HOSPITAL AND HOMECARE

Bridging the Gap between Hospital and Homecare [Claudia Weiner]

[Hunter CUNY Graduate Program in Anthropology]

Abstract

In North America today the percentage of the aged population is increasing as the baby boomers reach retirement age with more chronic disease, and the problem grows of how to deal with care outside of the hospital. The role of the Visiting Nurse is extending care to patients beyond the hospital, This thesis will describe how Visiting Nurse care is different from hospital nursing care, and how a Visiting Nurse has to deal with very different situations from a hospital nurse.

Chapter 1: Introduction

Today in North America the aged population is increasing as the baby boomers reach retirement age with more chronic disease, and the problem grows of how to deal with care outside of the hospital. The role of the Visiting Nurse is extending care to patients beyond the hospital,

Informal interviews of visiting nurses reveal that they are very different from hospital based nurses, bending the rules of biomedicine to get results. VN's bridge the gap between hospitals based and home care.

This paper explores ways the visiting empirically bend biomedicine's applications of patient care. The VN implements compliance within the public healthcare system. The VN's role is explained via ethnography, overlap treating patient after patient. I am taking a reflexive role, part actor and part observer, as I work professionally as a visiting nurse. This thesis is on nurse behavior and their personal anecdotes of patient care in the context of the home environment. It will describe how Visiting Nurse care is different from hospital care, and how a Visiting Nurse has to deal with very different situations from a hospital nurse. It appears that not much has been written about visiting nurses compared to other kinds of nurses. Medical anthropologists have rarely studied the particular kind of care, and the special problems that Visiting Nurses deal with, and this is the particular aim of my thesis.

Home healthcare delivery is different form hospital health care and operates through a unique structure.

Delivery of Home Health care is based upon a 60 day certification period. The continuity of care depends largely upon the billing structure and insurance reimbursement scheme.

Billing structure

Traditional Medicare

Covers all aspects of a 60 day home care period

Traditional Medicaid

60 day homecare

Managed Medicare Senior Plan (GHI, BCBS)

60 day

Managed Medicaid (Affinity, Healthsource)

Managed Care report sent to provider

Visits authorized for 2 weeks at a time

Managed Care/HMO

Authorization based upon report by nurse/therapist to cover 2 week period

Medicare while on service gets unlimited supplies, bandages etc. Medicaid gets replenished every 30 days.

Cases without insurance will be accepted as fee-subsidy or Medicaid pending, and a MSW will be assigned to work with them to procure insurance within a reasonable period.

A hospital nurse has less individualized decision making in this realm. Her assessments and notes may affect the decision of when to discharge a patient. For instance if the notes repeatedly state words like status quo, then the patient will be considered for immediate discharge. The choice of ...