Deck 31: Home Health Care

Question 1

An elderly woman receiving care reimbursed by Medicaid was moving to a different state to stay with her daughter-in-law.The disabled woman asked about Medicaid reimbursement in her daughter's state.How should the nurse respond?

A)"Because you paid into Social Security (FICA),you are eligible for assistance no matter where you go."
B)"Just be sure to call a home care agency as soon as you arrive so that they can assess your daughter-in-law's house and make sure it is acceptable."
C)"Medicaid is a federal program,so the rules will be the same wherever you go."
D)"Medicaid is sponsored in part by the state,so the rules may be very different there."

Answer 1

"Medicaid is sponsored in part by the state,so the rules may be very different there."

Question 2

How are home health agencies reimbursed for care from Medicare?

A)Diagnostic-related groups (DRGs)
B)Home Health Resource Group (HHRGs)
C)Outcomes Assessment and Information Set (OASIS)
D)Preferred Provider Organizations (PPOs)

Answer 2

Home Health Resource Group (HHRGs)

Question 3

A home care nurse was scheduled to attend a Medicare case conference for a client who was receiving care from the nurse and a physical therapist.What was the probable reason why the case conference was scheduled?

A)It offers an opportunity for the financial officer to evaluate the nurse and the physical therapist,as well as the appropriateness of care being given.
B)Medicare mandates a case conference every 60 days to coordinate care.
C)The home care staff was providing inadequate care and needed additional staff in-services.
D)Data could be collected and reported to the primary physician to ensure continued reimbursement for the physician.

Answer 3

Medicare mandates a case conference every 60 days to coordinate care.

Question 4

What was the primary reason home care agencies expanded so drastically in the late 1960s and 1970s?

A)Hospitals chose to focus on providing care for more acutely ill clients.
B)Increased numbers of elderly and poor persons were eligible for care because of federal legislation.
C)Early discharges influenced the need for clients to receive home care services after hospitalization.
D)There was lack of interest by the American society to contribute to charitable causes.

Question 5

A home care nurse was discussing her day with a nursing colleague who worked in acute care at the nearby metropolitan hospital."You have it easy," said the home care nurse."You never have to ...." Complete the home care nurse's sentence accurately.

A)"Remember to take exactly what you need with you on the visit."
B)"Spend hours every day documenting everything you did."
C)"Worry about whether your client will recover."
D)"Worry about who is going to pay for services or the rules of that payer."

Question 6

A home care nurse is going to a client's home to admit the client for home care services.What should the nurse's priority action be during the admission visit?

A)Complete the Outcomes Assessment and Information Set (OASIS)form for the Centers for Medicare and Medicaid Services (CMS).
B)Discuss the availability of financial resources or eligibility for a third-party payer.
C)Inform the client of his or her responsibility to follow the plan of care to continue receiving services.
D)Set up the equipment for the computer to relay data between the nurse and the client.

Question 7

What is the rationale behind public health departments' not offering home nursing?

A)Most of the agencies' energy and resources are spent on controlling communicable diseases instead.
B)Priorities have changed to focus on addressing the increasing public health problems.
C)Profit-making agencies are now providing more care for homebound clients.
D)Public health has not traditionally been involved in home care of individuals.

Question 8

A nurse is admitting a client to home care services,using Medicare as the funding source for the care that will be provided.Which of the following substantiated findings would make a client ineligible for these services?

A)Care is needed from both a nurse and a physical therapist.
B)Care is needed 24 hours a day on an ongoing basis.
C)The client is incapable of leaving the home.
D)None of these;the requested care seems reasonable and medically necessary.

Question 9

A nurse was told that the home health nursing agency had just been accredited by the Community Health Accreditation Program (CHAP).Among other requirements,what has the agency probably just completed?

A)A review of policies and procedures from other similar agencies
B)A walk-through assessment of the agency
C)Certification of the staff of the agency
D)A thorough self-evaluation

Question 10

In 1995,which type of agency provided most of the home care services?

A)Hospital-based home care agencies
B)Local and county health departments
C)Privately owned,but nonprofit,entrepreneurial home care agencies
D)Proprietary for-profit incorporated home health agencies

Question 11

An infant has been born with several congenital anomalies and is ventilator dependent.The nurse discusses options for home care services with the infant's parents.Why is home care considered in this situation?

A)Children at home have fewer infections and more consistent development.
B)Parents vastly prefer home care so that they can care for their child continuously.
C)It is easier for family members to visit the child at home rather than in the hospital.
D)There is better reimbursement for services provided in the home setting.

Question 12

Why did home care agencies expand in the 1980s?

A)Clients discovered they much preferred home care to hospital care.
B)The diagnostic-related group (DRG)system of reimbursement was phased into hospitals.
C)An increased number of elderly and poor persons became eligible for care because of federal legislation.
D)There was a lack of interest by American society in contributing to charitable causes.

Question 13

Besides professional home health care,what other kind of home care may be needed?

A)Community health home care,based on care needed in a community
B)Public health home care,based on principles of caring for aggregates
C)Technologic home health care,based on reimbursement guidelines
D)Technical home health care,based on a need for a piece of medical equipment

Question 14

A nurse knew that the home health agency had been accredited by the Community Health Accreditation Program (CHAP).What will be the agency's status in relation to required Medicare visits and self-study?

