Health Care Essay, Research Paper
America has a highly developed health care
system, which is available to all people. Although it can be
very complex and frustrating at times it has come a long
way from the health care organizations of yesterday.
Previously most health care facilities were a place where
the sick were housed and cared for until death. Physicians
rarely practiced in hospitals and only those who were
fortunate could afford proper care at home or in private
clinics. Today the level of health care has excelled
tremendously. Presently the goal of our health care is to
have a continuum of care for the patient, one which is
integrated on all levels. Many hospitals offer a referral
service or discharge plan to patients who are being
discharged. Plans for the patient are discussed with a
discharge planner. The discharge planner is a person who is
trained in assessing what the patient’s requirements for
health care will be after discharge from the hospital. This
enables the patient to continue ! their care at a level which
is most appropriate for them. Items reviewed for discharge
planning include but are not limited to therapies, medication
needs, living arrangements and identification of specific
goals. A few of the options that are available for persons
being discharged from an acute care hospital can include
home health care, assisted living facilities, long term care or
hospice Home Health Care According to Growing Old in
America (1996), "Home health care is one of the fastest
growing segments of the health care industry" (p. 114).
Alternatives for home care can meet both the medical and
non-medical needs of a patient. These services are
provided to patients and their families in their home or
place of residence. Home care is a method of delivering
nursing care and other therapies as required by the patient’s
needs. Numerous alternatives are available for persons
seeking health care at home. With transportable
technologies such as durable medical equipment, oxygen
supply and intravenous fluids there are countless
possibilities for treatment within the home setting. As stated
in The Continuum of Long Term Care "Home health
programs range from formal organizations providing skilled
nursing care to relatively informal networks that arrange
housekeeping for friends" (p. 185). This has allowed for
home care to quickly become an essential component of
the health c! are delivery system in the United States. In a
home health care situation the primary care giver is usually
not the physician. The physician is communicated with by
phone and with documentation from the caregivers. The
primary caregivers are usually the nurses and other team
members who are involved directly with the patient’s care.
Although, the original order to begin home care must be
initiated by the physician if skilled care is to be obtained.
According to the 1995 Guide to Health Insurance for
People with Medicare "Medicare pays the full cost of
medically necessary home health visits by a
Medicare-approved home health agency" (p. 5). This
coverage must meet specific criteria, but it can be a relief to
family members to know that their loved ones can be taken
care of at home without worrying about the expenses.
Unfortunately, if the care to be given within the home is
termed "not medically necessary" the expense is not
covered. This can include items such as meal and
medication delivery, a percentage of necessary durable
medical equipment, personal care and homemaker
services. My employment within a home health care agency
has allowed for review of services that are not covered by
Medicare and/or private insurance. Health care services
that are not included can become quite numerous. It is
often difficult for family members to understand why
specific services are not covered especially when they
appear to be necessary for the care of the patient. These
costs can add up quite quickly and the impact of the cost
can become quite distressing for family members and
patients on a limited budget. In these cases a Social
Worker is usually provided to help the patient and family
explore other avenues which may enable them to cover
their health care costs. Assisted Living Assisted living is an
arrangement to residents of a facility that enables them to
complete certain daily activities while remaining
independent. The services provided enable the resident to
achieve maximum function of their activities of daily living.
The services are unskilled and non-specialized personnel
provide the activities essential to the care of the resident.
These services help assist the aged, blind, disabled, and
other functionally limited individuals with necessary daily
activities which they require help with or are unable to
perform on their own. An example of some of the services
which may be available are light housekeeping, meal
preparation, medication reminders and personal care. The
personal care does not include specific health oriented
services which would require the services of a certified or
licensed professional. It is stated well in Aging "Although
the level of services provided may vary, assisted living
communities all share a common goal: e! nabling people to
live as active and independent a life as possible" (p. 212).
The goal of an assisted living facility is to have the residents
feel independent within their own home. According to the
article Assisted Living’s Future In Michigan Debated
"Assisted living facilities can offer consumers a great
opportunity to get personalized care in a comfortable
setting" (p. 2). Currently there is some controversy
surrounding the different types of assisted living facilities. In
Michigan facilities termed assisted living have no real legal
meaning and are not required to be licensed under this
name. According to the article Assisted Living’s Future In
Michigan Debated "Unlicensed facilities, unsubsidized care,
untrained staff, and unmet promises make some places
seem more like un-assisted living" (p. 1). Unfortunately
many facilities are misleading as to what level of care they
organizations are currently addressing this issue. My own
experience with an assisted living facility has been quite
good. Formerly my grandmother was a resident of an
assisted living facility. The facility was specifically built for
seniors and was that of an apartment like structure. The
facility provided social and recreational activities on a
continual basis. There was also transportation service
available for residents who wished to use it. My
grandmother thoroughly enjoyed living in an assisted living
facility where she had the opportunity to make numerous
friends, participate in activities and remain independent.
