Home Healthcare & Nursing Facility
· Describe the roles and responsibilities of the administration in each department of your chosen facilities.
· Identify and list the sources of financing available to consumers for the various programs provided by your chosen facilities. Identify the key public and private sources of reimbursement available. Also discuss the role played by managed care and its impact on long-term care reimbursement.
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· Describe the various government and private resources available that assist in developing and maintaining quality improvement programs in your chosen facilities. Describe the ways in which quality and cost are controlled in your chosen facilities. Also discuss the ethical aspect of access to care in the facilities, including rationing.
Based on your observations and learning from the two facilities, discuss the changes brought in the long-term care system to make it reach full status as a competition-driven system. You may include the following points in your discussion:
· Discuss the changes made in the control mechanisms (external and internal) in order to control the management, financing, and quality in the long-term care systems.
· Discuss the changes taking place in long-term care reimbursement system in order to provide better reimbursement options both to consumers and providers.
· Discuss the changes made in the efforts of providers to accommodate changing magnitude of the day-to-day needs of long-term care consumers.
Home Healthcare & Nursing Facility· Describe the roles and responsibilities of the administration in each department of your chosen facilities.· Identify and list the sources of fina
LONG TERM CARE 13 Long Term Care Name: Institutional Affiliation: Describe the roles and responsibilities of the administration in each department of your chosen facilities. Depending on the size of the nursing facility, the administration staff may comprise of a couple of people or dozens of employees at the various departments. Some of this include: Direct care staff. These are the personnel that have direct contact with the patient. They include registered nurses and the nursing assistants. The registered nurses are mandated by the law to assess the needs of the residents of the nursing facility. They then work with the practical nurses and the vocational nurses to plan and implement the care of the patients. These professionals should all be licensed. The nursing assistants work under the registered nurses. Their role and responsibility include the health and well-being of residents in their daily activities. This activities include grooming, dressing, eating and using the bathroom. Federal law also require that the nursing home enlist the services of a qualified dietician. He or she can work full time or part-time as a consultant. The nursing facility can alternately designate a director of food service who is required to frequently consult with the dietician. Administration and Support staff. This include the custodians, maintenance staff and the groundskeepers. They are in charge of caring for the building and grounds so as to ensure cleanliness of the facility. Administration staff for a large nursing home may contain employees in different departments such as the human resources, finance, procurement and public relations. Home health care administration is also provided by registered nurses and licensed practical nurses. Other professionals in provision of care at home include occupational therapists, psychotherapists, social workers and home health care assistants (Harris, 2015). The largest segment of home healthcare administrators comprise of unlicensed non-medical personnel who include caregivers. They help the patients to perform their everyday living tasks such as grooming. Identify and list the sources of financing available to consumers for the various programs provided by your chosen facilities and the key public and private sources of reimbursement available. Medicaid is the primary source of funding for nursing facilities. It is a federal government program that covers the long term nursing home costs for low income citizens. The eligibility rules for Medicaid slightly vary from state to state but it is generally available to people who are unable to care for themselves at home. They must however meet the state’s eligibility limit regarding income and wealth levels. Medicare is another federal source of financing that is available to consumers of nursing facilities. It is however a short-term source of financing as opposed to Medicaid. The program is also different to Medicaid as it pays for skilled nursing facility. It is available to adults over sixty-five years of age and specific young people with disabilities. Another source of financing for home health care and nursing facilities is private long-term care insurance. Private insurance requires that the insured pay premiums monthly in return for being insured for their long term care needs. The premiums paid are generally high if one takes this service at an advanced age. Personal resources or out-of-pocket spending is another source of spending on nursing facilities and home health care. These resources include the use of personal trusts and annuities. It is essential that one uses a financial planner to advice on the benefits and risks of this options so as to settle on the best alternative. Role played by managed care and its impact on long-term care reimbursement Managed care plays a big role in the management of the cost of health care. Medicaid managed care for instance provides for health benefits through constricted engagements between its state organizations