A)The agency will have difficulties because Medicare reimburses only agencies accredited by the Joint Commission.
B)The agency will have deemed status as accreditation standards are more rigorous than Medicare criteria.
C)The agency will need to demonstrate evidence of achieving positive outcomes in order to receive Medicare reimbursement.
D)The agency will need to engage in another self-evaluation and submit to Medicare peer review site visits.

Question 15

What is a reason why home health nurses do not engage in case finding and preventive health teaching to all members of the family?

A)These services do not result in reimbursement for the agency.
B)Caseloads are so high that there is no time to provide these services.
C)Home health nurses do not feel comfortable providing these services.
D)Federal regulations limit the amount of these services that agencies can provide.

Question 16

A home health nurse was competent and efficient,and yet a client simply was not ready to be discharged from care,although the client's date of discharge had now expired.What will happen to the client now that the original assessment and plan of care suggested that the client be discharged?

A)A different nurse can begin again with assessment and planning in preparation for an appeal of discontinuation of financial reimbursement.
B)The nurse's original assessment and plan were inaccurate,so a correction has to be filed to justify continued financial reimbursement.
C)The client will be discharged as planned and will have to depend on family or friends for assistance.
D)The client will continue to receive care as needed,and the agency will suffer a financial loss.

Question 17

How would a typical home care nurse spend the majority of his or her time?

A)Providing direct care in clients' homes
B)Calling physicians and getting certification for treatment
C)Supervising the home health aides who are giving the client's personal care
D)Teaching other family members and home care aides how to care for the client

Question 18

A registered nurse was attending new employee orientation at a home nursing agency.The agency supervisor reviewed the "Conditions of Participation." To what was the supervisor referring?

A)County statutes regarding who could be employed as a caregiver
B)Federal rules,standards,and criteria for Medicare certification
C)Professional standards concerning appropriate care documentation
D)State legislation regarding who was eligible for care

Question 19

Why do clients typically prefer home care over hospital care?

A)Clients feel better wearing personal clothing and preparing their own favorite foods.
B)Clients are comforted by the feeling of control and the familiarity of their own home.
C)Clients know that more visitors can stop by without concern for having limited space.
D)Clients resent the constant interruptions by nurses and other caregivers in a hospital.

Question 20

The Nursing Home without Walls (NHWW)staff compared the cost of care in the home with care in the hospital and drew what conclusion?

A)Home care services are slightly less expensive than what hospital care would cost.
B)Home care services are about half of what hospital care would cost.
C)Home care services are roughly equivalent to what hospital care would cost.
D)Home care services do not clearly demonstrate a difference in cost.

Question 21

Why will home health care continue to expand? (Select all that apply.)

A)Complex care can be more efficiently provided in the home setting.
B)Cost-containment measures are being implemented at all levels of government.
C)Insurance companies are requiring increased use of generic medications.
D)The public is demanding quality health care services in the home.
E)The public is exerting pressure to receive care in the most comfortable setting.
F)Technologic advances are occurring.

Question 22

A home care client was no longer eligible for insurance reimbursement of needed home care.What is the appropriate action for the nurse to take next?

A)Providing care until the client can be transferred to a different agency
B)Explaining that care is not free and that the nurse will not be returning
C)Consulting with the public health department so that the client will receive free services
D)Referring the client to social services for assistance

Question 23

What is the primary reason why home care agencies share information,such as how data are collected and terms defined?

A)Agencies are required to report these data to the Centers for Medicare and Medicaid Services (CMS).
B)Each is looking for weaknesses in the others that they can use as the basis of marketing campaigns for themselves.
C)Each wants to determine the cost for an episode of care for both themselves and the others in order to remain competitive.
D)Group data will help them negotiate managed care contracts with maximum gain on both sides.

Question 24

A home care nurse is caring for an adult client who has an infectious disease.What measures should the nurse tell the client's family members to take to protect themselves from the disease? (Select all that apply.)

A)Use protective barriers to prevent exposure to blood and other body fluids.
B)Body substances should be put in the toilet along with 1 cup of bleach each time the toilet is flushed.
C)Keep young children out of direct contact with the client.
D)Soiled dressings should be thrown in a trash can labeled "Hazardous Waste."
E)Use disposable dishes when serving the client his food.
F)Wash hands frequently.

Question 25

Which of the following features of hospice differentiates it from traditional home care?

A)Use of direct service volunteers as part of the interdisciplinary team
B)Need for accurate documentation in order to receive reimbursement
C)Use of Medicare reimbursement for services provided
D)Provision of direct nursing services for the client

Question 26

Which of the following is an example of a customer of home care?

A)An agency that employs and pays the nurse
B)A group of colleagues who evaluate the nurse's care
C)A client for whom the nurse is caring
D)A physician who refers a client to the home care agency

Question 27

Which of the following actions demonstrates a home care nurse integrating the Healthy People 2020 objectives into home care practice?

A)Referring a client to physical therapy
B)Instructing a client to visit the dentist on an annual basis
C)Administering an insulin injection to a diabetic client
D)Counseling a client about how to prevent the spread of infectious disease

Question 28

A home care client suffering from cancer asked the home care nurse if he could be referred to hospice,considering his diagnosis.How should the nurse respond?

A)"Certainly,since you are going to die regardless of what we do."
B)"If you and your physician agree to keep you comfortable while battling the cancer,your doctor can refer you."
C)"If you are sure you will die within the next 6 months and no longer want a physician's care,I will be happy to make the referral to hospice."
D)"For your physician to refer you to hospice,you need to decide to concentrate on enjoying life and staying comfortable rather than treating your cancer."