Chapter 31: Home Health care

1. Why do clients typically prefer home care over hospital care?

Clients feel better wearing personal clothing and preparing their own favorite foods.

Clients are comforted by the feeling of control and the familiarity of their own home.

Clients know that more visitors can stop by without concern for having limited space.

Clients resent the constant interruptions by nurses and other caregivers in a hospital.

Clients typically prefer home care over hospital care because they are comforted by the feeling of control and the familiarity of their own home. Being in a familiar environment allows clients to feel more at ease and in control of their own care. They can maintain their daily routines, have a sense of independence, and feel more comfortable in their personal space. This can contribute to a better overall experience and a greater sense of well-being for the clients.

Explanation

Clients typically prefer home care over hospital care because they are comforted by the feeling of control and the familiarity of their own home. Being in a familiar environment allows clients to feel more at ease and in control of their own care. They can maintain their daily routines, have a sense of independence, and feel more comfortable in their personal space. This can contribute to a better overall experience and a greater sense of well-being for the clients.

2. An infant has been born with several congenital anomalies and is ventilator dependent. The nurse discusses options for home care services with the infants parents. Why is home care considered in this situation?

Children at home have fewer infections and more consistent development.

Parents vastly prefer home care so that they can care for their child continuously.

It is easier for family members to visit the child at home rather than in the hospital.

There is better reimbursement for services provided in the home setting.

Home care is considered in this situation because children at home have fewer infections and more consistent development. This option suggests that providing care at home can help reduce the risk of infections that the infant may be exposed to in a hospital setting. Additionally, being in a familiar and comfortable environment can promote consistent development for the child.

Explanation

Home care is considered in this situation because children at home have fewer infections and more consistent development. This option suggests that providing care at home can help reduce the risk of infections that the infant may be exposed to in a hospital setting. Additionally, being in a familiar and comfortable environment can promote consistent development for the child.

3. What was the primary reason home care agencies expanded so drastically in the late 1960s and 1970s?

Hospitals chose to focus on providing care for more acutely ill clients.

Increased numbers of elderly and poor persons were eligible for care because of federal legislation.

Early discharges influenced the need for clients to receive home care services after hospitalization.

There was lack of interest by the American society to contribute to charitable causes.

In the late 1960s and 1970s, home care agencies expanded drastically primarily because there was an increase in the number of elderly and poor individuals who were eligible for care due to federal legislation. This legislation likely provided funding or support for home care services, making it more accessible to those who needed it. This expansion may have been driven by the need to provide care for a growing population of individuals who required assistance but did not necessarily need to be hospitalized.

Explanation

In the late 1960s and 1970s, home care agencies expanded drastically primarily because there was an increase in the number of elderly and poor individuals who were eligible for care due to federal legislation. This legislation likely provided funding or support for home care services, making it more accessible to those who needed it. This expansion may have been driven by the need to provide care for a growing population of individuals who required assistance but did not necessarily need to be hospitalized.

4. What is the primary reason why home care agencies share information, such as how data are collected and terms defined?

Agencies are required to report these data to the Centers for Medicare and Medicaid Services (CMS).

Each is looking for weaknesses in the others that they can use as the basis of marketing campaigns for themselves.

Each wants to determine the cost for an episode of care for both themselves and the others in order to remain competitive.

Group data will help them negotiate managed care contracts with maximum gain on both sides.

Home care agencies share information, such as how data are collected and terms defined, because they are required to report this data to the Centers for Medicare and Medicaid Services (CMS). This is necessary for compliance with regulations and to ensure that agencies are providing quality care to patients. Sharing this information allows CMS to monitor and assess the performance of home care agencies, ensuring that they are meeting the necessary standards and providing the appropriate level of care.

Explanation

Home care agencies share information, such as how data are collected and terms defined, because they are required to report this data to the Centers for Medicare and Medicaid Services (CMS). This is necessary for compliance with regulations and to ensure that agencies are providing quality care to patients. Sharing this information allows CMS to monitor and assess the performance of home care agencies, ensuring that they are meeting the necessary standards and providing the appropriate level of care.

