HSCI 2111 Midterm Study Guide -Fall 2023 FINAL
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HSCI 2111 Midterm Study Guide
The topics below represent the key content for the midterm exam. That does NOT mean that items in the chapters, PowerPoint presentations, or on the videos will not show up on the exam. In preparation, I would encourage you to review each of these items, ensure that you study both the acronyms and the full
name of the organizations they represent, and also, focus on any UNDERLINED
or BOLDED
content in the presentations.
The midterm exam will cover content from Chapters 1-7.
1.
Flexner Report – what it is, and how it impacted healthcare
An in-depth study, led by Abraham Flexner, that blueprints a major overhaul
of medical education labeled "Medical Education in the United States and Canada. “
published in 1910.
Impact on Healthcare:
a. Standardization of Medical Education: The Flexner Report advocated for the standardization and modernization of medical education. It recommended that medical schools adhere to specific criteria, including the integration of scientific knowledge, laboratory work, and clinical experience.
b. Closure of Substandard Schools: As a result of the report's recommendations, many substandard medical schools were closed or merged with larger institutions. This led to a significant reduction in the number of medical schools in the U.S.
c. Higher Educational Standards: The report's influence led to the establishment of higher admission standards and stricter accreditation processes for medical schools. This raised the overall quality of medical education in the country.
d. Professionalization of Medicine: The Flexner Report played a crucial role in the professionalization of medicine. It helped transform the medical profession into one based on scientific principles and evidence-based practices.
e. Influence on Medical Research: The report's emphasis on research and laboratory work contributed to the growth of medical research in the United States, laying the foundation for many
medical breakthroughs in the 20th century.
f. Impact on Healthcare Delivery: The report's recommendations contributed to the training of more competent and scientifically grounded physicians, which, in turn, improved the quality of healthcare delivered to patients.
2.
Medicare and Medicaid – key differences, who is eligible, what they provide, how funded?
Medicare primarily serves elderly individuals and some disabled individuals, is funded through payroll taxes and premiums, and provides coverage for various medical services, including hospital care and physician services. In contrast, Medicaid is a joint federal-state program that provides healthcare coverage to low-income individuals and families, with eligibility and benefits varying by state. Medicaid
is funded by both federal and state governments, and beneficiaries generally have lower out-of-pocket costs compared to Medicare.
Medicare
:
1.
Eligibility
:
Medicare primarily serves individuals aged 65 and older.
It also covers certain individuals under 65 with specific disabilities.
People of any age with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) are also eligible for Medicare.
2.
Funding
:
Medicare is primarily funded through payroll taxes that individuals and their employers contribute over their working years.
It also involves premiums and cost-sharing from beneficiaries.
The program is administered by the federal government.
3.
Coverage
:
Medicare consists of several parts:
Part A: Hospital Insurance, which covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.
Part B: Medical Insurance, which covers outpatient services, physician services, preventive care, and durable medical equipment.
Part C: Medicare Advantage plans, which are private insurance plans that offer Medicare benefits.
Part D: Prescription Drug Coverage, which helps cover the cost of prescription medications.
4.
Cost-Sharing
:
Beneficiaries may have to pay premiums, deductibles, coinsurance, and copayments for various parts of Medicare.
Medicaid
:
1.
Eligibility
:
Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families.
Eligibility and program specifics vary by state.
Medicaid covers a broad range of individuals, including low-income adults, children, pregnant women, elderly individuals, and people with disabilities.
2.
Funding
:
Medicaid is funded jointly by the federal government and individual states.
The federal government matches a percentage of the funds that states spend on Medicaid, with the matching rate varying based on the state's income level.
3.
Coverage
:
Medicaid provides comprehensive healthcare coverage, including doctor visits, hospital stays, prescription drugs, preventive services, and long-term care.
The specific benefits and eligibility criteria can vary from state to state.
4.
Cost-Sharing
:
Medicaid beneficiaries typically have little to no out-of-pocket costs.
