Chapter 31: Home Health care

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.

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

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.

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.

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.

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

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

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 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.

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.

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.

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.

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.

Diagnostic-related groups (DRGs)

Home Health Resource Group (HHRGs)

Outcomes Assessment and Information Set (OASIS)

Preferred Provider Organizations (PPOs)

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.

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.

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

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.

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.

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.

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.

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

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

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.

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