Discussion Topic- HA

Chapter 8 Community-Based Services

Learning Objectives

1. Define and describe community-based long-term care services

2. Identify and define the components of community-based long-term care services

3. Identify and describe regulations affecting community-based service providers

Learning Objectives (continued)

4. Understand the financial, ethical, and managerial issues facing community- based long-term care service providers

5. Identify trends in community-based long-term care services and management

Definitions

Community-based: Any service provided outside of a facility, including home health care, hospice care and adult day care

Home health care: Skilled nursing and other health- related services provided in the consumer’s home

Hospice care: End-of-life care

Adult day care: Interim supervision and socialization

How Home Health Care Developed

 City public health department’s visiting nurse services

 Freestanding visiting nurse associations  Growth based on better reimbursement

How Hospice Care Developed

 England in 1960s  U.S. in 1974  Compassionate care for the

dying

How Adult Day Care Developed

 To provide respite for family caregivers who needed to work

 Began with friends and family – eventually became more organized

Philosophy of Home Health Care

 To take services to consumers’ homes  Eligibility requirements (based on

Medicare regulations): • Physician-ordered • Intermittent • Homebound

Philosophy of Hospice Care

 Not a place, but a philosophy  Patient must be at or near the end of life  Designed to make last days comfortable  May be provided in a home or in an

institution  Serves both patient and family

Philosophy of Adult Day Care

 Less than 24-hour services  Provides both supervision and

socialization  Holistic approach, designed to

maintain quality of life  Allows family caregivers to work

Ownership of Community-Based Service Providers

 Mix of nonprofit, for profit, government owned  Growing number are affiliated with other

health care organizations: • Hospitals • SNFs • Rehabilitation facilities

Services Provided: Home Health Care

• Nursing • Therapy • Dental care • Lab tests • Nutrition • Care

management • Personal care • Homemaking • Transportation • Education

Services Provided: Hospice Care • Physician services • Nursing services

• Social services • Counseling • Medical appliances • Pain management • Homemaker services • Therapies

Services Provided: Adult Day Care

Social day care Health day care Dementia day care

• usually included in the other types

Consumers Served: Home Health Care

 Largely elderly  Some need ongoing care  Others need only temporary care

following a hospital stay

Consumers Served: Hospice Care

 Often very elderly  No hope of a cure  Very vulnerable, often emotionally

exhausted

Consumers Served: Adult Day Care

 Need some supervision, but not institutional care

 Most live at home or with family members

Informal Caregivers

 Family members and friends who provide much community-based care

 Make great sacrifices  Little assistance from the system –

financial or other

Market Forces

 Consumer choice  Cost-effectiveness  Social and demographic changes  Competition among other providers

Regulations

 Medicare certification • Home health and hospice care

 State licensure of provider organizations  Licensure of staff

Accreditation and Certification

 Joint Commission: • Home health and hospice

 CHAP: • Home health, hospice and some other services

 ACHC: • Home health, hospice and some other services

Financing Home Health Care

 Medicare • PPS

 Medicaid  Other government programs  Managed care  Private health insurance  Self-pay and other sources

Financing Hospice Care

 Medicare • Some, but not all services

 Medicaid • Increasing number of states

covering hospice

 Self-pay and other sources

Financing Adult Day Care

 Medicaid • Some states use federal waivers

 Managed care • Some, but not much

 Private insurance • Some, but not much

 Self-pay and other sources

Staffing

Combination of professional and non-professional staff

 Nurses  Home health aides  Therapists  Social Workers  Other specialists  Volunteers – especially in hospice care

Legal and Ethical Issues

 Patient noncompliance  Patient safety  Patient rights  Decision to accept hospice care  Inequitable access

Management Qualifications

 Not regularly licensed  Medicare “conditions of participation”

(where applicable)  Certifications

Management Challenges and Opportunities

 Home health and hospice – supervision of staff

 Hospice – coordinating professional and volunteer staff

 Hospice – the emotional element  Cultural, religious, and ethnic differences  Community and philanthropic groups

Significant Trends

 Consumer choice, quality of life  Olmstead decision  Technology  Managed care  Wellness programs

Summary

Community-based services, particularly home health care, hospice care, and adult day care, have become increasingly attractive in recent years and should continue to grow.