Some states may require nominal copayments for certain services, but these are generally minimal for low-income individuals.
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3.
How much does the U.S. spend on healthcare?
In 2020, the U.S. healthcare expenditure was estimated to be over $4 trillion, according to data from the Centers for Medicare & Medicaid Services (CMS). This represented approximately 17.7% of the country's Gross Domestic Product (GDP). Healthcare spending in the United States has consistently been one of the highest per capita among developed nations.
4.
GDP%
17.7%
5.
Professional organizations/agencies/laws – examples - HIPAA, FDA, CDC, OSHA, CMS and who they are/what the letters stand for NIH, HIPAA, OSHA, FDA, CDC, HRSA, DHHS, AHRQ
NIH - National Institutes of Health:
What it is:
The NIH is the primary agency for conducting and supporting medical research and is composed
of 27 Institutes and Centers. It funds and conducts research to improve human health, addressing a wide range of medical conditions and diseases.
HIPAA - Health Insurance Portability and Accountability Act:
What it is
: HIPAA is a federal law that sets standards for the protection of sensitive patient healthcare information, including medical records and personal health information. It also addresses the portability of health insurance coverage.
OSHA - Occupational Safety and Health Administration:
What it is
: OSHA is a federal agency responsible for ensuring safe and healthy working conditions for employees in the United States. It sets and enforces workplace safety and health regulations.
FDA - Food and Drug Administration:
What it is
: The FDA is a federal agency within the Department of Health and Human Services (HHS). It is responsible for regulating and supervising the safety and effectiveness of food, drugs, medical devices, vaccines, and other products related to public health.
CDC - Centers for Disease Control and Prevention:
What it is
: The CDC is a national public health agency that is part of the Department of Health and Human Services (HHS). It focuses on preventing and controlling diseases, injuries, and public health threats in the United States.
CMS - Centers for Medicare & Medicaid Services:
What it is
: CMS is a federal agency within the Department of Health and Human Services (HHS). It administers the nation's major healthcare programs, including Medicare and Medicaid, which provide healthcare coverage to millions of Americans.
HRSA - Health Resources and Services Administration:
What it is
: HRSA is an agency within the Department of Health and Human Services (HHS) that focuses on improving access to healthcare services for underserved and vulnerable populations. It manages various grant programs and initiatives.
DHHS - Department of Health and Human Services:
What it is
: DHHS is the U.S. government's principal agency for protecting the health and well-being of all Americans. It encompasses various agencies and offices, including the FDA, CDC, CMS, and HRSA.
AHRQ - Agency for Healthcare Research and Quality:
What it is
: AHRQ is an agency within the Department of Health and Human Services (HHS) that conducts research and provides evidence-based information to improve the quality and safety of healthcare in the United States.
6.
MD, DO, RN, LPN, APN
Licensed Practical Nurses (LPNs)
• There are approximately 724,000 LPNs in the
United States. They are the largest group of nurses
and provide basic nursing care.
• Education is offered by community colleges or
technical schools. Training takes approximately 12–
14 months and includes both education and
supervised clinical practice.
• Work primarily in hospitals, home health agencies,
and nursing homes.
• Median salary is approximately $35,000.
Registered Nurses (RNs)
• A registered nurse (RN) is a trained nurse who has
been licensed by a state board after passing the
national nursing examination.
• Can be registered in more than one state.
• Different levels of registered nursing based on
education: an associate degree or a 4-year degree.
• BS (BSN-RN) nurses’ median annual salary is
$70,000. The BSN is the most rigorous of the
nursing programs. These programs offered by
colleges and universities usually take 4–5 years to
complete.
Advanced Practice Nurses (APNs)
• Advanced practice nurses (APNs), or
midlevel practitioners, are nurses who
have experience and education beyond
the requirements of an RN.
– They operate between the RN and MD, which
is why they are called midlevel practitioners.
– They normally obtain a Master of Science in
Nursing (MSN) with a specialty in the field of
practice.
