Healthcare Systems

Question 1

what is the purpose of the Patient Self-Determination Act of 1990?

Answer 1

inform patients of their rights regarding decisions toward their own medical care, and ensure that these rights are communicated by the health care provider

Question 2

list several laws that pertain to employment issues

Answer 2

1. ADA
2. FMLA → Family and Medical Leave Act
3. Age Discrimination in Employment Act

Question 3

what is the ADA?

Answer 3

a law that prohibits discrimination on the basis of disability in employment, state and local government, public accommodations, commercial facilities, transportation, and telecommunication

Question 4

what is the purpose of the FMLA?

Answer 4

entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons

Question 5

what is the purpose of the Age Discrimination Act?

Answer 5

forbids age discrimination against people who are age 40 or older

Question 6

what is the purpose of power of attorney?

Answer 6

it is a legal document that gives one person (“the agent”) power to take actions on behalf of another person (“the principal”)

Question 7

what is the difference between power of attorney and durable power of attorney?

Answer 7

durable POA continues after principal becomes incapacitated

Question 8

what is springing POA?

Answer 8

gives the agent power only when the principal becomes incapacitated

Question 9

list the types of elder abuse

Answer 9

1. Caregiver and self-neglect
2. Emotional and psychological abuse
   
   1. deception
   2. intimidation
   3. threats
3. Fiduciary/financial exploitation
   
   1. typically includes psychological abuse
4. Physical abuse

Question 10

who typically carries out elder abuse?

Answer 10

1. family members
2. paid caregivers
3. nursing homes
4. scam artists

Question 11

List S/S of abuse

Answer 11

1. In the patient
   
   1. unexplained or untreated injuries
   2. poor hygiene
   3. malnutrition and dehydration
   4. dirty or inappropriate dress
2. In the abuser
   
   1. aggression toward or verbal abuse of the pt
   2. speaking for the pt during an exam or trx
   3. disagreeable to instructions or suggestions in pt’s best interest

Question 12

list screening tests for elder abuse

Answer 12

1. elder assessment instrument
2. indicators of abuse screen
3. brief abuse screen for the elderly

Question 13

T/F: geriatric rehab pros have a legal duty to act reasonably to ID elder abuse or neglect involving their pts

Answer 13

TRUE

as well as take appropriate action to prevent further abuse

Question 14

what does NC Gen Stat 108A-102(a) - (b)(a) state

Answer 14

any person having reasonable cause to believe that a disabled adult is in need of protective services shall report such info to the director of Adult Protective Services

Question 15

who should you contact when you suspect elder abuse

Answer 15

1. for a community-dwelling older adult
   
   1. local adult protective services agency
2. for an older adult in a long-term care facility
   
   1. local long-term care ombudsman
3. Other group
   
   1. citizen advocacy groups
   2. office of aging
   3. protective and advocacy system

Question 16

what are restraints?

Answer 16

devices (physical) or substances (chemical) that restrict freedom of movement

Question 17

T/F: evidence shows that restraints often increase the incidence of falls

Answer 17

TRUE

Question 18

law relating to restraints

Answer 18

pt has the right to be free from any physical or chemical restraints imposed for purposes of disciplines or convenience, and not required to treat the resident’s medical symptoms

Question 19

T/F: you do not need an MD order to restrain a pt

Answer 19

FALSE

1. requires MD order
2. must be discontinued after 24 hrs unless well documented for necessity
3. additionally, elaborate process to show failure of “less restrictive devices” prior to restraint implementation

Question 20

describe parameters for the use of restraints

Answer 20

1. prohibited in prone positions
2. may be used if necessary to prevent imminent danger or injury
3. may not be used as a discipline or for convenience
4. must be ended at the earliest possible time
5. may only be used when less restrictive interventions have been determined to be ineffective
6. must be ordered by a physician or other authorized, licensed practitioner

Question 21

list types of restraints

Answer 21

1. chair or bed alarm
2. bed rail
3. lap buddy, lap tray
4. seat belt
5. reclining WC or gerichair
6. wedge cushion
7. hand mitts
8. extremity tie-on-devices
9. waist and pelvic ties
10. posey vests

Question 22

list benefits to restriants

Answer 22

1. prevent falls and injuries (in theory)
2. allow medical procedure w/o pt interference
3. maintenance of body alignment (in theory)
4. protects others from physical harm by the individual

Question 23

list risks to restraints

Answer 23

1. injury from falls
2. strangulation
3. skin abrasions and breakdown
4. immobilization sequelae
5. decline in ADLs
6. social/emotional isolation

Question 24

what is included in the basic coverage of Medicare A?

Answer 24

1. IP hospital
2. SNF
3. Hospice
4. HH

Question 25

what are the premium costs for Medicare A?

Answer 25

usually no premiums 1. IP/SNF depends on days of coverage 2. HH and Hospice no additional costs

Question 26

what is included in the basic coverage in Medicare B?

Answer 26

1. OP care 2. MD visits 3. Preventive services 4. labs 5. DME 6. kidney supplies 7. wellness visits

Question 27

what are the premium costs for Medicare B?

Answer 27

monthly premium, sliding scale for income after deductible met, pay 80% of cost

Question 28

what is included in the basic coverage for Medicare C?

Answer 28

All Part A (except hospice) and B, usually D * benefits vary widely * some include eye, dental, hearing

Question 29

what are the premium costs for Medicare C?

Answer 29

administered by private health insurance plan monthly premiums vary by plan

Question 30

what is included in the basic coverage for Medicare D?

Answer 30

1. OP Rx drug benefit offered through private plans 2. limits applied annually

Question 31

What are the premium costs for Medicare D?

Answer 31

Monthly premium along with cost-sharing for brand and generic drugs “donut hole” coverage for costly drugs

Question 32

which Medicare programs can student DPTs treat?

Answer 32

A and C

Question 33

what is the Payment Driven Payment Model (PDPM)?

Answer 33

model that uses clinically relevant factors instead of volume-based services for determining payment ultimately reduces total therapy minutes → reduced therapy staffing

Question 34

list the social determinants of health

Answer 34

1. availability of resources to meet daily needs 2. access to educational, economic, and job opportunities 3. access to healthcare services 4. transportation options 5. social support 6. public safety 7. social norms (discrimination, racism, etc.)

Question 35

what influences the health of a population?

Answer 35

1. access and quality of healthcare 2. Patients behaviors 3. Socioeconomic conditions

Question 36

what are the 5 determinant areas that reflect critical components and influence health outcomes?

Answer 36

1. Neighborhood and the built environment 2. Economic stability 3. Health and healthcare 4. Education 5. Social and community context

Question 37

how do we help people with unmet SDOH needs?

Answer 37

1. Screening 1. health leads social needs screening toolkit 2. PRAPARE TOOLKIT 3. HealthBegins Upstream Risks Screening Tool 2. Tools to address SDOH needs 1. Findhelp.org 2. the neighborhood navigator

Question 38

Give some advocacy examples

Answer 38

1. Falls prevention 2. Medicare policy 3. Access to reimbursable treatments

Question 39

what is the purpose of palliative care?

Answer 39

provides comfort measures for individuals/families with life-threatening conditions that may or may not be terminal

Question 40

what is the purpose of hospice care?

Answer 40

provides comfort measures for individuals/families with terminal conditions and \>6 months of life focus → physical, emotions, spiritual care

Question 41

what is a “good death”?

Answer 41

defined as one that is free from avoidable distress and suffering for the pts, families, and caregivers in general accord with the pt's and families wishes and reasonably consistent with clinical, cultural and ethical standards