Health Care

America has a highly developed health care
system, which is available to all people. Although it can be
very complex and frustrating at times it has come a long
way from the health care organizations of yesterday.
Previously most health care facilities were a place where
the sick were housed and cared for until death. Physicians
rarely practiced in hospitals and only those who were
fortunate could afford proper care at home or in private
clinics. Today the level of health care has excelled
tremendously. Presently the goal of our health care is to
have a continuum of care for the patient, one which is
integrated on all levels. Many hospitals offer a referral
service or discharge plan to patients who are being
discharged. Plans for the patient are discussed with a
discharge planner. The discharge planner is a person who is
trained in assessing what the patient's requirements for
health care will be after discharge from the hospital. This
enables the patient to continue ! their care at a level which
is most appropriate for them. Items reviewed for discharge
planning include but are not limited to therapies, medication
needs, living arrangements and identification of specific
goals. A few of the options that are available for persons
being discharged from an acute care hospital can include
home health care, assisted living facilities, long term care or
hospice Home Health Care According to Growing Old in
America (1996), "Home health care is one of the fastest
growing segments of the health care industry" (p. 114).
Alternatives for home care can meet both the medical and
non-medical needs of a patient. These services are
provided to patients and their families in their home or
place of residence. Home care is a method of delivering
nursing care and other therapies as required by the patient's
needs. Numerous alternatives are available for persons
seeking health care at home. With transportable
technologies such as durable medical equipment, oxygen
supply and intravenous fluids there are countless
possibilities for treatment within the home setting. As stated
in The Continuum of Long Term Care "Home health
programs range from formal organizations providing skilled
nursing care to relatively informal networks that arrange
housekeeping for friends" (p. 185). This has allowed for
home care to quickly become an essential component of
the health c! are delivery system in the United States. In a
home health care situation the primary care giver is usually
not the physician. The physician is communicated with by
phone and with documentation from the caregivers. The
primary caregivers are usually the nurses and other team
members who are involved directly with the patient's care.
Although, the original order to begin home care must be
initiated by the physician if skilled care is to be obtained.
According to the 1995 Guide to Health Insurance for
People with Medicare "Medicare pays the full cost of
medically necessary home health visits by a
Medicare-approved home health agency" (p. 5). This
coverage must meet specific criteria, but it can be a relief to
family members to know that their loved ones can be taken
care of at home without worrying about the expenses.
Unfortunately, if the care to be given within the home is
termed "not medically necessary" the expense is not
covered. This can include items such as meal and
medication delivery, a percentage of necessary durable
medical equipment, personal care and homemaker
services. My employment within a home health care agency
has allowed for review of services that are not covered by
Medicare and/or private insurance. Health care services
that are not included can become quite numerous. It is
often difficult for family members to understand why
specific services are not covered especially when they
appear to be necessary for the care of the patient. These
costs can add up quite quickly and the impact of the cost
can become quite distressing for family members and
patients on a limited budget. In these cases a Social
Worker is usually provided to help the patient and family
explore other avenues which may enable them to cover
their health care costs. Assisted Living Assisted living is an
arrangement to residents of a facility that enables them to
complete certain daily activities while remaining
independent. The services provided enable the resident to
achieve maximum function of their activities of daily living.
The services are unskilled and non-specialized personnel
provide the activities essential to the care of the resident.
These services help assist the aged, blind, disabled, and
other functionally limited individuals with necessary daily
activities which they require help with or are unable to
perform on their own. An example of some of the services
which may be available are light housekeeping, meal
preparation, medication reminders and personal care. The
personal care does not include specific health oriented