With hospitals discharging patients to their homes sooner and sicker, families are not prepared and are overwhelmed. Many families do not want their loved one to go to a nursing home or skilled unit. Many families are never even given the option for home health care. Others think that when their family member is discharged form the hospital to home that there will be someone there 24 hours 7 days a week, for as long as the care is needed.

The home health care agency explained

There are two types of home health care agencies. The first addresses the health and medical care of the aging adult. Care is provided by home health care agencies, and can include the home health care aide, RN’s (registered nurse) and physical therapy. State and federal laws regulate these agencies. They are often Medicare and Medicaid certified. Many private insurances and HMO’s pay for these services as well. This means the agencies can get paid by these programs for providing home health services These services require a doctor’s order.

The services provided will be intermittent such as an RN coming in to do a dressing change or monitor vital signs. A home health care aide may come in a few times a week to assist with bathing and dressing. You must be housebound and only able to leave the house to go to the doctors or attend church to be eligible for these services.

The other type of home health care agency offers help with household duties and non-medical personal care. This could include preparing meals, bathing, dressing or moving around the house. Depending on the state, these agencies may or may not be licensed. This type of home health care allows a person with special needs to stay in their home. It is for individual’s who are getting older, are chronically ill, recovering from surgery or disabled. The best place to receive ongoing care may be in the comfort of your own home.

Studies show that our aging society not only wants to live independently as long as possible, but that they want to do it in their own home. Many have their own lives, live close to family and friends and have pets to keep them company and social activities to keep them busy. Mentally and emotionally, being at home is comfortable and often promotes wellness and healing.

Some feel that quality care at home can be expensive and is only for the wealthy

There are actually many ways for aging adults to receive qualify home health care. There are new programs such as reverse mortgages, VA benefits and long term care insurance. Many states now have state and local programs for the low income seniors that qualify for Medicaid to have waiver programs. These programs provide care at home in order to avoid an admission to a nursing home. There is a growing number of home health care agencies out there that provide for everything from companionship, to avoid loneliness to errand running and cooking and 24 hour live in services.

For medical and health care needs, there are home health care agencies that provide care when there is a change in the medical condition of the aging adult. The care required, must be deemed medically necessary by a physician.

For those individuals that want to age at home, having a good plan for the future in place is important. This may allow the aging adult to enjoy the comforts of home for as long as possible. You may no longer need to stay in a nursing home to receive good care.

If you are unsure if aging in place is an option for you or a loved one you may consider consulting with a care manager or eldercare consultant. A care manager can usually put together a plan that fits within a family budget. Care at home can be far less expensive than a move to a nursing home.

Diane Carbo is a Registered Nurse – As a geriatric care manager, that has cared for her father and mother in law in their homes, she learned first hand how overwhelming, stressful, and time consuming caring for a loved one can be. Staying in their homes was very important to them. As a result, Diane started http://www.aginghomehealthcare.com to assist others age in familiar surroundings and avoid the emotional and frustrating task of maneuvering the medical delivery system

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Unfortunately, far too many people ignore the risks and let their body and mind deteriorate through lethargy and lack of physical activity and exercise. Thus, the majority of the population will have to rely on the services of the commercial medical industry at some point in their lives. Sadly, for to many people, health care is unavailable too them, either due to cost, lack of insurance or lack of access, when they need it most. In developed and developing countries health services are rendered to each and every one irrespective of their capacity to pay. Also some of the government organizations provide the facility of medical care with a nominal fee.

Professionals of the medical industry include people who provide services which are related to the preservation or improvement of the health of individuals. Their services also include the treatment of wounded, ill, disabled or feeble individuals. Health care forms a big part of a country’s economy.

If you want to save money and have independence in your deciding in when and where to get medical care try home health programs when they are available. This type program helps an individual to be free from the confines of a hospital or any other medical centers. This program can be utilized by those people who need not be confined in a hospital.

Home health care programs offer an array of services. These services are done in the console of the patients own home. Home health plans are normally monitored by a doctor. But nurses and auxiliaries carry out the legal period of care in such plans.

Health is wealth is a good saying in the present world. So the big question is how we are to provide health care services to every one. We should think of a way to provide medical benefits to one and all. This is the problem which is facing far too many countries in the world.