Nurse Practitioners (NPs)
• Nurse practitioners (NPs) are the largest
category of advanced practice nurses.
– They are required to obtain an RN and a master’s
degree or doctoral degree.
– They may receive a certificate program and complete
direct patient care clinical training.
– NPs emphasize health education and promotion as
well as disease treatment, referred to as care and
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cure.
– NPs can write prescriptions in all states.
– There are 248,000 NPs in the United States with an
annual average salary of $105,000.
Certified Nurse Midwives (CNMs)
• Certified nurse–midwives (CNMs) are
RNs who have graduated from a nurse
midwifery education program that has been
accredited by the American College of
Nurse–Midwives’ Division of Accreditation.
– Nurse–midwives have been practicing in the
United States for nearly 90 years.
– The average annual salary is $105,000.
Certified Midwives (CMs)
• Certified midwives (CMs) are individuals
who do not have a nursing degree, but have
a related health background.
– They must take the midwifery education program,
which is accredited by the same organization.
– The average annual salary for a CM is $65,000.
Nurse Anesthetists (CRNAs)
• Nurse anesthetists (CRNAs) provide
anesthesia and related care before, during,
and after types of surgical procedures.
– They provide pain management and some
emergency services.
– The average annual salary for a CRNA is
$165,000.
Certified Nursing Assistants (CNAs)
• Certified nursing assistants (CNAs) are
unlicensed patient attendants who work under
the supervision of physicians and nurses.
– They answer patient call bells and assist patients
with personal hygiene, changing beds, ordering
their meals.
– Assist patients with their ADLs (activities of daily
living).
– Most CNAs are employed by nursing care facilities.
– The annual median salary is $27,520.
Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).
– MDs use an allopathic approach, which means
MDs actively intervene in attacking and
eradicating disease and focus their efforts on the
disease.
– DOs tend to stress preventive treatments and use
a holistic approach to treating a patient, which
means they do not focus only on the disease, but
on the entire person. Most DOs are generalists.
7.
Health Literacy
Health Literacy
:
Health Literacy Definition
: Health literacy refers to an individual's ability to obtain, understand, and use health information and services to make informed decisions about their health and healthcare. It encompasses a range of skills and competencies, including reading and comprehension skills, numeracy,
critical thinking, and the ability to navigate healthcare systems.
Importance of Health Literacy
: Adequate health literacy is essential for individuals to effectively manage their health and healthcare. It enables people to understand medical instructions, make informed
choices about treatment options, and engage in preventive health practices. Low health literacy can lead to misunderstandings, medication errors, missed appointments, and poor health outcomes.
Health Literacy Challenges
: Health literacy challenges can arise due to complex medical terminology, jargon, and the overwhelming amount of health information available online. Vulnerable populations, such as those with limited education, non-native English speakers, and older adults, may be at greater risk of low health literacy.
Health Literacy Promotion
: Healthcare providers, public health organizations, and policymakers play a
role in promoting health literacy. This includes using plain language in healthcare materials, improving communication with patients, and designing accessible health information. Health education programs also aim to enhance health literacy skills in communities.
8.
Community Health
Community Health Definition
: Community health refers to the health status, well-being, and healthcare services available to a specific geographic area or community. It involves assessing and addressing the health needs and concerns of a population within that community. Community health encompasses a broad range of factors, including social determinants of health, access to care, disease prevention, and health promotion.
Key Aspects of Community Health
:
Public Health Initiatives
: Community health involves public health initiatives aimed at preventing diseases, promoting healthy behaviors, and improving overall health outcomes in the community.
Healthcare Access
: Ensuring that community members have access to essential healthcare services is a critical aspect of community health. This includes primary care, specialty care, and emergency services.
Health Equity
: Community health efforts often focus on addressing health disparities and achieving health equity. This means working to eliminate disparities in health outcomes that are influenced by social, economic, and environmental factors.
