Who Are Health Care Employers?
Health care employers are a group of businesses that offer health care services to the public and provide jobs for health care personnel. Hospitals provide acute care services. Nursing homes provide chronic care services. Community home health agencies, adult day care centers, and mental health centers provide chronic care services at home, in-house, or as outpatients.
Hospitals care for people who are in crisis situations that have resulted from life-threatening health problems. Heart attacks, severe accidents, and diabetic reactions are a few examples of health problems that require acute care services.
Nursing homes provide caring services for people who have chronic health care problems caused by diseases, disabilities, or infirmities. The majority of people housed in nursing homes are elderly, although some are young and middle-aged. Nursing home residents receive rehabilitative and restorative care provided by nurses, nursing assistants, and the staff who are knowledgeable about the concepts of rehabilitation, human restoration, and the care of the elderly.
Community Health Agencies
Community health care agencies provide in-home and outpatient services to treat chronic (ongoing), non-life-threatening health problems. Arthritis, the aftereffects of stroke, depression, and persistent drug use are examples of some chronic health problems that might require community home health services. Some chronic health problems, such as those caused by AIDS, stroke, and chronic obstructive pulmonary diseases (bronchitis, asthma, emphysema) often require both chronic and acute care services.
Comparison of Hospitals
There are different kinds and types of hospitals. Community hospitals treat people in the immediate area. Regional hospitals treat people from several surrounding communities. Specialty hospitals treat people who belong to particular social groups. For example, Veterans' Administration hospitals treat former armed forces personnel, the men and women who served their country during both peace and wartime. Some specialty hospitals treat people who have similar health problems, like St. Jude's hospital in Memphis, Tennessee, where children with childhood cancer are treated. Medical centers offer diverse and specialized medical services and are often located in large cities. Oklahoma City Medical Center is an example of a large, urban hospital that offers many services not available in community and regional hospitals. This medical center was one of several hospitals that cared for the 1995 victims of the federal building bombing incident.
Hospitals treat patients on an in-and-out basis. People with heart attacks are treated as inpatients in cardiac care units. Follow-up care is often done on an outpatient basis. Many hospitals offer other outpatient services, such as dialysis units to treat patients with kidney disease or rehabilitation units to treat patients with orthopedic problems or people who need muscle retraining exercises.
More nursing assistant jobs are available in local community or regional hospitals because these institutions have less money to spend on licensed nursing personnel. Although hospitals utilize nursing assistants in similar ways, in recent years their job titles have changed. Patient care manager, ADL (activities of daily living) aide, and nurse extender are examples of titles that refer to nursing assistant positions. According to the American Hospital Association and OBRA (Omnibus Budget Reconciliation Act), hospitals, nursing homes, home health agencies, and other employers have awarded more than fifty titles to identify this occupational group.
Home Health Agencies
Hospital sponsored and community home health agencies will provide 92 percent more jobs for nursing assistants. New mothers who lack family support will need instruction and assistance with child rearing tasks such as infant bathing, feeding, diaper changing, and child super-vision. Elderly people living alone will need assistance to perform activities of daily living such as bathing, dressing, eating, and toileting. Daily monitoring by home health aides will become necessary because of failing hearing, vision, and ability to move independently. Mid-life people who care for their elderly parents and small children are expected to request respite time (time alone) services.
Housing communities that target elderly people with chronic health problems are being developed. Future predictions show that community housing residents will have access to good, cost-effective home care and adult day care services. Provision of these services will create a need for more home health aides.
Hospice Care
Hospice centers hire certified home health aides to provide basic nursing care to terminally ill patients in their homes or at hospice centers. Hospice centers support patients and their families. "Death is the final transition in life. We help patients to make that transition and help families to accept the reality of death. We couldn't function without our hospice aides," said an R.N. hospice director from Oklahoma City, Oklahoma. Hospice aides work eight-hour shifts for each twenty-four hours. They earn about $12,000 to $16,000 per year. People interested in hospice work are advised to volunteer at a hospice to see how people are cared for.
Nursing Homes
Nursing homes (also called long-term care facilities) employ more than 600,000, or over one-half of the more than 1,000,000 working nursing assistants, according to recent U.S. Labor Department and nursing home industry statistics. More nursing homes are being built to care for the growing numbers of frail elderly people (age eighty-five and over) who will require their services. Nursing homes will remain the major nursing assistant employer.
Longevity does not create chronic health problems. Genetic tendencies and lifestyle choices tend to escalate existing health problems during advanced old age. Some people are born with good gene mixes that enable them to be active and healthy well into old age, no matter how they choose to live. It is unknown who is born with good gene mixes. To remain healthy, it is prudent to pursue a healthy lifestyle that includes good nutrition, exercise, rest, a good work life, laughter, and fun!