Providing health coverage is a problem of major concern for all countries. If we try to cut one segment of the health care industry in an attempt to save money then every artery of the industry will start to bleed. The most pragmatic way to determine a solution to this trouble is to inquire of the medical professionals themselves who work with the system. They will be able to tell us what, where and how something is wrong.

Distributed Health Care Centers, doubtless have become popular because they extend low cost care that is not uncommitted elsewhere. A health center is fundamentally, any agency where health care is distributed, including education on health.

Long Term Health Care:

An individual who is not fit to take care of himself/herself and also not able to perform his daily duties like eating, having his bath or even dressing on his own may have to rely on long term care. Even certain diseases also make long term care necessary. Long term care need not be received in the hospital it can be received at home also. In general long term care is required by individuals who are 85 years or more. Long term health care is a bit costly and can be undertaken only by those who can afford it.

Steps can be taken to make health coverage affordable to one and all.
- The information with regard to health care cost and the medical procedures should be made easily available to consumers so that they are educated on that topic. This will help them to make better health care choices.
- Results and the outcomes of alternative medical plans have to be made available to the consumers. This will help them to take more informative decisions.
- Consumers themselves have to be more responsible towards maintaining their health and knowing when to seek treatment.
- Dizzy lawsuits and the threat of suits make the doctors to practice defensive medicine
- Consumers should allow their physicians to guide them on the most suitable treatment for their sickness or otherwise.

Chris McCombs manages a Personal Training Directory. At one time Chris was 143 pounds overweight. Chris lost the weight and started his own fitness business Positively Fit Inc, where he directs the Orange County Bodybuilding Program and the Fitness Boot Camp in Irvine, California.

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Professional home health care services givers include the medial aspect such as nurses, therapists, home health care assistants, and other licensed and certified medical caregivers. They are present to administer skilled care to the patient.

Home care services are provided to those who need assistance with tasks such as house cleaning, running errands, cooking, and just being around to assist if the patient needs other tasks such as these performed.

Social workers also play a part in home health care. They can provide counseling for emotional and social problems that the patient may be experiencing. They will direct those who need it to community resources which are available to them. They have various other services to offer as well.

Companions are another part of the care giving team. They are the ones who provide companionship to people who can not stay by themselves. If a disabled person stays by their self having a companion there to assist them can help if an emergency situation should occur.

To be assured that you have the best quality home health care for your disabled family member speak with others who are having or have had the same experience as you are going through.

Make sure that the home health caregiver that you request is experienced in care giving. The caregiver’s supervisor should manage the care provided to make sure the patient is receiving quality health care.

Whether you are hiring a home health care provider on your own or through an agency be sure to conduct an interview. Go over the needs of the patient and make sure the caregiver is capable of providing the type care that the patient needs. Advise the caregiver on medications, physical and mental problems that the patient may have, and how to deal with them. Make sure they know where everything is situated in the house which pertains to patient care. It will help in case of an emergency.

The payment for home health care services may be paid by the patient or some such as a family member. Medicare, under certain guidelines, will pay for skilled caregivers. There are others such as Medicaid, the Veterans Administration, and Social Services have programs which assist qualified patients. There are various other payers such as private insurances and more.

If the cause of illness is a work related incident workers compensation could pay for the home health care needed. In any case, the actual cost of home health care depends on which state the patient resides in.

Matt D Murren owns and operates http://www.home-health-care-advisor.com
Home Health Care

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Even in the era of doctor making house calls, people had confidence in their doctor, who, back then, represented the health care system. Confidence was based on trust, that the doctor was offering the best treatment and advances possible.

Today, patient trust is dwindling. Yet, there is still a great deal of trust in doctors and nurses. In a recent poll, the professions that were most greatly admired and respected by the public, second to firemen, were doctors and nurses.

Lack of confidence stems not from the health providers themselves, but from the system that the doctors and nurses work for.

Let’s examine some potential areas eroding public confidence in our health care system:

1.) Speed: Our system has always moved quickly, but the current pace is nothing short of phrenetic. Oh yes, a doctor or nurse could move slower, but the price would be at the expense of patients who would not be seen or cared for that day. Quietly, health providers talk about feeling like they are part of a “conveyor belt” that treats paperwork more than it does people.

Indeed, the amount of paperwork has increased exponentially and the “system” doesn’t show any signs of slowing down. Insurance companies, particularly managed care, has heavily contributed to this additional layer of bureaucracy taking time away from patient care. At the risk of offending managed care companies, this is the truth. Managed care was originally designed to contain costs. But the impact on care of patients is one that has yet to be determined.