and managed care providers that accept monthly contributions. Managed care reduces health costs through a variety of other mechanisms. One of this mechanism is the provision of economic incentives to patients and physicians so that they can choose less costly forms of care. This is accomplished through programs that review the necessity of certain medical procedures, control of the length of admission for inpatients and through the selective contracting of healthcare providers. Managed care has also improved the quality of healthcare. This is because it offers an integrated financing and delivery system that combines preventive care for its members. Through the integrated system, it is easier to monitor an individual’s holistic healthcare experience and coordinate care when needed. The comprehensive medical records database also enables healthcare researchers to measure clinical outcomes and recommend interventions to boost the quality of healthcare. Discuss the changes taking place in long-term care reimbursement system in order to provide better reimbursement options both to consumers and providers. Some of the modifications that are being witnessed in long-term care (LTC) reimbursement are aimed at decreasing LTC costs. Some of this changes are taking place at managed care organizations and other new groups that provide long term care services (Stefanacci, 2014). They include both regulatory and practice shifts that have been developed in order to ensure efficient and effective delivery of healthcare. This newly proposed regulations will also herald a decrease in use of emergency and hospice amenities for skilled nursing facilities (SNF). This will ensure that SNFs focus on results that they can account for. Additionally, regulatory and environmental changes in long term care will ensure that SNFs focus on medication management. The focus on bundled payments which began in 2013 will increase financial and performance accountability. Linking payment for the various services that beneficiaries receive is bound to increase the quality of healthcare while providing better reimbursement options through more coordinated delivery of care Bundled payments can also align the incentives of providers and mark an end to fragmented care and poor coordination. This will enable the healthcare providers and practitioners to easily partner across the various specialties so as to improve the experience of the patient both in their stay in the facility as well as during the discharge recovery. The inclusion of nursing homes in the Accountable Care Organizations (ACO) will also better the reimbursement options of the consumers and providers. This is because the organization can hold the providers to account for the quality and cost of their services to the consumers (Stefanacci, 2014). The ACO can also reduce the economic inducement for providers to carry out intrusive medical procedures that are only intended to make money. The move into compulsory managed care for all Medicaid recipients by the states is also bound to improve reimbursement options. This is because of the harmonization of processes that is bound to result in efficiency gains. Describe the various government and private resources available that assist in developing and maintaining quality improvement programs in your chosen facilities In developing and maintaining quality improvement in nursing homes, the government has strengthened the regulatory process through direct legislation. Long term care facilities such as nursing homes require a license. This is a federal law that is implemented by the states as they are in charge of licensing the facilities within their jurisdiction. In order to qualify for reimbursements, the nursing facilities must also show compliance to federal quality requirements. Tying Medicaid and Medicare reimbursements to quality certifications ensures that administrators of this facilities maintain the required quality level. The government agency, the Center for Medicare and Medicaid Services (CMS) is another government resource that administers federal standards and quality assurance enforcement to maintain quality improvement in nursing homes. This is a critical policing mechanism for ensuring quality as facilities identified as not meeting the regulatory requirements and standards are punished. The CMS has over time strengthened the federal oversight role by reducing the predictability of its surveys and by targeting the notorious nursing facilities. Regulations that mandate high-staffing ratios and that increase the minimum training and qualification requirement for nurses are vital in marinating quality. This is because they strengthen the nursing facilities workforce. Another private and government effort that maintains quality at the nursing home is the use of information systems for monitoring. The Federal-mandated minimum data set (MDS) requirement mandates nursing facilities to collect key data about its residents. They are then required to transmit this data to the CMS on quarterly. This data can be used as a quality indicator to identify facilities that are providing poor health care. The CMS is also vital in enforcing quality standards of home health care agencies. This is because of the requirements that the agency has mandated for the home health care providers if they are to qualify for reimbursements. They are for instance required to provide health care on an intermittent and continuous manner. The financial resources of the patient is one of the private resources that can affect the quality of care provided to home care patients. Other care givers in the home setting such as the patient’s family members is another private