Community Engagement
: Engaging the community in health promotion and decision-making is
essential. Community members, organizations, and leaders often collaborate to identify priorities
and implement interventions.
Preventive Health
: Preventive health measures, such as vaccinations, screenings, and health education, are fundamental in community health to reduce the burden of diseases.
Community Health Professionals
: Professionals in community health include public health workers, epidemiologists, healthcare administrators, community health educators, and others who work to assess
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and improve the health of communities. They may be employed by local health departments, nonprofit organizations, or healthcare institutions.
Assessment and Planning
: Community health often begins with a community health assessment to identify health needs and priorities. This assessment informs the development of community health improvement plans and programs.
9.
Epidemiology Triangle, Iron Triangle of health care
Epidemiological Triangle (1 of 2)
• Epidemiology is the study of disease distribution
and patterns among populations.
• Epidemiologists identify three major risk factor
categories for disease, called the epidemiological
triangle (see Figure 4-3):
1. The host, which is the population that has the disease
2. The agent or organism, which is causing the disease
3. The environment, or where the disease is occurring
Iron Triangle of Healthcare:
The Iron Triangle of healthcare is a model used to describe the inherent trade-offs and challenges faced in healthcare systems, particularly related to the quality, cost, and access to care. The Iron Triangle consists of three key components:
1.
Quality
: Quality of healthcare refers to the effectiveness, safety, and patient-centeredness of care. Achieving high-quality healthcare often requires resources, specialized training, and rigorous standards of care.
2.
Cost
: Cost represents the financial resources required to provide healthcare services. Balancing cost is a significant challenge, as
increasing the quality of care and expanding access can often result in
higher costs, which can strain healthcare budgets.
3.
Access
: Access to healthcare refers to the ability of individuals to obtain the healthcare services they need when they need them. Factors like geographic location, insurance coverage, and the availability of healthcare providers can affect access.
The Iron Triangle concept illustrates that changes in one element (e.g., improving quality) may impact the other two elements (e.g., increasing costs or altering access). Healthcare policymakers and administrators often grapple with the challenge of finding a balance among these three components to provide high-quality, affordable, and accessible healthcare to the population.
10. Lean Six-Sigma and PDSA
Lean Six Sigma: A Motorola approach that uses
statistics to identify and eliminate defects in
patient care. Focus is on data-driven decision-
making to reduce variation in processes and
promote efficient use of resources.
• Plan-Do-Study-Act (PDSA): Developed by the
Institute for Healthcare Improvement, a four-step
cycle that focuses on improvement of workflow.
11. Indicators used to assess health in U.S. - Life expectancy and infant mortality
Life Expectancy:
Life expectancy is a widely used indicator to assess the overall health and well-being of a population. It represents the average number of years a person can expect to live from birth, assuming current mortality rates remain constant. In the United States, life expectancy has been a key metric in monitoring population health. Factors
influencing life expectancy include healthcare access, lifestyle choices, public health measures, and socioeconomic conditions.
Infant Mortality:
Infant mortality rate measures the number of infants who die before their first birthday per 1,000 live births in a given year. It is a critical indicator of the quality of
healthcare and public health interventions for newborns and pregnant women. Reducing infant mortality is a goal of healthcare systems to ensure healthy starts for children.
12. For profit, Not-for-profit – the differences
For-Profit Healthcare
: For-profit healthcare organizations are businesses that are operated to generate profits for their owners or shareholders. These organizations aim to make money from healthcare services, which can include hospitals, clinics, pharmaceutical companies, and health insurance providers. Profit distribution goes to shareholders or owners.
Not-for-Profit Healthcare
: Not-for-profit healthcare organizations are typically structured as nonprofit entities, meaning they do not distribute profits to owners or shareholders. Instead, any surplus revenues are reinvested into the organization to support
its mission and improve healthcare services. Not-for-profit healthcare entities often have a mission-driven focus on providing care to underserved populations and fulfilling community health needs.