2.) Commercialiazation of health care: commercials etc….erodes public confidence. Patients regularly verbalize an overwhelmed and distorted image of the role of medication from watching television commercials. This is not the patient’s fault! And it works both ways, commercials can be suggestive, or implant resistance in patients who might genuinely benefit from a trial of medication. Patient’s decisions are influenced by marketing, rather than medical facts, and that just doesn’t make good clinical sense.

3.) “Pill popping society” – stems in part from commercialization but also from a stressed society looking for ways to make it easier to cope

4.) Conventional health care has yet to accept natural modalities as part of its treatment regimens. Yet, public opinion on this matter is very evident. Annual spending on Complementary/Alternative modalities exceeds ______/year. Yet, a large reason for this lack of integration into conventional health care remains lack of scientific research. Without large funding sources like pharmaceutical companies, natural treatments have been left largely to a word by mouth market.

And the word has spread like wildfire. And most often from people with chronic health challenges whose health has been restored. Yet why haven’t these potentially life-saving remedies been studied? In fact, for many health providers in conventional medicine, caring for people suffering with these chronic health challenges, it is heart wrenching not to be able to offer people more hope.

5.) The U.S. Health care system is rated 37th in the world according to the World Health Organization. Clearly these dismal results becry the need for health care solutions and transformation for the sake of our people.

Health: not simply the eradication of disease but the concept of healing, restoration and rejuvenation, particularly for those with chronic health conditions. Included in this is the incorporation of preventative health care into mainstream medicine.

Transformation of health care = Hope for all

Rebuilding confidence in the health care system with less not more [http://www.healthynutritionsite.info/]

Article Source: http://EzineArticles.com/?expert=Rolf_Rasmusson

In-Home Care

In-home health care is the best option for people who have a higher level of fitness, and want to remain as independent as possible throughout their later years. In this situation, home health care nurses may come and visit you daily, or every couple of days, to take care of your everyday medical needs. Also, a housekeeper may be utilized, as well as a personal health care attendant, who would be responsible for more of the day-to-day living help – such as a companion, driver, cook or the like. In-home health care is quite easy to locate; just contact a nurses’ association or look in the Yellow Pages.

Continuing Care

An intermediary between nursing homes and independent living, continuing care, or retirement communities, offer a wide variety of health benefits and services to their inhabitants. These communities are usually all-inclusive, where dwellers receive lodging, meals, social events, varying levels of health care, and sometimes other perks as well.

Entrance fees for these establishments can be quite high (ranging from $10,000 to over 300,000); added to their monthly fees (ranging from $800-4000), and this option can prove to be expensive health care. However, services are guaranteed for the remainder of your life if you choose this option, and if your health falters, you can always be moved to the nursing home portion of their health care facility.

Because of the all-inclusive nature of this kind of health care, you’ll want to read the fine print carefully in your contract. What are all of the recurring and one-time fees? What exactly is covered with those fees? What health care options are, and are not offered? Do you need to purchase extra health insurance to cover your specific care costs? Also don’t forget to check up with the Better Business Bureau about the status of the facility you are interested in; if you plan on living there the rest of your life, you may want to double check it’s reputation, too.

Nursing Homes

In a very simple sense, nursing homes will take care of your health care needs when you are no longer able to. This may be for a short period of time while you are recovering, or for a longer period of time as you age. Nursing homes are the whole meal deal of health care for the elderly or otherwise incapacitated. If this is an option that you think you may require, there are many things to discuss and consider when looking at your options. Does the home provide the type of care that you will require? Research the history of the nursing home; are there any black spots on their record? Talk to people who have lived there, have used their services, or who are still living there now, if at all possible. Get their viewpoint.

For more more information about health care please visit http://www.1health-center.com/articles/How-To-Jump-Rope-For-Health-and-Fitness.php

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In addition to traditional organizing, health care union organizers are using more radical corporate campaigns that target hospital donors, shareholders, community groups, and even patients. The unions push these target groups to put pressure on hospital owners to allow unions to organize their employees. Many critics have argued that some of these agreements with employers have greatly limited workers’ power and emphasized the union’s cooperation with management.

The following article provides an overview of the major unions involved in the health care industry, as well as strategies to ensure your organization is prepared and remains successful.

