with ADLs
– Nursing home on site
• May be accredited or not
• Billing is a large entry fee plus monthly
payments
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Nursing Homes
• Care for people who cannot live in home or community
– May have medical, physical, mental problems
– Facilities help with ADLs, provide nursing care
– Some homes are hospital-like, others are home-like (for
example, have kitchen facilities and social activities)
• Services include medical, nursing, personal care
– A physician draws up a plan of care
– Nursing care pertains to routine medications, acute conditions,
rehabilitation, special care units
• Facility should be licensed/accredited, although
Medicare usually does not pay
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Other Long Term Care
Options for Older Adults
• Community-based services
– Various programs, coordinated by state agencies
– State Medicaid may help with costs
• In-law apartments
– Defined as a separate living space on a property
– Subject to local and state laws
• Subsidized housing
– Provide residence for older adults/disabled/poor, other services
– Federal or state agency funds the program
– Billing is a percentage of monthly income
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Hospice Care
• Intended for patients with a terminal illness
• Focus is palliative, or comfort care
• Care is provided at home, dedicated hospice facility,
hospital, assisted living facility, or nursing home
• Services may include medical/nursing care, medical
equipment, counseling, social services, help with
ADLs and housework, respite care
• Home care workers should be licensed/bonded
• Contact with family is an important focus
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Legal and Ethical Issues
• Patients may/may not be able to make decisions
• Family may not be available; patient may need legal
guardian
• Patient has right to participate in important decisions
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–
–
–
–
Long term care options
Informed consent
Informed refusal
Advance directives, living wills
Do-not-resuscitate order (DNR), termination of treatment
Power of attorney for healthcare
• Long term care facilities have ethical/legal obligations
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Long Term Hospitals
• Acute-care hospitals that provide prolonged care
(for more than 25 days)
• Patients may have complex medical problems
– May come from intensive care units
– May have more than one condition
– May need rehabilitation
• Medicare covers hospital stay if hospital is
certified
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Specialty Hospitals, Rehabilitation
Care
• Specialty hospitals focus on particular diseases or
medical fields
– Common examples are cardiology, orthopedics, women’s health,
and surgery
– Less common example: end-stage kidney disease
• Rehabilitation hospitals
– Stand-alone hospitals or units within a hospital
– Provide intensive daily rehabilitation
• Outpatient rehabilitation is also available through
agencies, clinics
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
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Psychiatric Hospitals
• Psychiatric care has evolved
– Hospitalization is voluntary in most cases
• Many types of care exist
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–
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Open units
Crisis stabilization units
Medium-term units
Juvenile wards
Long term care psychiatric hospitals
• Some psychiatric hospitals specialize in certain
illnesses or addictions
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
19
Day Hospitals
• Provide mental health treatment during the day
– Patient goes home at night
• Considered an alternative to outpatient care
– Distinct from hospitalization, residential treatment,
and day care
• Patients are adults or children
• Most facilities are hospitals or community centers
• Provide individual/group therapy, other treatments
• Goal is for patient to function within community
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
20
Community Mental
Health Centers
• Provide treatment for elderly, adults, or
children
• Patients have chronic mental illness or recent
hospital discharge
• Services include outpatient care, emergency
care, partial hospitalization, rehabilitation
• May be reimbursed by Medicare
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
21
Substance Abuse
Treatment Centers
• Help patients overcome drug and/or alcohol
abuse
• Various facilities
– Residential treatment centers
– Outpatient programs
– Hospitals
• Programs may specialize
– By drug (for example, cocaine addiction)
– By age group (for example, adolescents)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
22
Delivering Healthcare (Part 1)
Summary – Lecture d
• Multiple healthcare options exist for medical, mental
health, substance abuse, and end-of-life issues
• Care location can be school, home, community,
hospital
• Large variation exists in services, quality, costs
• Facilities may or may not be licensed/certified
• Services may or may not be reimbursed by
Medicare/Medicaid
• Complex financial, legal, ethical issues apply
• Need for elder care will only grow in the future
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
23
Delivering Healthcare (Part 1)
Summary
•
•
•
•
Described the organization of healthcare at the
federal, state and local levels (Lecture a)
Described the organization of the VA system
and Military Health System (Lecture b)
Described the structure and function of hospital
clinical and administrative units (Lecture c)
Described different types of long term care
facilities, with an emphasis on their function
(Lecture d)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
24
Delivering Healthcare (part 1)
References – Lecture d
References
•Administration on Aging. A profile of older Americans: 2010.
http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf. Accessed April 12, 2011.