13. Teaching hospital, State hospitals
Teaching Hospital
: A teaching hospital is a medical facility affiliated with a medical school or university. These hospitals play a critical role in medical education and training future healthcare professionals, including medical students, residents, and fellows. Teaching hospitals often engage in medical research and provide specialized and advanced medical services.
State Hospitals:
State hospitals are healthcare institutions owned and operated by a state government. They may serve various purposes, such as providing psychiatric care, long-
term care, or services for individuals with developmental disabilities. State hospitals are often funded and overseen by state health agencies.
14. Licensure for professional provider’s vs certification-
Licensure
: Licensure is a legal process through which a government authority grants permission to an individual to practice a specific profession, such as medicine, nursing, or
pharmacy. It ensures that healthcare providers meet the necessary education, training, and
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competency requirements to practice safely and effectively. Licensure is typically required for healthcare professionals to legally provide patient care.
Certification:
Certification is a voluntary process by which a professional demonstrates expertise or specialized knowledge in a particular area of practice within their field. It is often offered by professional organizations or certifying bodies. Certification can enhance
a healthcare provider's qualifications and may be required for certain positions or to demonstrate proficiency in specialized skills. While certification is not the same as licensure, it can be an important credential for career advancement.
15. Role of Public Health - fed, state and local levels
Local Health Departments’ Role (1 of 2)
• The government organizations that provide
the most direct services to the population.
– Over 90% of local health departments provide
immunizations to adults and children.
– Over 90% offer communicable/infectious
disease surveillance.
– Over 80% offer tuberculosis screening and
75% offer tuberculosis treatment.
– Community Education and Prevention
Campaigns
– Over 75% offer environmental surveillance.
– Approximately 70% offer population nutrition
services.
– Nearly 75% provide school/day care center
inspection.
– Approximately 75% provide food safety
education.
– Pool and recreation center inspections
• There are 2,800 local health departments
across the United States
16. Acute care, Emergency Departments, Urgent Care, LTC, Rehab,
Acute Care:
Acute care facilities, such as hospitals, are designed to provide immediate and intensive medical care to patients with severe or sudden health issues. These facilities have the equipment and expertise to address critical medical conditions, including emergencies like heart attacks, strokes, trauma,
and surgeries. Acute care is focused on stabilizing patients and providing treatment to resolve acute health problems.
Emergency Departments (ED):
Emergency departments are specialized units within hospitals that are open 24/7 and equipped to handle medical emergencies. They serve as the first point of contact for individuals with life-
threatening or severe conditions. EDs provide critical care, diagnostics, and interventions to stabilize patients and determine the appropriate course of treatment, whether it's admission for further care, discharge, or referral to other specialists.
Urgent Care:
Urgent care centers offer a middle-ground option between primary care and the emergency department. They provide immediate medical
attention for non-life-threatening but urgent health concerns that require timely care. Urgent care facilities are known for their extended hours, walk-in appointments, and shorter wait times compared to EDs. Common issues treated in urgent care include minor injuries, infections, and illnesses.
Long-Term Care (LTC): Long-term care encompasses a range of services provided to individuals who have chronic medical conditions, disabilities, or advanced age-related care needs. LTC settings include nursing homes, assisted
living facilities, and home care services. These facilities offer assistance with activities of daily living (ADLs) such as bathing, dressing, and mobility, as well as medical supervision and support for individuals who can no longer live independently.
Rehabilitation (Rehab): Rehabilitation facilities and programs focus on helping individuals recover physical, cognitive, or functional abilities after injuries, surgeries, or medical conditions. Rehabilitation may involve physical therapy, occupational therapy, speech therapy, and other specialized interventions. The goal is to improve the patient's quality of life and restore independence.
17. The Aging Population
The aging population refers to the increasing proportion of older adults in society, often driven by longer life expectancies and declining birth rates. This
demographic shift has significant implications for healthcare and various other
sectors, including social services and the economy. Key considerations related
to the aging population include.