Service Employees International Union
The Service Employees International Union (SEIU) began in 1921 primarily as a janitor’s union and branched out to include government, security, and health care workers. By 2000, it was the largest, fastest-growing union in the United States, with much of that growth stemming from a series of strategic mergers with smaller unions. In June 2005, the SEIU and six other unions left the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) to form the Change to Win coalition. Citing the need for a renewed effort to organize workers, Change to Win purports to be focused on achieving fair wages, health care benefits, and secure retirement for all employees. The coalition also encourages workers to unionize on an industry-wide basis, consolidating smaller unions within larger unions.

SEIU Healthcare
In 2007, the SEIU announced plans to launch a new health care union to serve approximately one million members, such as nurses and service workers at hospitals and nursing homes. SEIU Healthcare combined financial and personnel resources from the 38 local SEIU Healthcare unions. Of the SEIU’s 1.9 million members, 900,000 work in health care. In September 2008, the SEIU reported it would begin several high-profile projects to bring business leaders, health care providers, community organizations, and elected officials together to work on the nation’s health care system. SEIU leaders were part of a May meeting held by President Obama to discuss a health care overhaul. More recently, SEIU members attended town hall meetings to speak out in support of the proposed health care reform. In August, the SEIU was part of a group-largely funded by the pharmaceutical industry’s lobby-that launched $12 million in television advertisements to support Obama’s health care proposal. This group, the Americans for Stable Quality Care, could spend tens of millions more this fall.

SEIU and NUHW
The SEIU attempted to consolidate three local units representing home health care workers into one unit last December, taking authority away from the local units. The SEIU accused the local unit officials of financial misconduct, and in response, the leaders of the local units criticized the SEIU’s practice of centralizing power at its Washington headquarters and making corrupt deals with employers. In January, a 150,000-member SEIU local unit in Oakland was put under trusteeship by the SEIU, and the local officials of that unit were dismissed. The ousted officials formed a new union, the National Union of Healthcare Workers (NUHW).

The NUHW announced the first workers had cast votes in favor of representation by the new union in March. A majority of 350 union-represented workers at four nursing homes in northern California managed by North American Health Care wanted to end their labor relationship with SEIU and join the NUHW. The day after this announcement, the SEIU filed unfair labor practice charges against the four nursing homes, charging that administrators of the facilities had illegally withdrawn union recognition and colluded with a competing labor union. In that same month, a National Labor Relations Board regional director ruled against the NUHW, saying that the contract between the SEIU and the hospital chain prevented the effort by a new labor union to represent 14,000 Catholic Healthcare West workers. Despite the ruling, the founding convention to formally launch the NUHW took place in April 2009. According to the NUHW, approximately 91,000 California health care workers have signed petitions filed at the labor board, stating they would like be members of the new union.

The NUHW also claims that, in response to these decertification drives, the SEIU has resorted to harassment and intimidation and tactics similar to union prevention. The SEIU argues that the new group has unfairly restrained and coerced workers, as well as complained to the National Labor Relations Board. A decisive battle between the two unions will come in 2010, when the SEIU-UHW contract with Kaiser Permanente expires and the opportunity for decertification elections reopens. Kaiser, the largest health care provider in California, has 50,000 workers that could potentially become members of NUHW.

California Nurses Association/National Nurses Organizing Committee
The California Nurses Association (CNA) began as a state chapter of the American Nurses Association (ANA) in 1903. The ANA has a federated structure: Nurses do not typically join the organization directly, but instead join their respective state organization, which has membership in the ANA. After several years of believing the ANA was not providing them adequate financial support to increase collective bargaining activity in California, the CNA broke ties with the ANA in 1995 and formed its own union, becoming the first state organization to secede from the ANA. Since its break from the ANA, the CNA has acquired a reputation as one of the most aggressive labor unions in the country. In 2004, the CNA began establishing itself in other states under the name National Nurses Organizing Committee (NNOC). The CNA voted to seek affiliation in the AFL-CIO in 2007. CNA membership has doubled over the last seven years and represents 80,000 members from all 50 states.

UAN-NNOC
In February, CNA/NNOC, United American Nurses (UAN), and the Massachusetts Nurses Association (MNA) announced the formation of another new union: the United American Nurses-National Nurses Organizing Committee (UAN-NNOC). With a combined membership of more than 150,000 affiliates in 19 states, it is the largest nursing union in the history of the United States.