5. A registered nurse was attending new employee orientation at a home nursing agency. The agency supervisor reviewed the Conditions of Participation. To what was the supervisor referring?

County statutes regarding who could be employed as a caregiver

Federal rules, standards, and criteria for Medicare certification

Professional standards concerning appropriate care documentation

State legislation regarding who was eligible for care

The supervisor was referring to the federal rules, standards, and criteria for Medicare certification during the orientation. These rules and standards are important for the agency to follow in order to be eligible for Medicare certification. It is crucial for the nurse to understand and adhere to these guidelines in providing care to patients.

Explanation

The supervisor was referring to the federal rules, standards, and criteria for Medicare certification during the orientation. These rules and standards are important for the agency to follow in order to be eligible for Medicare certification. It is crucial for the nurse to understand and adhere to these guidelines in providing care to patients.

6. How are home health agencies reimbursed for care from Medicare?

Diagnostic-related groups (DRGs)

Home Health Resource Group (HHRGs)

Outcomes Assessment and Information Set (OASIS)

Preferred Provider Organizations (PPOs)

Home health agencies are reimbursed for care from Medicare through the Home Health Resource Group (HHRGs) system. HHRGs is a payment model that categorizes patients into groups based on their clinical characteristics and care needs. The reimbursement amount is determined by the group that the patient falls into, taking into account factors such as the severity of their condition and the services required. This system helps ensure that agencies are fairly compensated for the care they provide to Medicare beneficiaries.

Explanation

Home health agencies are reimbursed for care from Medicare through the Home Health Resource Group (HHRGs) system. HHRGs is a payment model that categorizes patients into groups based on their clinical characteristics and care needs. The reimbursement amount is determined by the group that the patient falls into, taking into account factors such as the severity of their condition and the services required. This system helps ensure that agencies are fairly compensated for the care they provide to Medicare beneficiaries.

7. What is the rationale behind public health departments not offering home nursing?

Most of the agencies energy and resources are spent on controlling communicable diseases instead.

Priorities have changed to focus on addressing the increasing public health problems.

Profit-making agencies are now providing more care for homebound clients.

Public health has not traditionally been involved in home care of individuals.

Public health departments have shifted their priorities to focus on addressing the increasing public health problems rather than offering home nursing. This means that they are allocating their energy and resources towards controlling communicable diseases and other public health issues. As a result, the responsibility of providing home care for individuals has traditionally not been within the scope of public health departments. Instead, profit-making agencies have taken on the role of providing care for homebound clients.

Explanation

Public health departments have shifted their priorities to focus on addressing the increasing public health problems rather than offering home nursing. This means that they are allocating their energy and resources towards controlling communicable diseases and other public health issues. As a result, the responsibility of providing home care for individuals has traditionally not been within the scope of public health departments. Instead, profit-making agencies have taken on the role of providing care for homebound clients.

8. A nurse is admitting a client to home care services, using Medicare as the funding source for the care that will be provided. Which of the following substantiated findings would make a client ineligible for these services?

Care is needed from both a nurse and a physical therapist.

Care is needed 24 hours a day on an ongoing basis.

The client is incapable of leaving the home.

None of these; the requested care seems reasonable and medically necessary.

The client being in need of care 24 hours a day on an ongoing basis would make them ineligible for Medicare-funded home care services. Medicare typically covers intermittent skilled nursing care, physical therapy, and other related services for a limited period of time. However, continuous care that requires around-the-clock assistance is not covered under Medicare home care benefits. Therefore, this substantiated finding would make the client ineligible for these services.

Explanation

The client being in need of care 24 hours a day on an ongoing basis would make them ineligible for Medicare-funded home care services. Medicare typically covers intermittent skilled nursing care, physical therapy, and other related services for a limited period of time. However, continuous care that requires around-the-clock assistance is not covered under Medicare home care benefits. Therefore, this substantiated finding would make the client ineligible for these services.

9. A home care client suffering from cancer asked the home care nurse if he could be referred to hospice, considering his diagnosis. How should the nurse respond?

Certainly, since you are going to die regardless of what we do.

If you and your physician agree to keep you comfortable while battling the cancer, your doctor can refer you.