Long Term Care Long-term care patients are categorized
by having a chronic condition and/or disease. The
long-term care facility can be either hospital-based or
freestanding. It consists of an organized medical staff,
which provides continuous nursing services under
professional nurse direction. The patient’s status is
reviewed on a regular basis to determine if they meet
criteria to remain at the facility. The long-term care facility
is regulated by state licensure regulations, federal
regulations and Joint Commission on Accreditation of
Health Care Organizations (JCAHO). State licensure is
mandatory, Federal regulation is only necessary if the
facility participates with Medicare and Medicaid, and
JCAHO standards are voluntary. Long term-care is very
expensive and it often becomes a financial catastrophe for
the elderly person and their family. Private insurance is
unlikely to cover the full cost of care and Medicare only
pays for a limited amount. The person usually must
eliminate a substantial amount of their assets to become
eligible for Medicaid which covers long term care.
According to Growing Old In America "In order for elderly
persons to qualify for nursing home care under Medicaid,
they usually must reduce their personal financial status to
the poverty level (p. 119-120). Regretfully, the cost is not
the only disturbing factor of a long-term care facility. A
family decision to place my grandfather who was suffering
from Alzheimer’s disease into a nursing home was a very
difficult and emotional experience for everyone involved.
Regular visits by all family members continually raised
concerns about the quality of care that he was receiving.
Staffing was also a concern for our family. It seemed there
was not enough staff to meet the needs of the patients
within the facility. Although licensing agencies regulated
these aspects, this was not comforting to our concerns.
Fortunately, we were able to move my grandfather to a
different facility. The nursing home was newer and better
staffed and all family members felt more comfortable about
the care he was receiving. The experience of placing a
loved one into a long term care facility is one I would prefer
to not experience again. It is comforting to know that there
are good facilities availab! le and caregivers that really care
about the patient’s needs. These aspects are very important
for families to understand before making a final decision
when they must place a loved one into a facility. Hospice
Unfortunately the last resort for some patients may be
hospice care. Hospice is an organized program that offers
dying persons and their families an alternative to traditional
care for terminal illness. As stated in Aging "Hospice care is
exclusively for dying people. It therefore brings expertise to
helping patients and their families face issues specific to
death and dying" (p. 180). Hospice enables the patient to
receive palliative medical care, while meeting the
psychosocial and spiritual needs of the patient, their family
and friends. Hospice programs also offer bereavement
services for 13 months (or beyond if required) following the
patient’s death for any family members or friends who wish
to receive the service. The article The Continuum of Long
term Care emphasizes "The philosophy of hospice is that
terminally ill individuals should be allowed to maintain life
during their final days in as natural and comfortable a setting
as possible" (p. 198). The quality of life of the terminally ill
patients relies heavily on the psychosocial skills of their
health care team. The health care team consists of a
physician, nurse, social worker, chaplain, home health aide
and volunteers. The team develops an individual care plan
which will provide an appropriate support system for the
patient and their family up to and beyond the patient’s
death. Weekly meetings allow the team to focus on the
changing needs of the patient and make adjustments to their
plan. Hospice care can be received in a variety of
organizational settings. The most preferred setting is of
course within the patient’s own home, but nursing homes,
hospitals and long term care facilities are a few who can
also provide hospice care. Hospice care is a covered
benefit under Medicare and most private insurance
companies. The regulating agencies that set the standards
for hospices are Medicare, the National Hospice
Organization, Joint Commission on Accreditation of Health
Care Organizations (JCAHO) and state hospice agencies. I
have found that the medical record content in a hospice
program contains an extensive amount of identifying
information in regards to the patient and their primary
caregiver(s). All aspects of patient care are well
documented and assure well-coordinated, continuous care.
The medical record acts as a communication tool between
the different team members and is used on a continuous
basis throughout the patient’s care. Conclusion Although
there are many options other than those listed for health
care after discharge from a hospital, The most important
aspect for a person is to be well informed and
knowledgeable about the variety of options available. It can
be very confusing, especially to an elderly person when talk
of finances, regulations and covered and non-covered items
are discussed. It is our responsibility as future health care
administrators to provide adequate information to the
person who is opting for alternatives to health care.
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