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Diets 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 that 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 it 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 that is most appropriate

for them. Items reviewed for discharge

planning includes but is 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

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 care 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 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. Examples of some of the

services that may be available are light housekeeping, meal preparation,

medication reminders and personal care. The personal care does not include

specific health oriented services that 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:

enabling 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 are

providing. Both the government and national 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 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. State

licensure regulations, federal regulations and Joint Commission on Accreditation

of Health Care Organizations (JCAHO) regulate the long-term care facility. 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

available 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. 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 that 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.

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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