National Federation of Nurses
The National Federation of Nurses (NFN) was officially launched in April at an event in Portland, Oregon. The NFN represents more than 70,000 nurses in six state nurses’ associations, including New York, New Jersey, Ohio, Montana, Oregon, and Washington. Based on a federated model (much like the ANA), the NFN recognizes the independence of each member organization. Membership is open to state nurses’ associations and other labor organizations that represent RNs. The NFN is tied to the ANA, which outlines standards for nursing practices, but has historically opposed nurse unionism and includes managers in its leadership. Since nurse union leaders expect many of the 15 unions with nurse memberships to flood hospitals with authorization cards if the Employee Free Choice Act (EFCA) passes, they want to establish their own national union to ensure nurses are organized by nurses.

SEIU and CNA: From Violent Disputes to Cooperative Agreements
The SEIU signed a neutrality agreement in March 2008 with an Ohio Catholic hospital to organize 8,000 workers. The day before voting was scheduled to begin, members of the CNA distributed leaflets to discourage workers from joining the SEIU. After the workers received the leaflets attacking SEIU and its arrangement with management for an election, SEIU called off the vote. Then at an April 2008 conference in Detroit, SEIU staff and members protested at a banquet of CNA members, resulting in violence. The two unions have also launched raids and counter-raids across the country, and both have sent mailings to thousands of nurses (including nurses in other unions, as well as nurses whose unions are currently trying to organize) attacking each other.

After more than a year of fighting, the SEIU and CNA signed a cooperation agreement in March. They will work together to bring union representation to all non-union RNs and other health care employees, as well as improve patient care standards. The unions have also agreed to refrain from raiding each other’s members and will work together toward common goals, including lobbying for congressional passage of the EFCA. SEIU and CNA will coordinate campaigns at the largest health care systems and launch an intensive national organizing campaign. Catholic hospital chains will likely be among the first targets.

In June, the U.S. Conference of Catholic Bishops and the nation’s largest unions (including the SEIU and the AFL-CIO) signed an agreement describing how union organizing will be conducted at Catholic health care facilities. (The document is similar to the one Catholic Healthcare Partners and Community Mercy Health Partners created last year with the SEIU before the CNA protest canceled the vote.) This agreement is significant because Catholic health care providers represent the largest employers and providers of services in many communities. The agreement provides seven guidelines for management at Catholic health care facilities and unions, making it easier organize health care workers at these facilities.

What This Means for Your Organization
Many experts agree that expanded unionization, along with the passage of the EFCA, will negatively impact our health care system. Both health care providers and industry analysts fear that unionization could mean higher costs and more restrictive work rules, adding to the soaring cost of delivering health care. Hospital and health care facilities need to be aware of these issues and how they can educate their supervisors and workers about the threat of unionization.

Communication with your employees is a critical first step. Many issues are involved in the possible unionization of a health care facility (economic factors, working conditions, quality of patient care, employee satisfaction, etc.). To prepare for possible union activity, identify issues that are relevant to your facility and address those needs publicly. Train leadership and include information about your union-free policy in the employee hiring and orientation procedures. Assess your wage and benefit structure, and be sure to promote what you offer.

You can use brochures, meetings, video, webinars, e-mail, Web sites, or eLearning tools to reach your employees. The most effective efforts include an employee feedback system that encourages two-way communication.

Walter Orechwa is CEO of Projections, Inc. Established in 1979, Projections is the country’s leading provider of employee communication resources (video, web, elearning), specializing in critical issues such as skills and management training, health care issues, layoffs and closings, pension and retiree issues, new employee orientations, corporate compliance and ethics, labor relations and other employment-related issues.

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Home health care is allowing the patient and their family to maintain dignity and independence. According to the National Association for Home Care, there are more than 7 million individuals in the United States in need of home health care nurse services because of acute illness, long term health problems, permanent disability or terminal illness.

Home Health Care Basics

Nurses practice in a number of venues: Hospital settings, nursing homes, assisted living centers, and home health care. Home health care nursing is a growing phenomenon as more patients and their families desire to receive care in their homes. The history of home health care stems from Public Health Nursing where public health nurses made home visits to promote health education and provide treatment as part of community outreach programs. Today academic programs train nurses in home care and agencies place home health care nurses with ailing individuals and their families depending on the nurse’s experience and qualifications. In many cases there is a shared relationship between the agency and the academic institution.

