Introduction to Healthcare Delivery and Nursing Assistant Roles

Healthcare Settings and Levels of Care

• Healthcare delivery is categorized into various settings based on the timeline and intensity of patient needs.

• Acute Pain vs. Long-Term Care: Acute pain is typically short-term, such as the feeling after a physical workout. Long-term care, by contrast, involves subacute or skilled nursing environments.

• Subacute and Skilled Nursing Facilities: These are for patients who no longer require hospital-level care but are not yet stable enough to return home.

• Skilled Rehabilitation Facilities: These locations provide specific recovery services. Examples of such facilities in the Madison area include:

  • Wisteria.

  • The Woodlands.

  • Edgewood.

• Skilled Unit Features: Some nursing homes may house both a skilled unit and a long-term unit. The skilled unit specifically addresses needs such as:

  • Rehabilitative therapy.

  • Intravenous (IV) therapy.

• Home Health Care: Professional care provided within the patient's residence. This often involves skilled nursing, physical therapy (PT), and occupational therapy (OT).

• Hospice Care: Specialized care for individuals with approximately six months or less to live.

  • The primary goal is comfort rather than curative treatment.

  • The objective is to maximize the quality of life in the final months, focusing on providing a "good life" rather than prolonged suffering.

The Critical Role of Documentation (Charting)

• Documentation is a fundamental responsibility for all healthcare providers to ensure accountability and facility reimbursement.

• The Legal Standard: In the healthcare field, if an action was not documented in the medical chart, it is legally considered not to have happened.

• Charting for Litigation: Providers are taught to "chart like you are going to court." Even if a provider performs every task correctly, they can be named in a malpractice suit if their name is attached to a patient's chart. Proper documentation is the only proof of care once several years have passed.

• Falsification of Records: Documenting a task that was not actually performed is considered falsifying documentation and is a serious offense.

• Insurance and Funding: Facilities receive funding based on the services documented. If a provider fails to chart specific care (such as a total bath or specialized assistance), the facility will not receive the reimbursement it deserves for the level of care provided.

Patient Care and Assisted Living Activities

• Charting often includes daily tasks such as a total bath, which involves cleaning the patient from head to toe.

• Assisted Care Examples: Patients may sit in a shower chair in a shower room. While a patient may be able to scrub most of themselves, a caregiver is needed for areas they cannot reach.

  • Example: An $80$-year-old woman may have mobility limitations that prevent her from reaching her back or properly shampooing her hair.

Professional Hierarchy and Chain of Command

• The chain of command is a structured hierarchy that defines the flow of authority and communication. It is similar to structures found in the military or educational institutions.

• Organizational Direction: Healthcare workers must follow the chain of command by starting with their immediate supervisor and working their way up the hierarchy.

• Educational Institution Example: At a college, a student does not go directly to the President (e.g., Dr. Basic). They follow the proper path:

  • Instructor (e.g., Ms. Dunaway).

  • Dean (e.g., Dean Chanley or Dean Elliott).

  • Vice President (e.g., VP Ware).

  • President (e.g., Dr. Basic).

• In healthcare, the chain of command ensures that issues are handled at the appropriate level of authority.

Oversight and Regulatory Agencies

• Several federal and governmental organizations oversee healthcare facilities to ensure competence and safety.

• The Joint Commission: This organization supervises hospitals. Failure to follow their standards, including infection control and quality of care, can result in the organization closing the hospital's doors.

• State Agencies: These agencies oversee nursing homes. Nursing homes are graded on a scale of one to five stars. This information is public record.

  • Example: Edgewood was reportedly a one-star facility based on specific incidents observed by surveyors or family members.

• OSHA (Occupational Safety and Health Administration): OSHA is designed to protect both patients and employees.

  • Infection Control: OSHA mandates protocols for taking care of patients with communicable diseases to prevent staff from contracting infections.

  • Sharps Safety: It is an OSHA violation if a facility does not provide sharps containers for the disposal of needles.

  • Equipment Training: OSHA requires that employees receive proper training on equipment, such as mechanical lifts, to prevent injury to the resident and the worker.

• Other Agencies: The Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) also play roles in protecting public and worker safety.

The Holistic Approach to Healthcare

• A holistic approach involves treating the "whole" person rather than just a specific disease or diagnosis.

• Socioeconomic Factors: Caregivers must consider a patient's financial status, social support, and background.

• Spiritual Needs: Healthcare workers should help meet a patient's spiritual needs by coordinating with a social worker to find a chaplain of the patient's choice.

• Interdisciplinary Support (Social Workers): Social workers are vital resources for non-clinical needs, such as financial burdens or transportation.

  • Case Study: A family traveled from North Mississippi (near Tupelo) to Jackson via helicopter or ambulance and lacked the means for transportation back home. The social worker utilized donated funds to provide a cab or Uber for their return trip.

Insurance and Financial Barriers in Care

• Insurance types (Medicare, Medicaid, PPOs, and HMOs) often dictate the type of care a patient can receive.

• The Insurance "Limbo": Some individuals make too much money to qualify for Medicaid but not enough to afford private insurance.

• Facility Realities: Hospitals and nursing homes operate as businesses with expenses such as electricity, water, and staff payroll. Consequently, they may be unable to accept patients without a funding source (insurance or private pay).

• Limited Charitable Beds: Some facilities, such as Methodist Rehab or UMC, may designate a very small number of beds for uninsured patients.

  • Example: A woman who was employed but uninsured broke her leg. Because she did not qualify for Medicaid and had no insurance, facilities were reluctant to accept her for rehab, even though she could not walk or use the bathroom independently.

Questions & Discussion

• Question: Why was the instructor told to "chart like you're going to court"?

• Answer: Even if you follow all procedures perfectly, you can be named in a malpractice suit if your name is in the patient's chart. Documentation is the only long-term proof of your actions.

• Question: Why look at a question before looking at the answer choices during a test?

• Answer: This strategy helps you understand what the question is specifically asking or geared toward before being distracted by the options. It prevents skimming past important details.

• Question: Can a hospital be shut down for poor performance?

• Answer: Yes, organizations like the Joint Commission have the potential to close a hospital's doors if standards are not met.

• Question: Does the hospital provide transportation for patients?

• Answer: Some hospitals have their own vehicles but may have distance limitations. Other third-party companies specialize in patient transport and may have contracts with the hospital for discounted rates.