America has a highly developed health caresystem, which is available to all people. Although it can bevery complex and frustrating at times it has come a longway from the health care organizations of yesterday.

Previously most health care facilities were a place wherethe sick were housed and cared for until death. Physiciansrarely practiced in hospitals and only those who werefortunate could afford proper care at home or in privateclinics. Today the level of health care has excelledtremendously.

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Presently the goal of our health care is tohave a continuum of care for the patient, one which isintegrated on all levels. Many hospitals offer a referralservice or discharge plan to patients who are beingdischarged. Plans for the patient are discussed with adischarge planner.

The discharge planner is a person who istrained in assessing what the patient’s requirements forhealth care will be after discharge from the hospital. Thisenables the patient to continue ! their care at a level whichis most appropriate for them. Items reviewed for dischargeplanning include but are not limited to therapies, medicationneeds, living arrangements and identification of specificgoals. A few of the options that are available for personsbeing discharged from an acute care hospital can includehome health care, assisted living facilities, long term care orhospice Home Health Care According to Growing Old inAmerica (1996), “Home health care is one of the fastestgrowing segments of the health care industry” (p.

114).Alternatives for home care can meet both the medical andnon-medical needs of a patient. These services areprovided to patients and their families in their home orplace of residence. Home care is a method of deliveringnursing care and other therapies as required by the patient’sneeds. Numerous alternatives are available for personsseeking health care at home.

With transportabletechnologies such as durable medical equipment, oxygensupply and intravenous fluids there are countlesspossibilities for treatment within the home setting. As statedin The Continuum of Long Term Care “Home healthprograms range from formal organizations providing skillednursing care to relatively informal networks that arrangehousekeeping for friends” (p. 185). This has allowed forhome care to quickly become an essential component ofthe health c! are delivery system in the United States.

In ahome health care situation the primary care giver is usuallynot the physician. The physician is communicated with byphone and with documentation from the caregivers. Theprimary caregivers are usually the nurses and other teammembers who are involved directly with the patient’s care.Although, the original order to begin home care must beinitiated by the physician if skilled care is to be obtained.According to the 1995 Guide to Health Insurance forPeople with Medicare “Medicare pays the full cost ofmedically necessary home health visits by aMedicare-approved home health agency” (p. 5).

Thiscoverage must meet specific criteria, but it can be a relief tofamily members to know that their loved ones can be takencare of at home without worrying about the expenses.Unfortunately, if the care to be given within the home istermed “not medically necessary” the expense is notcovered. This can include items such as meal andmedication delivery, a percentage of necessary durablemedical equipment, personal care and homemakerservices. My employment within a home health care agencyhas allowed for review of services that are not covered byMedicare and/or private insurance. Health care servicesthat are not included can become quite numerous. It isoften difficult for family members to understand whyspecific services are not covered especially when theyappear to be necessary for the care of the patient. Thesecosts can add up quite quickly and the impact of the costcan become quite distressing for family members andpatients on a limited budget.

In these cases a SocialWorker is usually provided to help the patient and familyexplore other avenues which may enable them to covertheir health care costs. Assisted Living Assisted living is anarrangement to residents of a facility that enables them tocomplete certain daily activities while remainingindependent. The services provided enable the resident toachieve maximum function of their activities of daily living.The services are unskilled and non-specialized personnelprovide the activities essential to the care of the resident.These services help assist the aged, blind, disabled, andother functionally limited individuals with necessary dailyactivities which they require help with or are unable toperform on their own. An example of some of the serviceswhich may be available are light housekeeping, mealpreparation, medication reminders and personal care. Thepersonal care does not include specific health orientedservices which would require the services of a certified orlicensed professional.

It is stated well in Aging “Althoughthe level of services provided may vary, assisted livingcommunities all share a common goal: e! nabling people tolive as active and independent a life as possible” (p. 212).The goal of an assisted living facility is to have the residentsfeel independent within their own home. According to thearticle Assisted Living’s Future In Michigan Debated”Assisted living facilities can offer consumers a greatopportunity to get personalized care in a comfortablesetting” (p. 2). Currently there is some controversysurrounding the different types of assisted living facilities. InMichigan facilities termed assisted living have no real legalmeaning and are not required to be licensed under thisname.

According to the article Assisted Living’s Future InMichigan Debated “Unlicensed facilities, unsubsidized care,untrained staff, and unmet promises make some placesseem more like un-assisted living” (p. 1). Unfortunatelymany facilities are misleading as to what level of care theyare providing. Both the government and nationalorganizations are currently addressing this issue. My ownexperience with an assisted living facility has been quitegood. Formerly my grandmother was a resident of anassisted living facility. The facility was specifically built forseniors and was that of an apartment like structure.

