Long-term Care Outpatient

These flashcards cover key concepts related to Long-term Care Outpatient, including definitions, demographic data, service characteristics, and reimbursement aspects.

What is the main focus of Outpatient Long-term Care (LTC)?

Outpatient LTC focuses on care that does not require an overnight stay in a facility and includes services like home care, adult day services, and hospice.

What are the key differences between Home Health Care and Home Care?

Home Health Care involves medically ordered care for homebound consumers, while Home Care provides assistance with daily living activities without medical involvement.

What is home health care characterized by?

Home health care is characterized by consumers being homebound, the care being intermittent, and it being ordered by a physician.

How many individuals receive Home Health Care, and what is the demographic breakdown?

7.2 million individuals receive Home Health Care, with 69% over age 65, 64% women, 82% Caucasian, and 30% widowed.

What are the major primary diagnoses for Home Health Care clients?

The major primary diagnoses include circulatory system diseases, endocrine and metabolic disorders, and musculoskeletal system disorders.

What are some characteristics of Home Health Care Agencies as of 2014?

In 2014, there were almost 12,400 Medicare-certified Home Health Agencies, primarily for-profit and free-standing, with increasing utilization.

What are the primary sources of reimbursement for Home Health Care?

The main sources of reimbursement for Home Health Care are Medicare, Medicaid, state/local government, private insurance, and private pay.

What does Medicare cover in terms of Home Health Care?

Medicare covers services during a 60-day episode of care but does not cover 24-hour care, prescription drugs, meals, or custodial care if that is the only need.

What does PDGM stand for and when did it begin?

PDGM stands for Patient Driven Groupings Model, which began in 2020 as a Medicare mandate.

What does the Quality Assessment in Home Health Care involve?

Quality Assessment involves measuring clinical severity, functional status, sociodemographic factors, health status, and environmental support systems.

What role does the Program of All-Inclusive Care for the Elderly (PACE) play in elderly care?

PACE is a managed care system for frail elderly individuals, providing comprehensive care and services in the community.

What is hospice care?

Hospice care is a program and philosophy that addresses the physical, emotional, and spiritual needs of patients and families during the last phases of terminal illness, emphasizing quality of life.

What criteria must be met for a patient to qualify for the Medicare hospice benefit?

To qualify, a patient's physician and hospice must confirm a life expectancy of 6 months or less, and there must be a written agreement not to pursue curative treatments.

What services does the hospice benefit cover?

The hospice benefit covers physician and nursing services, medical equipment and supplies, drugs for pain management, and various therapeutic services.

Why is hospice care considered underutilized?

Hospice care is underutilized due to societal resistance to discussing death, lack of public awareness, physician training deficits, and financial and access barriers.