Chapter 31: Home Health Care Nursing School Test Banks
Chapter 31: Home Health Care
1. 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.
Home care agencies expanded in the 1960s and 1970s as a result of Medicare/Medicaid legislation to pay for care of elderly persons and those in poverty.
DIF: Cognitive Level: Knowledge REF: p. 777
2. 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
Proprietary for-profit, freestanding home health agencies constituted the largest percentage of home care agencies in 1995. Hospital-based home care agencies represented the second largest percentage.
DIF: Cognitive Level: Knowledge REF: p. 778
3. 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.
A significant result of the DRG system was a decrease in the clients length of hospital stay and an increased demand for home health agencies to provide care to clients who were still recovering from surgery or an illness. The federal legislation that increased the number of elderly and poor persons eligible for care happened with the passage of Medicare and Medicaid in 1965.
DIF: Cognitive Level: Comprehension REF: p. 778
4. 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.
An NHWW study concluded in 2001 demonstrates that the cost of home care services has been half of the cost of corresponding institutional care.
DIF: Cognitive Level: Knowledge REF: p. 778
5. 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.
Although all of the options could on occasion be true, the primary reason that clients feel better at home is because it is their own, familiar territory where they are in control.
DIF: Cognitive Level: Comprehension REF: p. 778
6. 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
There are two types of home care, the first being professional home care, which consists of professionals in practice giving care. The second type of home care is technical home care, which consists of agencies that sell or rent durable medical equipment.
DIF: Cognitive Level: Comprehension REF: p. 779
7. 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
For Medicare certification, agencies must meet the Medicare conditions of participation (COPs), which include rules, standards, and criteria established by the federal government.
DIF: Cognitive Level: Application REF: p. 779
8. 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
The process of accreditation requires the agency to conduct a thorough self-evaluation based on identified objectives, write a self-evaluation report, and submit to an unannounced, on-site survey by peer reviewers, including home visits to clients.
DIF: Cognitive Level: Application REF: p. 781
9. A nurse knew that the home health agency had been accredited by the Community Health Accreditation Program (CHAP). What will be the agencys 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.
Medicare criteria are more than minimum standards but are not really quality standards. Accreditation represents quality service. Consequently, any agency that meets the quality standards of accreditation from either the CHAP or The Joint Commission has more than met Medicare standards and is considered to have deemed status. An agency that meets accreditation standards is deemed to have met the Medicare standards as well.
DIF: Cognitive Level: Application REF: p. 781
10. 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.
Public health agencies are supported by tax dollars and give care under state legislation, as well as local statutes. The focus is on public health more than on direct client care. The highest priorities are bioterrorism and mothers and children at high risk for health problems.
DIF: Cognitive Level: Comprehension REF: p. 781
11. 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.
Most home health agencies do not provide public health services such as case finding or health-promotion activities because traditional third-party payers do not reimburse for such activities.
DIF: Cognitive Level: Comprehension REF: p. 781
12. An infant has been born with several congenital anomalies and is ventilator dependent. The nurse discusses options for home care services with the infants 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.
Home care is more effective in development, socialization, and normal family functioning, and infections at home are fewer.
DIF: Cognitive Level: Application REF: p. 782
13. A home health nurse was competent and efficient, and yet a client simply was not ready to be discharged from care, although the clients 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 nurses 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.
Under the prospective payment system, if it takes more visits than anticipated to meet the clients documented needs, the agency has to provide the care and assume the financial costs.
DIF: Cognitive Level: Application REF: p. 782
14. 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)
The HHRG in which the client will be placed is determined by OASIS questionnaire data. Each HHRG has a set amount of dollars reimbursed to the home health agency caring for the patient. DRGs are used for hospital reimbursement. PPOs are managed health organizations comprised of medical providers who offer discounted services for their members.
DIF: Cognitive Level: Comprehension REF: p. 783
15. 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.
The five criteria for Medicare reimbursement are (1) being homebound, (2) having a completed plan of care, (3) needing skilled professional services, (4) needing skilled services that are reasonable and necessary, and (5) needing services on a part-time or intermittent basis. Needing full-time care would not be the purpose of home care services under Medicare.
DIF: Cognitive Level: Application REF: pp. 783-784
16. 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 daughters 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-laws 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.
Medicaid is based on income and assets and is not contingent on any previous payments to the federal or state government. However, Medicaid is jointly sponsored by the federal government and the states. Therefore, Medicaid coverage differs from state to state. These differences can often be dramatic. The elderly disabled woman may not be eligible in her daughters state of residence and may want to check this carefully before moving permanently.