Military Employers
The United States Armed Forces (Army, Navy, Marines, Air Force, and Coast Guard) offer opportunities for employment and train people to become nurse assistants. Training is similar to that of civilian nursing assistant training curriculums. According to military sources, more job training opportunities will become available for recruits who want to become nursing assistants.
Mental Health
Mental health centers will offer more job opportunities for nursing assistants. Mental health centers now include organizations that treat people with severe and untreatable dementia (i.e., Alzheimer's disease). New Alzheimer's centers are expected to be built by 2005. Other mental health centers will treat young and middle-aged people who experience health problems due to chronic alcoholism or other drug use. Mental health centers have evolved from the large, expensive-to-operate psychiatric hospitals. They are more efficient because they are divided into smaller units that provide multi-care options.
Training
On-the-job training is available at work. Vocational schools provide one-year courses and community colleges provide two-year courses.
Certification Process
Medical assistants can become certified by the American Association of Medical Assistants after completing an approved training course. To qualify, they must have a high school diploma and one year's working experience.
Medicare/Medicaid
All health care businesses that provide patient care services need financial support in order to operate. The majority of them are supported through federal and state payment systems, such as Medicare and Medicaid. Medicare provides federal funds for people aged sixty-five and over. Medicaid provides federal and state funds for poor people of all ages and protects the uninsured who cannot afford to buy health insurance coverage.
Health Maintenance Organizations
There are more than 139 million people who are covered by health maintenance organizations (HMOs). HMOs are health insurance plans designed to provide cost-effective health care services. Blue Cross/Blue Shield, Aetna, Prudential, and Humana are a few examples of HMOs that support the need for preventive health care services and appropriate cost-effective care to treat existing health problems. HMOs are in a period of social transition. They have been implicated in negative situations by doctors, nurses, and the insured. Concerned HMO directors are adapting their services to meet public demand for good, honest, competent, and affordable health care payment systems.
Other Funding Agencies
Health care businesses also receive funds from private insurers, individual contributions from endowments (financial gifts), and government grants.
Federal/State/Health Care Guidelines
The general purpose of federal and state standards is to keep the public safe from harmful care. Hospitals must meet guidelines set by the Joint Commission on Accreditation of Health Care Organizations (JCOHA) in order to maintain Medicare/Medicaid funding. JCOHA guidelines define responsibilities for the delivery of competent, caring services.
OBRA (Omnibus Budget Reconciliation Act)
The Health Care Financing Administration (HCFA) defines federal standards for nursing homes and other long-term-care facilities that receive Medicare and Medicaid funding. The HCFA introduced the Omnibus Budget Reconciliation Act of 1987. OBRA has changed how long-term-care facilities operate to deliver caring services to the public and has developed strict training content for nursing assistants who care for the elderly in long-term-care facilities.
Legal Guidelines
Patient rights, patient abuse laws, advanced directives (patient self-determination legislation), The Right to Know Law, and Occupational Safety and Health Administration (OSHA) standards are important legal guidelines that must be addressed and adapted for each type of health care business.
Patient Rights: Patient rights laws were developed by the American Hospital Association in 1973. This law ensures that patients have a legal right to confidential care by health care providers who respect each patient's personal privacy and dignity.
Patient Abuse Laws: Patient abuse laws were enacted during the 1980s. These laws protect each patient from abuse by health care providers. Patient abuse has been defined as harmful acts against patients. These acts could be physical, mental, sexual, and financial. Patient rights and patient abuse laws have been adapted for nursing homes and other community agencies that provide health care services to people of all ages.
Advanced Directives (patient self-determination legislation): Advanced directives are legal documents that protect patients when they can no longer communicate their personal wishes. Patients have the right to appoint a durable power of attorney to make health care decisions for them should a life-threatening situation or a terminal state of health occur. Proxies make clear whether lifesaving interventions are to be initiated. These surrogate decision makers must follow advanced directives that were written down by patients regarding their personal wishes. A do-not-resuscitate (DNR) order is an example of an advanced directive. Proxies can make decisions only in circumstances when patients cannot speak for themselves.
The Right to Know Law: The Right to Know Law protects health care workers from environmental hazards that could be harmful to their health and safety. Health care employers are obligated by federal law to advise employees of potential hazards and provide safeguards to protect them on the job. Nursing assistants use potentially harmful substances for cleaning tasks. Employers are mandated to inform nursing assistants about potentially harmful substances and advise them of what steps to take to prevent personal accidents or injuries.
OSHA and Standard Precautions
OSHA provides information on standard precautions for health care providers who deal with blood-borne pathogens (disease-producing germs in the blood and body fluids). Essentially, nursing assistants should always wear latex gloves when handling human excreta (urine, feces, and sputum). Good hand-washing techniques and the use and application of personal protective equipment (gloves, glasses, and facial masks) are essential to prevent the spread of blood-borne pathogens.