The aging population is a demographic shift with significant implications for society and healthcare:
Increased Demand for Healthcare Services
: As people age, they often require more healthcare services to manage chronic conditions, age-related illnesses, and complex care needs. This places a greater demand on healthcare systems and providers.
Chronic Disease Management
: Older adults are more likely to have chronic health conditions, such as diabetes, heart disease, and arthritis. Healthcare systems must focus on effective disease management and preventive care to address these issues.
Healthcare Policy
: Policymakers must adapt to the changing demographics by implementing policies and programs that support older adults, including Medicare and Medicaid reforms, long-term care options, and elder abuse prevention.
Workforce Challenges
: There is a growing need for healthcare professionals specializing in geriatric care, including geriatricians, nurses, and caregivers, to
provide the necessary support and services to older adults.
Economic and Social Implications
: The aging population affects retirement planning, social security, housing, and family dynamics. It also presents opportunities for intergenerational collaboration and innovative healthcare solutions to enhance the well-being of older adults.
18. ACA, EMTALA, TJC
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ACA
- The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive healthcare reform law passed in 2010. It aimed to expand access to health insurance, regulate insurance practices, and improve the quality and affordability of healthcare in the United States.
EMTALA
- The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires hospitals to provide emergency medical services to all individuals, regardless of their ability to pay or insurance status. It prohibits patient dumping and ensures that individuals with emergency conditions receive appropriate care.
TJC
- The Joint Commission (TJC), formerly known as the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO), is an independent, nonprofit organization that accredits and certifies healthcare organizations and
programs in the United States. TJC sets standards for quality and safety in healthcare and conducts regular assessments and surveys to ensure compliance.
19. Local, State, and Federal Health Departments
In the United States, healthcare and public health are managed by various government agencies at the local, state, and federal levels. Each level of government plays a distinct role in healthcare and public health management. Here's an overview of the responsibilities and key agencies at each level:
Local Health Departments
:
1.
Responsibilities
:
Local health departments (LHDs) are responsible for addressing public health issues within specific geographic areas, such as counties or cities.
They often focus on community health assessments, health education, disease surveillance and control, food safety inspections, immunization programs, and emergency
preparedness at the local level.
2.
Examples
:
New York City Department of Health and Mental Hygiene
Los Angeles County Department of Public Health
Chicago Department of Public Health
State Health Departments
:
1.
Responsibilities
:
State health departments (SHDs) oversee public health activities at the state level and coordinate efforts between local health departments.
They manage public health policies and regulations, Medicaid programs, healthcare licensure, and state laboratories.
SHDs play a crucial role in responding to health emergencies and outbreaks within their states.
2.
Examples
:
California Department of Public Health
Texas Department of State Health Services
Florida Department of Health
Federal Health Departments
:
1.
Responsibilities
:
Federal health agencies are responsible for setting national health policies, conducting research, and regulating healthcare and public health practices.
They provide funding to states and localities, oversee healthcare programs like Medicare and Medicaid, and manage agencies focused on public health, medical research, and disease control.
2.
Key Federal Health Agencies
:
Department of Health and Human Services (HHS)
: HHS is the principal federal department responsible for overseeing health and human services in the U.S. It includes agencies such as the CDC, FDA, CMS, and NIH.
Centers for Disease Control and Prevention (CDC)
: CDC focuses on disease prevention, health promotion, and emergency preparedness and response at the national level. It conducts research and provides guidance on various health issues.
Food and Drug Administration (FDA)
: FDA is responsible for regulating and ensuring the safety and efficacy of foods, drugs, medical devices, vaccines, and other healthcare products.
Centers for Medicare & Medicaid Services (CMS)
: CMS administers federal healthcare programs, including Medicare and Medicaid, which provide coverage to millions of Americans.
National Institutes of Health (NIH)
: NIH is the nation's medical research agency, conducting and funding research on a wide range of health-related topics.
