-2 1. 2. 3. to act as an advisory group to the hospital in the formulation to provide self-regulation and discipline of the medical staff to provide for continued education of staff members, interns, As part of its duty to maintain proper professional standards, the governing board of the hospital chooses the physicians who enjoy the privileges of the hospital. This responsibility is shared with the medical staff and the board's action is usually based on recommendations of the staff. In seeking the privilege of caring for his patients in the hospital, the physician in return accepts certain responsibilities and obligations, such as agreeing to provide the best care for each patient, and to help in maintaining the general efficiency of the institution. In order to define the responsibilities, duties, and limitations of activity of staff members, bylaws are usually prepared and published. These set forth the internal organization of the staff and procedural guides for self-government and various actions which affect the operation of the entire institution. Thus, in the organization and function of the medical staff in a hospital there is a responsible authority for initiating patient care policies and insuring that all aspects of patient care programming will be routinely reviewed through a careful process of professional scrutiny. Through this method, plans can be expressed in terms of goals. The obvious benefits of this are: 1. purposeful and integrated planning is made easier; 2. unproductive work is more likely to be avoided; 3. 4. operating goals or standards can be used as building blocks in goals serve as standards for purposes of control, and play an Comparing these conditions to those which prevail in the nursing home, although many nursing homes are of sufficient size to warrant the activation of an organized medical staff, the usual pattern of physician participation has been for each patient's doctor to be on his own. He responds to a call for help by the patient or the nursing home administrator, but this is a far cry from the requirements of positive and sound medical care of chronic illness. relatively few physicians with interest in caring for the chronically ill makes the necessary physician participation required by an organized medical staff difficult to achieve. The Under these circumstances, what are the alternatives for designing a suitable framework for administration of nursing home patient care programs? -3 First, the most simple approach, sufficient to meet Medicare requirements, requires that at least one physician and one registered professional nurse must develop and review patient care policies. The nurse must see to it that the policies are carried out. A second alternative for a large nursing home is the organization of a medical staff. A third alternative, the organization of a patient care policy committee or council, offers the most effective method for the nursing home. It is the alternative which could best meet the specific requirements of the nursing home's patient care problems. The fourth alternative, the medical staff equivalent, is of recent origin. This aggregate community solution, which may be activated by a local medical society, is especially desirable, since it attempts to develop for several nursing homes in a community patient care policies, utilization review, and other important features that contribute to continuity of care for the longterm patient (i.e., community-wide transfer agreement, inter-agency referral system). "If we shift our sights from meeting needs according to the way In the case study developed for use in training nursing home administrators, Mr. Bill Jones, the Administrator of the Colonial Hills Nursing Home, after considering the several alternatives open to his organization, convinces his governing body that the best way to proceed now would be the activation of a patient care policy committee (or council). It is recognized that there are significant reasons for working with the local medical society, hospital and nursing home administrators, and others to achieve a medical staff equivalent, designed to serve the best interests of the entire community, including the interests of the several nursing homes and their patient How does the administrator solve problems in establishing a patient care policy committee to develop policies and provide an operational framework for professional scrutiny of all aspects of patient care? The committee, including the physician advisor, the director of nursing, the several health professionals who serve on the staff (full-time or part-time by arrangement), is organized to assess patient needs and determine whether the facility's resources are used appropriately to meet those needs. Senator Frank E. Moss, Chairman, Committee on Aging, U. S. Senate Hearings in Denver, Colorado, February, 1965. -4 A "Statement of Organization" has been introduced to define the goals, provide for the makeup of the group, specify the responsibility of its members, and establish a method by which it can adequately perform its function of review and appraisal of patient care programs. Significant contributions of Federal health legislation for the long-term care institution are those provisions of Titles XVIII and XIX of the Social Security Act (Medicare and Medicaid) which provide the basis for a different kind of participation by health professionals, in the efforts of the nursing home to advance higher standards of care. Health professionals from the community hospital or the public or voluntary health agency are beginning to effect relationships with the long-term care facility, not only to provide direct patient care services but also to serve as members of the patient care policy committee, as advisors to the utilization review committee, and as instructors in the facility's in-service training program. Reimbursement to the facility for all those services is now authorized. In conclusion, only where the health professional comes into the long-term care facility to participate actively in effecting policies, to teach its staff, and to help evaluate the effectiveness of patient care, can there be established a meaningful program that will help the nursing home take its place among the community's health facilities. CASE STUDY ORGANIZING PATIENT ACTIVITY SERVICES IN AN EXTENDED CARE FACILITY Background Information: Colonial Hills was built as an extended care facility by a group of physicians and community leaders in anticipation of an increased need for more beds for county nursing and medical care patients. The facility is owned by a corporation and operated by an experienced administrator with the guidance of a Board of Directors. The full and part-time professional staff includes a director of nursing, physicians, and a dentist. The impetus for initiating a patient activities program stems from the Board's desire to meet treatment and service standards set under a Tiller County medical plan and by nursing home accrediting agencies. The proposed activities program is one segment of an overall plan for updating the facility's services. The Administrator has made a preliminary survey of the facility!s present activities program and practices and has drawn the following conclusions: 1) 2) 3) 4) Problem: There is a minimum number of activities available for the These activities are relatively unorganized and the needs of The use of community resources, including volunteer groups or A limited number of activity areas are available for activities; however, many areas in the nursing home could be easily adapted or modified for activity use. Colonial Hills is a modern 100-bed proprietary medical and nursing care facility near two towns, Dixon and Fernville, in Tiller County, any state, U.S.A. This facility is presently upgrading the caliber of services it makes available to its patients. The Board of Directors of Colonial Hills has asked the administrator to study the feasibility of including an organized practical patient activity program in the services provided by the agency for its patients. Questions to Consider: -2 1) What are the specific activity needs of the nursing home patients, and how can a well planned activity program meet these needs? 2) 3) 4) 5) 6) What should be the goals of a comprehensive patient activity What facilities and equipment are necessary to insure an adequate patient activity program? What qualities and qualifications are desirable for personnel What steps can be taken to initiate a patient activity program? What community resources should be investigated to supplement 7) What would be the cost of initiating and maintaining an adequate activity program? |