Many changes have taken place in the area of home health care. These include Medicare and Medicaid, and Long Term Care insurance reimbursement and documentation. It is important for the nurse and nursing agency to be aware of the many factors involved for these rules and regulations resulting from these organizations. Population and demographic changes are taking place as well. Baby boomers approaching retirement and will present new challenges for the home health care industry. Technology and medical care in hospitals has lead to shorter inpatient stay and more at-home rehabilitation. Increases in medical outpatient procedures are also taking place with follow-up home care. This has resulted in the decrease of mortality rate from these technologies and medical care has lead to increases in morbidity and chronic illness that makes the need for home health care nursing a greater priority.

Home Health Care Nurse Job Description

Through an array of skills and experience, home health care nurses specialize in a wide range of treatments; emotional support, education of patients who are recovering from illnesses and injury for young children and adults, to women who have experienced recent childbirth, to the elderly who need palliative care for chronic illness.

A practicing nurse must have the skills to provide care in a unique setting such as someone’s home. The nurse is working with the patient and the family and must understand the communication skills for such dynamics. Rapport is evident in all nursing positions, but working in a patient’s own living space needs a different level of skill and understanding. There is autonomous decision making as the nurse is no longer working as a team with other nurses in a structured environment, but is now as a member of the “family” team. The host family has cultural values that are important and are different for every patient and must be treated with extreme sensitivity. Other skills include critical thinking, coordination, assessment, communication, and documentation.

Home health care nurses also specialize in the care of children with disabilities that requires additional skills such as patience and understanding of the needs of the family. Children are living with disabilities today that would have resulted in mortality just twenty years ago. Genetic disorders, congenital physical impairments, and injury are just a few. Many families are familiar with managing the needs of the child, but still need expert care that only a home health care nurse can provide. It is important that a home health care nurse is aware of the expertise of the family about the child’s condition for proper care of the child. There are many complexities involved, but most important, a positive attitude and positive reinforcement is of utmost importance for the development of the child.

Medication coordination between the home health care nurse, doctor, and pharmacist, ensures proper management of the exact science behind giving the patient the correct dose, time of administration, and combinations. Home health care nurses should be familiar with pharmacology and taught in training about different medications used by patients in the clinical setting.

Many advanced practicing nurses are familiar with medication regiments. They have completed graduate level programs. Home health care agencies believe that a nurse should have at least one year of clinical experience before entering home health care. Advanced practicing nurses can expedite that training by helping new nurses understand the home health care market and teaching.

Employment and Salary

According to the United States Department of Labor, there were 2.4 million nurses in America, the largest healthcare occupation, yet many academic and hospital organizations believe there is a gross shortage in nursing staff. The shortage of nurses was 6% in 2000 and is expected to be 10% in 2010. The average salary for hospital nursing is $53,450 with 3 out of 5 nursing jobs are in the hospital. For home health care, the salary is $49,000. For nursing care facilities, they were the lowest at $48,200.

Training and continuing education

Most home health care nurses gain their education through accredited nursing schools throughout the country with an associate degree in nursing (ADN), a Bachelor of Science degree in nursing (BSN), or a master’s degree in nursing (MSN). According to the United States Department of Labor, in 2004 there were 674 BSN nursing programs, 846 ADN programs. Also, in 2004, there were 417 master’s degree programs, 93 doctoral programs, and 46 joint BSN-doctoral programs. The associate degree program takes 2 to 3 years to complete, while bachelors degrees take 4 years to complete. Nurses can also earn specialized professional certificates online in Geriatric Care or Life Care Planning.

In addition, for those nurses who choose to pursue advancement into administrative positions or research, consulting, and teaching, a bachelor’s degree is often essential. A bachelor’s degree is also important for becoming a clinical nurse specialist, nurse anesthetists, nurse midwives, and nurse practitioners (U.S. Department of Labor, 2004).

All home health care nurses have supervised clinical experience during their training, but as stated earlier advanced practicing nurses hold master’s degrees and unlike bachelor and associate degrees, they have a minimum of two years of post clinical experience. Course work includes anatomy, physiology, chemistry, microbiology, nutrition, psychology, and behavioral sciences and liberal arts. Many of these programs have training in nursing homes, public health departments, home health agencies, and ambulatory clinics. (U.S. Dep. of Labor, 2004).

