Health Care Delivery Notes

Health Care Delivery

Levels of Care in Inpatient Settings

  • Acute Care Hospital:

    • Provides emergency care, surgeries, inpatient care.
    • Offers diagnostic testing and possibly outpatient care.

  • Long Term Acute Care Hospital:

    • Patients have serious medical problems requiring continued medical treatment.
    • Typically lasts 20-30 days.

  • Skilled Nursing Facility:

    • Provides a less intense level of care than a traditional hospital.
    • The stay can range from a few days to 100 days.

Long Term Residential Care

  • Assisted Living:

    • Offers less nursing care than long-term care facilities.
    • Provides 24 hour assistance.
    • Assistance with medications and personal care is provided.
    • Meals are often provided.

  • Memory Care:

    • Care for residents with cognitive issues.
    • 24 hour care provided by CNAs.
    • RN or LPN is available on the unit or on call.

  • "Nursing Home":

    • Nursing care is provided around the clock.
    • Staffed by RNs, LPNs, and CNAs.

Outpatient Care

  • Examples of Outpatient Care:
    • Ambulatory care centers
    • Observation units
    • Mental Health Services
    • Cardiac rehabilitation
    • Ambulatory Care clinics
    • Health Departments
    • Medical Offices
    • Home health care
    • Hospice

Delivery of Nursing Care

  • Team Nursing:

    • A team that consists of nurses and assistive personnel
    • Traditional model

  • Patient-Centered Care:

    • Patient has control of managing their care
    • Often seen in rehab facilities
    • Generally, fewer people are involved in giving care

  • Primary Care Nursing:

    • One nurse is responsible for all aspects of nursing care
    • Common in ICUs

  • Case Management:

    • Nurse functions in multiple roles to meet the overall needs of the patient.
    • Found in a variety of facilities; insurance, hospitals, LTC

Affordable Care Act

  • Signed into law in 2010 to provide insurance to all Americans.
  • Addresses four major issues:
    • Cost containment
    • Pre-existing conditions
    • Small business premiums
    • Lifetime benefit caps

Reimbursement Platforms

  • Medicare:
    • Federal government insurance for people older than 65.
    • Uses payment schedule based on diagnosis-related groups (DRGs).
    • Parts A thru D
  • Medicaid:
    • Federal-state program that provides health care for individuals below the poverty level as well as disabled individuals, children, and pregnant women.
  • Private Health Insurance:
    • Insurance typically offered through an employer
    • Multiple health plans are provided