DIF: Cognitive Level: Application REF: p. 784
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 clients personal care
d. Teaching other family members and home care aides how to care for the client
Although a home care nurse engages in all of the tasks listed, the most common intervention performed is teaching, because most care provided in the home is the responsibility of someone other than the nurse.
DIF: Cognitive Level: Comprehension REF: pp. 784-785
18. 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.
Medicare mandates case conferences at periodic intervals, and a written summary must be sent to the primary physician for review. Sometimes the client or the clients caregivers may be included in the case conference. There is no evidence that any of the other possible responses are true.
DIF: Cognitive Level: Application REF: pp. 786-787
19. 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 nurses 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.
Acute care nurses also spend hours on documentation, have to remember what supplies to take in preparation for giving care, and worry about their clients. Usually, however, they do not have to remember the requirements of the third-party payers or determine the clients ability to pay on a sliding fee scale. A unique aspect of the role of the home care nurse is involvement in the financial aspects of delivering care. The home care nurse must know who is going to pay for services.
DIF: Cognitive Level: Synthesis REF: p. 787
20. A home care nurse is going to a clients home to admit the client for home care services. What should the nurses 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.
Although the OASIS questionnaire is required under Medicare, the patient may have insurance or other financial resources. The nurse must first discuss financial resources to determine how payment will be made, which will affect decisions regarding planning of care and whether the OASIS form must be completed.
DIF: Cognitive Level: Application REF: p. 787
21. 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.
Beginning in fall 2003, the home care industry was the subject of a new program called Home Care Compare. In this program, the agencies must report key variables, and these variables will be made public by CMS. CMS took out full-page ads in newspapers in the region telling consumers how home care agencies fared on patient outcomes in relation to the variables in the Home Care Compare program.
DIF: Cognitive Level: Comprehension REF: p. 787
22. 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 nurses care
c. A client for whom the nurse is caring
d. A physician who refers a client to the home care agency
Patients or clients are the health care consumers. However, customers are those people or agencies that refer the patient or client to the particular home care agency.
DIF: Cognitive Level: Application REF: p. 788
23. 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
Home care agencies are prohibited from discharging clients from care simply because they are unable to pay for the needed service. Rather, the agency must continue to give care until care is no longer needed or referral can be made to another agency that will care for the client. Although the public health department may be able to provide free or reduced care to some clients, a consultation would not ensure that the client would receive these services
DIF: Cognitive Level: Application REF: p. 789
24. 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 physicians 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.
To be accurate, positive, and supportive of the client, the nurse must discuss the alternative of seeking comfort rather than cure. To be eligible for hospice, a person must have the diagnosis of a terminal illness, with a prognosis of 6 months or less, with informed consent from the client and a referral by the clients attending physician. Hospice implies ceasing to battle for length of life and focusing on comfort and quality of life.
DIF: Cognitive Level: Synthesis REF: p. 790
25. 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
Instructing a client to visit the dentist on an annual basis demonstrates the nurse integrating the Healthy People 2020 objective Increase to 49% the proportion of children and adults who use the oral health care system each year. The other actions are important actions of the home care nurse but do not address the Healthy People 2020 objectives.
DIF: Cognitive Level: Analysis REF: p. 792
26. 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
One of the unique features of hospice is that direct service volunteers are part of the interdisciplinary team. Volunteers provide a variety of services, including respite care, meal preparation, and friendly visiting. Accurate documentation, Medicare reimbursement, and direct nursing services are all part of hospice, but they are also part of traditional home care services.
DIF: Cognitive Level: Comprehension REF: p. 794
1. 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.
ANS: A, B, D, F
There are numerous reasons that home health care will continue to expand, including advances in technologies, which allow equipment to move from hospitals to homes; policies for cost containment by care in less expensive settings; and the ongoing public demand for quality care.
DIF: Cognitive Level: Comprehension REF: p. 791
2. A home care nurse is caring for an adult client who has an infectious disease. What measures should the nurse tell the clients 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.
ANS: A, F
Specific measures to control infection do not include disposable dishes if regular dishes can be washed in hot, soapy water; isolation of the ill family member compromises quality of care and may create social-psychological issues; client wastes can just be flushed without further action. It is important for everyone to wash their hands frequently and to use protective barriers when one may have potential contact with hazardous body fluids.
DIF: Cognitive Level: Application REF: p. 794