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Overview of Health Care Agencies

• Vary in size, services, and staff; patient is the focus of care across all agencies.

• Must follow local, state, and federal laws.

• Staff bring specialized talents, knowledge, and skills to meet individual needs (care for ill/injured, prevent disease, promote health, community health).

• Many agencies are learning sites for students.

Types of Health Care Agencies

• Hospitals: inpatient and outpatient care; can address acute, chronic, or terminal illnesses.

• Rehabilitation and subacute care: for those not needing hospital care but too weak/disabled to go home; care between hospital and long-term care; may involve complex equipment.

• Long-term care centers: residents live there; for those who can’t care for themselves at home but don’t need hospital care; care ranges from simple to complex; includes Skilled Nursing Facilities (SNFs).

• Skilled Nursing Facilities (SNFs): provide complex care within long-term care.

• Assisted living residences: housing, personal care, support services, healthcare, and social activities in a home-like setting.

• Mental health centers: address problems with life events; can be outpatient or inpatient.

• Home care agencies

• Hospices: promote comfort and quality of life for dying persons and their families.

• Health care systems: own hospitals, doctor offices, home care services, nursing centers, medical suppliers.

• Memory care: for dementia/Alzheimer’s; usually secured areas.

• Urgent care

• Adult day care

• Doctor offices / Clinics

Agency Purposes and Roles

• Health promotion: reduce risk of illnesses.

• Disease prevention: immunizations, lifestyle changes.

• Detection and treatment of disease: physical exams, diagnostic tests, surgery, emergency care, therapies.

• Rehabilitation and restorative care: return individuals to highest possible physical/mental function and independence.

• Many agencies are learning sites for students who assist in care.

Organization and Health Team

• Governing body: board of trustees/directors sets policies.

• Administrator manages the agency; reports to the board.

• Directors/department heads manage specific areas.

• Health team focuses on total person care; goal is high-quality care with the person as the focus.

• Health team includes diverse roles across departments and disciplines.

Health Team Members (examples)

• Board of trustees; Administrator; Directors (Business, Nursing, Medical, Ancillary services)

• Medical staff; Nursing supervisors; Staff RNs; LPNs/LVNs; Nursing assistants

• Support roles: Clerical, Public relations, Housekeeping, Purchasing, Payroll, Billing

• Ancillary services: X-ray, Laboratory, Respiratory therapy, Physical therapy, Occupational therapy, Speech therapy, Dietary, Social services, Spiritual care, Pharmacy

The Nursing Team

• Nursing team includes: Registered nurses (RNs); Licensed practical/licensed vocational nurses (LPNs/LVNs); Nursing assistants

• All focus on physical, social, emotional, and spiritual needs of person and family.

• RNs delegate tasks to LPNs/LVNs and nursing assistants; supervision by the nurse in charge.

• Nursing education (staff development) is part of nursing services: in-service programs, new equipment training, policy reviews, orientation for new staff.

• In many agencies, CNA in-service hours are required (example: 12 hours).

Nursing Care Patterns

• Functional nursing: tasks assigned by function/job rather than by patient.

• Team nursing: a team led by an RN provides care tailored to patient needs.

• Primary nursing: an RN responsible for total care of the patient; team assists as needed.

• Case management: coordinates a patient’s care from admission through discharge and into home/long-term care; led by an RN.

• Patient-focused care: services moved to bedside; nursing team performs basic skills often done by other staff (e.g., RN draws blood).

Paying for Health Care

• Private insurance: bought by individuals/families.

• Group insurance: bought by groups/organizations for individuals.

• Medicare: federal health insurance for persons 65 years or older; some younger people with certain disabilities.

• Medicaid: federal program operated by states; for people/families with low incomes; AHCCCS in Arizona.

• ACA (Patient Protection and Affordable Care Act) of 2010: marketplace options for those not qualifying for Medicare/Medicaid.

• Prospective payment systems (PPS): fixed amount paid for a service; if costs are less, agency keeps the difference; if costs are higher, agency bears the loss.

Meeting Standards

• Agencies must meet standards set by federal/state governments and accrediting bodies.

• Standards relate to policies, procedures, and quality of care.

• Types of compliance:

  • Licensure: required to operate and provide care.

  • Certification: required to receive Medicare/Medicaid funds.

  • Accreditation: voluntary; signals quality and excellence.

• Surveys are used to assess whether standards are met.

  • Surveys review policies/procedures and medical records, interview staff/patients, observe care, check safety and cleanliness, ensure staff qualifications.

  • If standards are met, agency receives license/certification/accreditation.

  • If deficiencies are found, agency is given time to correct, may be fined, and can lose license/certification/accreditation.

• Your role in meeting standards: contribute to quality care and participate in surveys (as described under Focus on Surveys).

Quick Reference: Key Points for Exam

• Healthcare agencies serve diverse needs: hospital, long-term care, home care, hospice, mental health, memory care, urgent care, clinics.

• Core agency purposes: health promotion, disease prevention, detection/treatment, rehabilitation/restoration.

• Organization centers on governance (board), administration, and a multidisciplinary health team focused on the patient.

• Nursing roles and patterns drive day-to-day care and efficiency (functional, team, primary, case management, patient-focused care).

• Financials: private/group insurance, Medicare, Medicaid/AHCCCS, ACA marketplace; PPS affects how much agencies are paid.

• Standards drive licensure, certification, and accreditation; surveys ensure compliance; staff involvement is essential to maintain quality care.