If you are sure you will die within the next 6 months and no longer want a physicians care, I will be happy to make the referral to hospice.

For your physician to refer you to hospice, you need to decide to concentrate on enjoying life and staying comfortable rather than treating your cancer.

The nurse should respond by informing the client that in order for their physician to refer them to hospice, they need to make the decision to focus on enjoying life and staying comfortable instead of treating their cancer. This response acknowledges the client's desire for hospice care while also emphasizing the importance of their own decision and mindset in seeking this type of care.

Explanation

The nurse should respond by informing the client that in order for their physician to refer them to hospice, they need to make the decision to focus on enjoying life and staying comfortable instead of treating their cancer. This response acknowledges the client's desire for hospice care while also emphasizing the importance of their own decision and mindset in seeking this type of care.

10. How would a typical home care nurse spend the majority of his or her time?

Providing direct care in clients homes

Calling physicians and getting certification for treatment

Supervising the home health aides who are giving the clients personal care

Teaching other family members and home care aides how to care for the client

A typical home care nurse would spend the majority of his or her time teaching other family members and home care aides how to care for the client. This involves providing education and training on various aspects of caregiving such as medication administration, wound care, and personal hygiene. By teaching others, the nurse ensures that the client receives consistent and appropriate care even when the nurse is not present. This also empowers the family members and home care aides to become more knowledgeable and confident in providing care, ultimately improving the overall quality of care for the client.

Explanation

A typical home care nurse would spend the majority of his or her time teaching other family members and home care aides how to care for the client. This involves providing education and training on various aspects of caregiving such as medication administration, wound care, and personal hygiene. By teaching others, the nurse ensures that the client receives consistent and appropriate care even when the nurse is not present. This also empowers the family members and home care aides to become more knowledgeable and confident in providing care, ultimately improving the overall quality of care for the client.

11. An elderly woman receiving care reimbursed by Medicaid was moving to a different state to stay with her daughter-in-law. The disabled woman asked about Medicaid reimbursement in her daughters state. How should the nurse respond?

Because you paid into Social Security (FICA), you are eligible for assistance no matter where you go.

Just be sure to call a home care agency as soon as you arrive so that they can assess your daughter-in-laws house and make sure it is acceptable.

Medicaid is a federal program, so the rules will be the same wherever you go.

Medicaid is sponsored in part by the state, so the rules may be very different there.

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Explanation

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12. A home care nurse was scheduled to attend a Medicare case conference for a client who was receiving care from the nurse and a physical therapist. What was the probable reason why the case conference was scheduled?

It offers an opportunity for the financial officer to evaluate the nurse and the physical therapist, as well as the appropriateness of care being given.

Medicare mandates a case conference every 60 days to coordinate care.

The home care staff was providing inadequate care and needed additional staff in-services.

Data could be collected and reported to the primary physician to ensure continued reimbursement for the physician.

The probable reason why the case conference was scheduled is that Medicare mandates a case conference every 60 days to coordinate care. This ensures that all healthcare professionals involved in the patient's care, such as the nurse and physical therapist, can come together to discuss the patient's progress, treatment plan, and any necessary adjustments to ensure coordinated and effective care. It also allows for the evaluation of the appropriateness of care being given and helps in maintaining reimbursement for the physician.

Explanation

The probable reason why the case conference was scheduled is that Medicare mandates a case conference every 60 days to coordinate care. This ensures that all healthcare professionals involved in the patient's care, such as the nurse and physical therapist, can come together to discuss the patient's progress, treatment plan, and any necessary adjustments to ensure coordinated and effective care. It also allows for the evaluation of the appropriateness of care being given and helps in maintaining reimbursement for the physician.

13. A home care nurse was discussing her day with a nursing colleague who worked in acute care at the nearby metropolitan hospital. You have it easy, said the home care nurse. You never have to . . . . Complete the home care nurses sentence accurately.

Remember to take exactly what you need with you on the visit.

Spend hours every day documenting everything you did.

Worry about whether your client will recover.

Worry about who is going to pay for services or the rules of that payer.