resource that can affect the quality of care. Professional clinicians have limited authority over this arrangements. Describe the ways in which quality and cost are controlled in your chosen facility. One of the ways through which quality at nursing facilities is controlled through the staffing patterns of nursing personnel. This is because there exists a positive relationship between staffing and the quality outcomes of care. Features of the facility such as its ownership, size and accreditation can also be leverage in controlling quality and cost in nursing facilities. Facility ownership for instance has an effect on the payment sources and consequently on aspects such as staffing. Nursing facilities also compete for private pay patients as they pay at a higher rate as compared to Medicaid and Medicare residents. Competing for private pay residents can also boost the quality of care at a nursing facility as competition generally leads to better services as providers try to outdo each other. Another way of controlling the quality and cost of care at the nursing home is through measuring processes. Process measures such as how personal services are provided to patients for instance during the provision of special services can detect variances in the quality of care so that intervention is timely to ensure that quality is controlled (Stefanacci, 2014). Discuss the ethical aspect of access to care in the facilities, including rationing. The rationing of healthcare resources certainly poses numerous moral dilemmas and conflicts for those charged with making healthcare decisions (Berney, Kelly, Feder, & Jones, 2005). There is for instance the difficulty in determining the extremity of the need in order to prioritize a case. This is because of the difference in perception that is bound to arise between the health care provider and the patient. The failure or limitation to perform particular services of care because of inadequate resources such as personnel or funds therefore poses a moral challenge in addition to the obvious economic challenge. This is because it requires judgements that potentially conflict with both personal and professional values. Past studies have also revealed that nurses ration their time and care in provision of healthcare at the nursing facilities. This raises serious ethical issues as it poses serious threats to the quality of care as well as to the safety and well-being of the patient (Papastavrou, 2013). Rationing can lead to omission or limiting of services such as surveillance, care documentation, patient support and even hygiene. Studies have also revealed significant associations between the limiting of healthcare services and patient-related results such as falls, amplified mortality rates and poor satisfaction rates among the consumers of healthcare services (Papastavrou, 2013). As such, the ethical implications of healthcare rationing are clear in that they can jeopardize health care at the nursing facilities. According to the hypothetical theory of missed care, the decision on whether to suspend or overlook some aspects of care is influenced by an internal factor including morals, attitudes and views that the nurses hold about their duties and accountabilities (Papastavrou, 2013). Consequently, there is the need to consider the nurses ethical commitment to the equal worth of every life and equal worth of care regardless of any economic or racial stratification. Consequently, rationing of healthcare undermines important nursing values such as empathy and holistic care. Nevertheless, some degree of rationing in healthcare could be unavoidable as patient needs are unlimited whereas the resources to match this are limited. This assumption can make rationing of healthcare morally justifiable to healthcare providers (Papastavrou, 2013). Discuss the changes made in the efforts of providers to accommodate changing magnitude of the day to day needs of long term care consumers. One of the major progresses that have been undertaken in the endeavors of long term care providers in a bid to keep up with shifting consumer expectations is in the integration of long term care into other healthcare programs. By coordinating the needs of long term care patients through coordination of the long term care services with the health and social service systems, providers are in a position to offer a holistic experience to their patients. Integrating long-term care with preventive and chronic health care to achieve integrated funding for healthcare can also boost the quality of care provided right from the admission of the patient through to discharge. Integration can also reduce the costs for instance by minimizing unnecessary medical procedures. The level of formal requirements and training for the different professionals in long term care is also vital in accommodating the changing needs of LTC consumers. Decisions on the various types of workforces needed in particular long term care facilities based on the kind of skill and abilities required is essential in ensuring that the practitioners are able to keep up with the needs of consumers (Harris, 2015). References Berney, L., Kelly, M., Feder, G., & Jones, I. (2005). Ethical principles and the rationing of health care: a qualitative study in general practice. The British Journal of General Practice 55(517), 620-625. Harris, M. D. (2015). Handbook of Home Health Care Administration. Jones & Bartlett Learning. Papastavrou, E. (2013). The ethical complexities of nursing care rationing. Health Science Journal Vol. 7 Is. 4. Stefanacci, R. (2014). Long term care regulatory and practice changes: impact on care, quality, and access. Anals of long term care 22 (11), 24-28.