20. Board of Directors, shareholders vs. stakeholders
Board of Directors
: In healthcare organizations, the board of directors is a group of individuals, often chosen from various backgrounds, who are responsible for overseeing the organization's
operations and making strategic decisions. The board typically includes executives, physicians, community members, and sometimes representatives from outside the healthcare industry. Their primary duty is to ensure that the organization operates ethically, legally, and in the best interests of its mission and stakeholders.
Shareholders
: Shareholders in healthcare typically refer to individuals or entities that hold shares or ownership stakes in for-
profit healthcare companies, such as publicly-traded hospital corporations or pharmaceutical companies. Shareholders aim to receive returns on their investments through dividends and capital appreciation. Their primary interest is often financial gain.
Stakeholders
: Stakeholders in healthcare encompass a broader group of individuals and entities who have an interest or "stake" in the healthcare organization's performance and outcomes. This includes not only shareholders but also patients, employees, healthcare providers, payers, government agencies, communities, and advocacy groups. Each stakeholder group has its own interests and concerns. For example:
Patients want high-quality, affordable care.
Healthcare providers seek fair compensation and resources.
Payers aim for cost containment.
Government agencies focus on regulatory compliance and public health.
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Communities
want access to healthcare services and economic benefits.
21. % of people health care industry employs In 2021, healthcare and social assistance represented one of the largest sectors of the U.S. economy, employing millions of people.
The percentage of the U.S. workforce employed in healthcare was approximately 10-11% of the total workforce, making it one of the largest employers in the country.
The healthcare industry includes a wide range of jobs, from healthcare providers (physicians, nurses, therapists) to administrative and support roles (hospital administrators, medical billing specialists, etc.).
22. Long-term care financing – how to pay for it.
Payment for Long-Term Care (1 of 9)
• Personal funds, Medicare and Medicaid,
and long-term care insurance are ways to
pay for long-term care services.
• Medicare does not cover most long-term
care costs.
• Individuals pay out of pocket for long-term
care services until their personal funds are
depleted, and then they access Medicaid to
pay for them.
Most continuing-care retirement
communities and assisted-living facilities
are paid for by the individual, although
Medicaid may pay for the costs in some
states.
• The Veteran’s Administration may help with
paying for long-term care costs incurred by
disabled veterans
Medicare covers medically necessary short-term or
acute care such as doctor visits, prescription drugs,
and hospital stays.
• Physical therapy also is covered by Medicare for
conditions that will be improved.
• Medicare does not pay for the largest part of long-
term care services, such as help with activities of
daily living.
• It will pay for a short-term stay in a skilled nursing
facility or home health care if certain conditions are
met.
The Older Americans Act (1965) has federal
programs that provide home- and community-
based services to older adults.
– These programs are provided by state and local
agencies
– Include in-home personal care, meals in the
community and homebound, local transportation,
respite care such as adult day care, and services
for older Native Americans.
These programs are targeted to low-income,
frail or disabled, over 60, minority older adults
and older adults living in rural areas.
• An annuity is a series of payments over a
specified period of time. Entering a contract
with an insurance company for an annuity
may help pay for long-term care services.
Life insurance policies
are purchased to
financially protect a beneficiary in the event
of the death of the insured. They typically
provide a lump sum to the beneficiary
23. Inpatient vs. outpatient In the healthcare system, services are categorized as either inpatient or outpatient, and the distinction between the two is based on the level of care provided and the duration of the stay. Here are the key differences between inpatient and outpatient services:
Inpatient Services
:
1.
Definition
: Inpatient services refer to medical care or treatment that requires a patient to be admitted to a hospital, clinic, or healthcare facility for an overnight stay or longer.
2.
Level of Care
: Inpatient care typically involves more intensive medical attention and monitoring. It is often required for conditions that are severe, acute, or complex and need 24-hour supervision.
3.
Examples of Inpatient Care
:
Hospitalization for major surgery (e.g., heart surgery, organ transplant).