The home care nurse was implying that her colleague in acute care does not have to worry about the financial aspect of providing care to patients. In acute care, the hospital usually takes care of the payment and deals with insurance companies or other payers. However, in home care, the nurse often has to navigate the complexities of insurance coverage and reimbursement, which can be a significant concern and added stress.

Explanation

The home care nurse was implying that her colleague in acute care does not have to worry about the financial aspect of providing care to patients. In acute care, the hospital usually takes care of the payment and deals with insurance companies or other payers. However, in home care, the nurse often has to navigate the complexities of insurance coverage and reimbursement, which can be a significant concern and added stress.

14. A nurse was told that the home health nursing agency had just been accredited by the Community Health Accreditation Program (CHAP). Among other requirements, what has the agency probably just completed?

A review of policies and procedures from other similar agencies

A walk-through assessment of the agency

Certification of the staff of the agency

A thorough self-evaluation

The agency has probably just completed a thorough self-evaluation. This is because accreditation by the Community Health Accreditation Program (CHAP) typically involves a comprehensive assessment of the agency's policies, procedures, and overall performance. A self-evaluation allows the agency to critically analyze its practices and identify areas for improvement. It is an important step in the accreditation process to ensure that the agency meets the required standards and provides high-quality care to its patients.

Explanation

The agency has probably just completed a thorough self-evaluation. This is because accreditation by the Community Health Accreditation Program (CHAP) typically involves a comprehensive assessment of the agency's policies, procedures, and overall performance. A self-evaluation allows the agency to critically analyze its practices and identify areas for improvement. It is an important step in the accreditation process to ensure that the agency meets the required standards and provides high-quality care to its patients.

15. The Nursing Home without Walls (NHWW) staff compared the cost of care in the home with care in the hospital and drew what conclusion?

Home care services are slightly less expensive than what hospital care would cost.

Home care services are about half of what hospital care would cost.

Home care services are roughly equivalent to what hospital care would cost.

Home care services do not clearly demonstrate a difference in cost.

The NHWW staff compared the cost of care in the home with care in the hospital and concluded that home care services are about half of what hospital care would cost. This suggests that receiving care at home is more cost-effective compared to being admitted to a hospital.

Explanation

The NHWW staff compared the cost of care in the home with care in the hospital and concluded that home care services are about half of what hospital care would cost. This suggests that receiving care at home is more cost-effective compared to being admitted to a hospital.

16. A home health nurse was competent and efficient, and yet a client simply was not ready to be discharged from care, although the clients date of discharge had now expired. What will happen to the client now that the original assessment and plan of care suggested that the client be discharged?

A different nurse can begin again with assessment and planning in preparation for an appeal of discontinuation of financial reimbursement.

The nurses original assessment and plan were inaccurate, so a correction has to be filed to justify continued financial reimbursement.

The client will be discharged as planned and will have to depend on family or friends for assistance.

The client will continue to receive care as needed, and the agency will suffer a financial loss.

The client will continue to receive care as needed, and the agency will suffer a financial loss. This suggests that even though the client's date of discharge has expired, the nurse recognizes that the client is not ready to be discharged and will continue to provide care. However, the agency will suffer a financial loss because they will not be reimbursed for the extended care period.

Explanation

The client will continue to receive care as needed, and the agency will suffer a financial loss. This suggests that even though the client's date of discharge has expired, the nurse recognizes that the client is not ready to be discharged and will continue to provide care. However, the agency will suffer a financial loss because they will not be reimbursed for the extended care period.

17. A home care client was no longer eligible for insurance reimbursement of needed home care. What is the appropriate action for the nurse to take next?

Providing care until the client can be transferred to a different agency

Explaining that care is not free and that the nurse will not be returning

Consulting with the public health department so that the client will receive free services

Referring the client to social services for assistance

The appropriate action for the nurse to take next is to provide care until the client can be transferred to a different agency. This ensures that the client's needs are still being met while the nurse helps facilitate the transition to another agency that may provide insurance reimbursement for the needed home care.

Explanation

The appropriate action for the nurse to take next is to provide care until the client can be transferred to a different agency. This ensures that the client's needs are still being met while the nurse helps facilitate the transition to another agency that may provide insurance reimbursement for the needed home care.