•American Health Care Association, National Center for Assisted Living. Consumer information about long term care.
http://www.longtermcareliving.com/assess/index.htm. Accessed April 11, 2011.
•American Hospital Association. Long term acute care hospitals. http://www.aha.org/aha_app/issues/Medicare/LongTerm-Care-Hospitals/index.jsp. Accessed April 11, 2011.
•Centers for Medicare & Medicaid Services. https://www.cms.gov. Accessed April 11, 2011.
•Commission on Accreditation of Rehabilitation Facilities International. Who we are.
http://www.carf.org/About/WhoWeAre. Accessed April 11, 2011.
•Dubler NN. Legal and ethical issues. In: The Merck Manual of Geriatrics. Whitehouse Station, NJ: Merck & Co., Inc.;
2009-2010. http://www.merckmanuals.com/mm_geriatrics/sec1/ch14.htm. Accessed April 12, 2011.
•Hospital.com. Choosing a long-term psychiatric hospital. http://www.hospital.com/psychiatry.html. Accessed April 11,
2011.
•Medicare.gov. Types of long-term care. http://www.medicare.gov/longtermcare/static/TypesOverview.asp. Updated
March 25, 2009. Accessed April 11, 2011.
•MedlinePlus. Health system. http://www.nlm.nih.gov/medlineplus/healthsystem.html. Updated May 21, 2010. Accessed
April 11, 2011.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
25
Delivering Healthcare (part 1)
References – Lecture d (continued)
References (continued)
•National Assembly on School-Based Health Care.
http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2554077/k.BEE7/Home.htm. Accessed April 11, 2011.
•National Association for Home Care & Hospice. Basic statistics about home care.
http://www.nahc.org/facts/10HC_Stats.pdf. Updated 2010. Accessed April 11, 2011.
•Office of Disability, Aging and Long-Term Care Policy. Licensed board and care homes: preliminary findings from the
1991 National Health Provider Inventory. http://aspe.hhs.gov/daltcp/reports/1993/rn06.htm. Published May 1993.
Accessed April 11, 2011.
•Pace B. Hospice care. JAMA. 2006;295(6):712.
•The Joint Commission. http://www.jointcommission.org. Accessed April 11, 2011.
•U.S. General Accounting Office. Specialty hospitals: geographic location, services provided, and financial performance.
http://www.gao.gov/new.items/d04167.pdf. Published October 2003. Accessed April 11, 2011.
•U.S. National Institutes of Health. National Institute on Aging. Workshop report.
http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm. Updated
August 6, 2009. Accessed April 11, 2011.
•Wiener JM, Hanley RJ, Clark R, Van Nostrand JF. Measuring the activities of daily living: comparisons across national
surveys. Office of Disability, Aging and Long-Term Care Policy. March 9, 1990.
http://aspe.hhs.gov/daltcp/reports/meacmpes.htm. Accessed April 11, 2011.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
26
Delivering Healthcare (part 1)
References – Lecture d (continued)
Charts, Tables, Figures
1.5 Chart: The US Population Aging 65 years and Older from 1990 to 2050. From the US Census Bureauum, Population
Projections of the US by Age, Race, and Hispanic Origin: 1993 - 2050, pp 25-1104, 1993. Available from
http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm
1.6 Chart: Bar chart depicting the percent of people with limitations in activities of daily living (ADL) by age group; 2007. Available
from http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf
1.7 Chart: Available from http://www.medicare.gov/longtermcare/static/TypesOverview.asp
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
27