Whether a nurse is training in a hospital, nursing facility, or home care, continuing education is necessary. Health care is changing rapidly and staying abreast with the latest developments enhances patient care and health procedures. Universities, continuing education programs, and internet sites, all offer continuing education. One such organization that provides continuing education is the American Nurses Association (ANA) or through the American Nurses Credentialing Center (ANCC).

Conclusion

There are many rewards to becoming a home health care nurse. Some rewards include the relationship with a patient and their family, autonomy, independence, and engaging in critical thinking. The 21st Century brings with it many opportunities and challenges. We must meet these challenges head on – there is an aging baby boomer population, a growing morbidity factor due to increased medical technology and patient care, and the growing shortage in nursing care.

Becoming a home health care nurse today is exciting and an opportunity to make a difference one life at a time. With clinical experience and proper education, a home health care nurse will lead the future of medical care.

By Michael V. Gruber, MPH is a contributing author to My Nursing Degree Online, providing articles and resources for nurses looking for continuing education online. With a Masters of Public Health and two years of medical school, Michael provides a unique perspective on the current nursing shortage crisis on the Nursing Career Blog as well as comprehensive articles about nurse education and advancement.

Find more information about becoming a Home Health Care Nurse including certification and job openings at My Nursing Degree Online.

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Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ’sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

- “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

- The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

- The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

- DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

- REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

- REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

- PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

- PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

Daniel J. Osborne, M.S., is a renowed expert on health care fraud issues and recognized authority on health care compliance. He can be contacted at Provider Fraud Consultants, Inc., dba Chiropractic Compliance Consultants, Inc., 18065 238th Street, Tonganoxie, Kansas 66086, 913-369-9000, http://www.cccpfc.com

Article Source: http://EzineArticles.com/?expert=Daniel_J_Osborne

Those who maintain that health is an individual responsibility do not want a system that requires them to contribute tax dollars to support fellow citizens who do not act responsibly in protecting or promoting their own health. They argue that they want the freedom to choose their own physicians and treatments, and suggest that government cannot know what is best for them.  These people argue that preserving the current system with improvements to provide better insurance coverage for citizens who remain uninsured or under insured for their medical care needs is the only reform that is needed.

Those who believe health care is an individual right support a universal health care system with the argument that every citizen deserves to have access to the right care at the right time and that a government’s responsibility is to protect its citizens, sometimes even from themselves.

Two opposing arguments arising from two opposing ideologies.  Both are good arguments but neither can be the supporting argument for implementing or denying universal health care.  The matter must be resolved through an ethical framework.

Examination of the ethical issues in health care reform would require consideration of much different arguments  than those already presented.   Ethical issues would center on the moral right.  Discussion would begin with not “What is best for me?” but rather  “How should we as a society be acting so that our actions are morally correct?”

Ethics refers to determining right and wrong in how humans relate to one another.  Ethical decision making for health care reform then would require human beings to act in consideration of our relationships to each other not our own individual interests.

Examination of some of the common ethical decision making theories can provide a foundation for a different perspective than one that is solely concerned  with individual rights and freedoms.

Ethical decision making requires that specific questions be answered in order to decide on whether intended actions are good or morally correct.  Here are some questions that could be used in ethical decision making for health care reform.

* What action will bring the most good to the most people?
* What action in and of itself is a good act and helps us to fulfill our duties, obligations, and responsibilities to each other?
* What action in and of itself shows caring and concern for all citizens?

As the answer to all  these questions, universal health care can always be considered the right thing to do.

The United States is in the most advantageous position there is when it comes to health care reform.  They are the only developed country without a national health care system in place for all citizens.  They have the opportunity to learn from the mistakes that have been made by all the other countries that have already gone down the universal health care road. They have an opportunity to design a system that can shine as a jewel in the crown of universal health care systems everywhere.

However, all ethical decision making is structured around values.  In order for universal health care to be embraced by all citizens in the United States, they will first have to agree to the collective value of equity and fairness and embrace the goal of meeting their collective responsibility to each other while maintaining individual rights and freedoms. That may prove to be the most difficult obstacle of all.

Beverly Hansen OMalley is a nurse with over 35 years experience in nursing education. She is health promotion specialist and is passionate about the necessity to address social determinants of health as part of overall health promotion strategies. She is the owner of http://www.registered-nurse-canada.com where she provides information on the Canadian health care system, the nursing profession in Canada, and the nursing entrance tests for the US and Canada.

Article Source: http://EzineArticles.com/?expert=Beverly_OMalley