Thefacility provided social and recreational activities on acontinual basis. There was also transportation serviceavailable for residents who wished to use it. Mygrandmother thoroughly enjoyed living in an assisted livingfacility where she had the opportunity to make numerousfriends, participate in activities and remain independent.Long Term Care Long-term care patients are categorizedby having a chronic condition and/or disease. Thelong-term care facility can be either hospital-based orfreestanding. It consists of an organized medical staff,which provides continuous nursing services underprofessional nurse direction. The patient’s status isreviewed on a regular basis to determine if they meetcriteria to remain at the facility.

The long-term care facilityis regulated by state licensure regulations, federalregulations and Joint Commission on Accreditation ofHealth Care Organizations (JCAHO). State licensure ismandatory, Federal regulation is only necessary if thefacility participates with Medicare and Medicaid, andJCAHO standards are voluntary. Long term-care is veryexpensive and it often becomes a financial catastrophe forthe elderly person and their family. Private insurance isunlikely to cover the full cost of care and Medicare onlypays for a limited amount. The person usually musteliminate a substantial amount of their assets to becomeeligible for Medicaid which covers long term care.According to Growing Old In America “In order for elderlypersons to qualify for nursing home care under Medicaid,they usually must reduce their personal financial status tothe poverty level (p.

119-120). Regretfully, the cost is notthe only disturbing factor of a long-term care facility. Afamily decision to place my grandfather who was sufferingfrom Alzheimer’s disease into a nursing home was a verydifficult and emotional experience for everyone involved.Regular visits by all family members continually raisedconcerns about the quality of care that he was receiving.Staffing was also a concern for our family. It seemed therewas not enough staff to meet the needs of the patientswithin the facility. Although licensing agencies regulatedthese aspects, this was not comforting to our concerns.

Fortunately, we were able to move my grandfather to adifferent facility. The nursing home was newer and betterstaffed and all family members felt more comfortable aboutthe care he was receiving. The experience of placing aloved one into a long term care facility is one I would preferto not experience again.

It is comforting to know that thereare good facilities availab! le and caregivers that really careabout the patient’s needs. These aspects are very importantfor families to understand before making a final decisionwhen they must place a loved one into a facility. HospiceUnfortunately the last resort for some patients may behospice care. Hospice is an organized program that offersdying persons and their families an alternative to traditionalcare for terminal illness. As stated in Aging “Hospice care isexclusively for dying people.

It therefore brings expertise tohelping patients and their families face issues specific todeath and dying” (p. 180). Hospice enables the patient toreceive palliative medical care, while meeting thepsychosocial and spiritual needs of the patient, their familyand friends. Hospice programs also offer bereavementservices for 13 months (or beyond if required) following thepatient’s death for any family members or friends who wishto receive the service. The article The Continuum of Longterm Care emphasizes “The philosophy of hospice is thatterminally ill individuals should be allowed to maintain lifeduring their final days in as natural and comfortable a settingas possible” (p. 198). The quality of life of the terminally illpatients relies heavily on the psychosocial skills of theirhealth care team.

The health care team consists of aphysician, nurse, social worker, chaplain, home health aideand volunteers. The team develops an individual care planwhich will provide an appropriate support system for thepatient and their family up to and beyond the patient’sdeath. Weekly meetings allow the team to focus on thechanging needs of the patient and make adjustments to theirplan. Hospice care can be received in a variety oforganizational settings.

The most preferred setting is ofcourse within the patient’s own home, but nursing homes,hospitals and long term care facilities are a few who canalso provide hospice care. Hospice care is a coveredbenefit under Medicare and most private insurancecompanies. The regulating agencies that set the standardsfor hospices are Medicare, the National HospiceOrganization, Joint Commission on Accreditation of HealthCare Organizations (JCAHO) and state hospice agencies. Ihave found that the medical record content in a hospiceprogram contains an extensive amount of identifyinginformation in regards to the patient and their primarycaregiver(s).

All aspects of patient care are welldocumented and assure well-coordinated, continuous care.The medical record acts as a communication tool betweenthe different team members and is used on a continuousbasis throughout the patient’s care. Conclusion Althoughthere are many options other than those listed for healthcare after discharge from a hospital, The most importantaspect for a person is to be well informed andknowledgeable about the variety of options available. It canbe very confusing, especially to an elderly person when talkof finances, regulations and covered and non-covered itemsare discussed. It is our responsibility as future health careadministrators to provide adequate information to theperson who is opting for alternatives to health care. Bibliography:

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