18. A nurse knew that the home health agency had been accredited by the Community Health Accreditation Program (CHAP). What will be the agencys status in relation to required Medicare visits and self-study?

The agency will have difficulties because Medicare reimburses only agencies accredited by the Joint Commission.

The agency will have deemed status as accreditation standards are more rigorous than Medicare criteria.

The agency will need to demonstrate evidence of achieving positive outcomes in order to receive Medicare reimbursement.

The agency will need to engage in another self-evaluation and submit to Medicare peer review site visits.

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Explanation

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19. Which of the following is an example of a customer of home care?

An agency that employs and pays the nurse

A group of colleagues who evaluate the nurses care

A client for whom the nurse is caring

A physician who refers a client to the home care agency

A physician who refers a client to the home care agency can be considered as a customer of home care because they are actively involved in the process of referring clients to the agency. The physician plays a crucial role in the decision-making process and acts as a gatekeeper for the client's access to home care services. They have a direct impact on the agency's business by recommending their patients to receive care from the agency.

Explanation

A physician who refers a client to the home care agency can be considered as a customer of home care because they are actively involved in the process of referring clients to the agency. The physician plays a crucial role in the decision-making process and acts as a gatekeeper for the client's access to home care services. They have a direct impact on the agency's business by recommending their patients to receive care from the agency.

20. Besides professional home health care, what other kind of home care may be needed?

Community health home care, based on care needed in a community

Public health home care, based on principles of caring for aggregates

Technologic home health care, based on reimbursement guidelines

Technical home health care, based on a need for a piece of medical equipment

Technical home health care may be needed when a person requires a specific piece of medical equipment to be used at home. This type of care is focused on providing assistance with the proper use and maintenance of the equipment, ensuring the individual's safety and well-being. It is different from professional home health care, which involves skilled medical services provided by healthcare professionals. Community health home care and public health home care are not mentioned in the question and do not relate to the need for medical equipment. Technologic home health care, based on reimbursement guidelines, is not a valid option as it is not mentioned in the question.

Explanation

Technical home health care may be needed when a person requires a specific piece of medical equipment to be used at home. This type of care is focused on providing assistance with the proper use and maintenance of the equipment, ensuring the individual's safety and well-being. It is different from professional home health care, which involves skilled medical services provided by healthcare professionals. Community health home care and public health home care are not mentioned in the question and do not relate to the need for medical equipment. Technologic home health care, based on reimbursement guidelines, is not a valid option as it is not mentioned in the question.

21. What is a reason why home health nurses do not engage in case finding and preventive health teaching to all members of the family?

These services do not result in reimbursement for the agency.

Caseloads are so high that there is no time to provide these services.

Home health nurses do not feel comfortable providing these services.

Federal regulations limit the amount of these services that agencies can provide.

Home health agencies are typically reimbursed for the services they provide to patients. However, case finding and preventive health teaching to all members of the family may not be reimbursable. This could be because these services are not considered essential for the patient's immediate care or because they are not covered by the insurance plans that the agency works with. As a result, home health nurses may prioritize other services that are reimbursable in order to meet the financial needs of the agency.

Explanation

Home health agencies are typically reimbursed for the services they provide to patients. However, case finding and preventive health teaching to all members of the family may not be reimbursable. This could be because these services are not considered essential for the patient's immediate care or because they are not covered by the insurance plans that the agency works with. As a result, home health nurses may prioritize other services that are reimbursable in order to meet the financial needs of the agency.

22. In 1995, which type of agency provided most of the home care services?

Hospital-based home care agencies

Local and county health departments

Privately owned, but nonprofit, entrepreneurial home care agencies

Proprietary for-profit incorporated home health agencies

In 1995, the majority of home care services were provided by proprietary for-profit incorporated home health agencies. These agencies were privately owned and operated for profit.

Explanation

In 1995, the majority of home care services were provided by proprietary for-profit incorporated home health agencies. These agencies were privately owned and operated for profit.

23. A home care nurse is going to a clients home to admit the client for home care services. What should the nurses priority action be during the admission visit?