Treatment of serious illnesses or injuries (e.g., pneumonia, trauma).
Psychiatric hospitalization for severe mental health issues.
Extended stays in a skilled nursing facility or rehabilitation center.
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4.
Duration of Stay
: Inpatient stays can vary in length, from a few days to several weeks or even longer, depending on the patient's condition and treatment needs.
5.
Billing and Insurance
: Inpatient services are billed differently from outpatient services and are usually covered by health insurance plans, often requiring co-pays, deductibles, or co-insurance.
Outpatient Services:
1.
Definition
: Outpatient services are medical procedures or treatments that do not require an overnight stay in a healthcare facility. Patients receive care and return home on the same day.
2.
Level of Care
: Outpatient care is typically less intensive than inpatient care and is suitable for less severe or chronic conditions, as well as preventive and routine healthcare services.
3.
Examples of Outpatient Care
:
Routine medical check-ups and examinations.
Laboratory tests and diagnostic imaging (e.g., X-rays, blood tests).
Minor surgeries (e.g., cataract surgery, dental procedures).
Physical therapy sessions.
Chemotherapy or radiation therapy administered in a clinic.
Urgent care visits for non-life-threatening conditions.
4.
Duration of Stay
: Outpatient services are typically completed in a matter of hours, and patients return home on the same day.
5.
Billing and Insurance
: Outpatient services are billed separately from
inpatient care, and the cost structure may involve co-pays, deductibles, or co-insurance, depending on insurance coverage.
The choice between inpatient and outpatient care depends on the specific
medical condition, treatment plan, and physician's recommendations.
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In many cases, outpatient care is preferred when it is medically appropriate and can help minimize the cost and disruption associated with a hospital stay. Inpatient care is reserved for situations where continuous monitoring and a higher level of care are necessary to address severe or acute health issues.
24. ADLs and IADLs – what are the differences?
ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living) are two classifications used in healthcare and gerontology to assess a person's functional abilities, particularly in the context of their ability to live independently. While both ADLs and IADLs are related to a person's daily life and functioning, they differ in terms of the complexity of the tasks they encompass:
Activities of Daily Living (ADLs):
ADLs are basic self-care tasks that individuals typically learn and perform from a young age. They are essential for maintaining one's personal hygiene, physical health, and well-being. ADLs are often used to assess a person's ability to perform essential self-care activities independently. Common ADLs include:
Bathing: The ability to clean oneself, including taking a shower or bath.
Dressing: The capacity to select appropriate clothing and put it on.
Grooming: Tasks like brushing teeth, combing hair, and shaving.
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Eating: The ability to feed oneself, including using utensils or eating with one's hands if necessary.
Transferring: Moving from one place to another, such as getting in and out of bed or a chair.
Toileting: Managing basic hygiene tasks related to using the toilet
.
Instrumental Activities of Daily Living (IADLs):
IADLs are more complex tasks that are necessary for an individual to
live independently within the community and manage day-to-day responsibilities. These tasks often require a higher level of cognitive and physical functioning. IADLs include:
Managing Medications: Keeping track of and taking prescribed medications at the correct times and doses.
Managing Finances: Handling financial responsibilities, including paying bills, budgeting, and managing money.
Meal Preparation: Planning and preparing meals, including grocery shopping and cooking.
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Household Chores: Managing household tasks like cleaning, laundry, and maintaining the living environment.
Transportation: The ability to use public transportation or drive a
car to get to appointments, work, or run errands.
Shopping: The capacity to shop for necessary items, including groceries, clothing, and household goods.
Communication: Being able to use a phone or other communication devices to maintain contact with others and seek
help if needed.
The distinction between ADLs and IADLs is important in healthcare and elder care settings, as it helps assess an individual's functional independence and can guide care plans and support services. When a person struggles with ADLs or IADLs due to age, illness, or disability, it may indicate a need for assistance or supportive services to help maintain their quality of life and independence for as long as possible.
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