To support your work, use scholarly sources and also use outside sources. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Regulations in Long-Term Care
There are many federal and state regulations when it comes to long-term care. Using scholarly sources and the Internet research any four specific regulations related to long-term care and summarize them.
Based on the regulations you identified, respond to the following questions:
- What are the benefits and shortcomings of your identified regulations? Which of these shortcomings have an effect on the quality and the cost of health care services? How?
- Do you believe there is a link between regulations and better care? Why or why not?
- Why do you think long-term care services are subjected to so much external control by government agencies? Provide a rationale for your respons
- How is quality measured in long-term care? Is there only one, or are there several approaches to measure quality? What are they? Who should be given the responsibility to measure quality?
Notes from class
|The increasing need for long-term care has caused several public and private agencies to participate in its managing process. These public and private agencies are increasingly attempting to control costs, providing protection to consumers considered unable to protect themselves. Public controls are nonvoluntary and are imposed by government agencies through the implementation of laws and regulations. Private controls are provided by nongovernment agencies and organizations, and compliance is voluntary.Public Control
Public control on long-term care is imposed by federal, state, or local (including county and municipal) government units. These units set laws, regulations, and standards to be followed by long-term facilities in order to:
• Give better care facilities to the poor, who are unable to take care of themselves, by making them formal or informal wards of the state.
• Provide quality health care facilities to consumers.
• Create awareness in consumers regarding the types of services provided in the facilities and let the consumers themselves judge the quality of the services.
• Set the minimum level of staffing, cleanliness, and safety, ensuring consumers needing long-term care are treated properly and receive the necessary services.
• Follow all long-term care regulations to provide quality care.
Besides government agencies, several private organizations are involved in managing long-term care. Both public and private control focus on long-term care organizations as well as the individuals in those organizations. The only difference is public control can maintain both the cost and the quality of care, while private care can focus only on measuring, evaluating, and ensuring the quality of care.
Private control agencies focusing on the quality of care of long-term organizations are known as accreditation bodies, while those focusing on the quality of care provided by individual health care professionals or practitioners are known as certification bodies.
Lets discuss some of the most common private control agencies.
Long-term care regulations cover both organizational providers and individuals working in the field of long-term care. Most of the regulations are aimed at either maintaining the level of quality in the goods and services produced or minimizing the level of payment for goods or services.
Regulation of Quality
The primary reason for the regulation of long-term care is to maintain quality. Consumers have the right to receive high-quality care. However, to maintain the level of quality, you must be able to measure quality. Quality can be measured on the basis of processes, structures, and outcomes. Process-based measurement looks at how tasks are accomplished and whether they follow accepted procedures. Structure-based measurement focuses on the capacity of an organization to provide care. Outcome-based measurement focuses on the result of treatment by measuring changes in the functional status accrued from the care provided.
In November 2002, the Centers for Medicare & Medicaid Services (CMS), an agency of the United States Department of Health and Human Services, began a national Nursing Home Quality Initiative (NHQI). This is a federal standard measure that all residents in a nursing home are being evaluated and compared with to monitor care. The nursing home quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. These measures assess residents physical and clinical conditions and abilities, as well as preferences and life care wishes. These assessment data have been converted to develop quality measures that give consumers another source of information that shows how well nursing homes are caring for their residents physical and clinical needs.
Long-term (chronic care) care residents are evaluated on the percent of:
- Residents whose need for help with daily activities has increased
- Residents who have moderate to severe pain
- Residents who were physically restrained
- High-risk residents who have pressure sores
- Low-risk residents who have pressure sores
- Residents with a urinary tract infection
- Residents who spent most of their time in bed or in a chair
- Residents who have become more depressed or anxious
- Low-risk residents who lose control of their bowel or bladder
- Chronic or long term care residents who lose too much weight
- Residents who have or had a catheter inserted and left in their bladder
- Residents whose ability to move about in and around their room got worse
Short-stay (temporary) care residents are evaluated on the percent of residents:
- Who had moderate to severe pain
- With delirium
- With pressure sores
Regulation of Payment
The primary purpose of the regulation of payment is to avoid excessive payment, save money for government agencies, and prevent fraud and abuse in government funding programs. The two sources of payment regulation are Medicare and Medicaid. These two programs represent a major source of reimbursement for long-term care organizations.
The Health Insurance Portability and Accountability Act
The primary purpose of Health Insurance Portability and Accountability Act (HIPAA) is to protect the consumers health insurance, security, and health care data and promote standardization and efficiency in the health care industry. HIPAA requires everyone to use the standard format for processing claims and payments. It has standards for several types of electronic health information transactions and maintenance of information and data.
Next, lets discuss the roles of federal and state governments in long-term care.
n the United States, reimbursement of long-term care depends on how the care is financed. The type of reimbursement and the amount reimbursed dictate the access to care, availability of specific services, and equality of care. Both public and private sources are available for long-term care reimbursement. However, neither sector has satisfactory mechanisms for helping individuals anticipate and pay for their care.
|One of the most important aspects of managing long-term care is to maintain the quality of care and control the cost of services. In this respect, several quality improvement programs have been developed in long-term care that focus on monitoring and evaluating physical, functional, and psychological indicators over time. To establish effective quality improvement programs, health care organizations should:• Define customers.
• Identify the demands of customers in terms of quality and determine standards against which quality is to be measured.
• Monitor the key indicators to measure quality.
• Evaluate whether the data produced is sufficient enough to draw a conclusion.
• Identify appropriate corrective steps to improve the measurement of quality in particular areas.
• Continue the process of quality measurement against standards.
Besides internal programs for quality improvement, quality assurance, and quality management, organizations also take several external initiatives so as to improve the overall quality of the long-term care system.
As discussed earlier, both federal and state governments regulate and monitor the quality of care provided to consumers covered by government-run plans such as Medicaid and Medicare. Several government agencies are involved in quality-related research, such as the Agency for Healthcare Research and Quality (AHRQ). These agencies develop quality indicators that serve as valuable measures, both for researchers and for individuals, to maintain the quality of care. The government agencies also develop several nationwide quality initiatives to provide information to the public about health care quality and ways to judge quality for themselves.
Some of the significant private quality improvement programs include Quality First, the American Association of Homes and Services for Aging (AAHSA), the American Health Care Association (AHCA), and the American Health Quality Association (AHQA).