Complete the Outcomes Assessment and Information Set (OASIS) form for the Centers for Medicare and Medicaid Services (CMS).

Discuss the availability of financial resources or eligibility for a third-party payer.

Inform the client of his or her responsibility to follow the plan of care to continue receiving services.

Set up the equipment for the computer to relay data between the nurse and the client.

The nurse's priority action during the admission visit should be to discuss the availability of financial resources or eligibility for a third-party payer. This is important because it ensures that the client has the necessary financial support or insurance coverage to receive home care services. By addressing this issue early on, the nurse can help the client understand their financial responsibilities and explore potential options for funding their care. This step is crucial in ensuring that the client can continue to receive the necessary services without any financial barriers.

Explanation

The nurse's priority action during the admission visit should be to discuss the availability of financial resources or eligibility for a third-party payer. This is important because it ensures that the client has the necessary financial support or insurance coverage to receive home care services. By addressing this issue early on, the nurse can help the client understand their financial responsibilities and explore potential options for funding their care. This step is crucial in ensuring that the client can continue to receive the necessary services without any financial barriers.

24. Which of the following actions demonstrates a home care nurse integrating the Healthy People 2020 objectives into home care practice?

Referring a client to physical therapy

Instructing a client to visit the dentist on an annual basis

Administering an insulin injection to a diabetic client

Counseling a client about how to prevent the spread of infectious disease

The correct answer is instructing a client to visit the dentist on an annual basis. This action aligns with the Healthy People 2020 objective of promoting oral health and preventing dental diseases. Regular dental visits are essential for early detection and prevention of oral health problems, which contributes to overall health and well-being. By instructing the client to visit the dentist annually, the home care nurse is integrating this objective into their practice and promoting the importance of oral health.

Explanation

The correct answer is instructing a client to visit the dentist on an annual basis. This action aligns with the Healthy People 2020 objective of promoting oral health and preventing dental diseases. Regular dental visits are essential for early detection and prevention of oral health problems, which contributes to overall health and well-being. By instructing the client to visit the dentist annually, the home care nurse is integrating this objective into their practice and promoting the importance of oral health.

25. Why did home care agencies expand in the 1980s?

Clients discovered they much preferred home care to hospital care.

The diagnostic-related group (DRG) system of reimbursement was phased into hospitals.

An increased number of elderly and poor persons became eligible for care because of federal legislation.

There was a lack of interest by American society in contributing to charitable causes.

In the 1980s, home care agencies expanded because the diagnostic-related group (DRG) system of reimbursement was phased into hospitals. This system changed the way hospitals were reimbursed for services, leading to shorter hospital stays and increased emphasis on outpatient care. As a result, many patients preferred to receive care at home instead of staying in the hospital, which led to the growth of home care agencies.

Explanation

In the 1980s, home care agencies expanded because the diagnostic-related group (DRG) system of reimbursement was phased into hospitals. This system changed the way hospitals were reimbursed for services, leading to shorter hospital stays and increased emphasis on outpatient care. As a result, many patients preferred to receive care at home instead of staying in the hospital, which led to the growth of home care agencies.

26. Which of the following features of hospice differentiates it from traditional home care?

Use of direct service volunteers as part of the interdisciplinary team

Need for accurate documentation in order to receive reimbursement

Use of Medicare reimbursement for services provided

Provision of direct nursing services for the client

Hospice differentiates itself from traditional home care by utilizing direct service volunteers as part of the interdisciplinary team. This means that in addition to the professional healthcare providers, hospice also involves trained volunteers who offer support and assistance to patients and their families. These volunteers play a crucial role in providing emotional support, companionship, respite care, and other non-medical services. This feature distinguishes hospice from traditional home care, where the care is typically provided solely by healthcare professionals.

Explanation

Hospice differentiates itself from traditional home care by utilizing direct service volunteers as part of the interdisciplinary team. This means that in addition to the professional healthcare providers, hospice also involves trained volunteers who offer support and assistance to patients and their families. These volunteers play a crucial role in providing emotional support, companionship, respite care, and other non-medical services. This feature distinguishes hospice from traditional home care, where the care is typically provided solely by healthcare professionals.