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131 Cards in this Set
- Front
- Back
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Early Man:
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Used rituals of art, music, and dance as tools of healing and as a magical influence on the spirits.
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Egyptian Civilization:
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This culture believed that surroundings influenced health; they placed the sick in a stable, pleasant, stimulating environment that they believed would promote healing.
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Indian Culture:
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Advocated the use of toys and games; magic was used to heal.
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Chinese Culture:
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Gymnastics and massage and recreational activities were used in the treatment of illness.
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Greek Culture:
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Created Spas and temples and used diet, walks, exercise, and diversions (theatre, music, and art) to stimulate healing of both body and mind. Hippocrates made medicine and art. The patient was the center of treatment; records of illnesses were kept.
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Roman Civilization:
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Baths were used in a systematic way for relaxation, socialization, and hygiene; the first hospitals were created in this period; aquaducts carried clean water to the city.
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Mosaic Law:
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The first public health codes came about because of the Jewish emphasis on cleanliness and purification; hygiene and sanitation were built into codes, but illness was seen as a punishment linked to sin or being a member of the caste called sinners.
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Post Fall of Rome:
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As tribes conquered Roman territories, civilization became more primitive, treatment declined, and for some illnesses even became punitive. Sick persons were treated as outcasts; illnesses reflected primitive religious views of punishment for sins, and bodily torture was used to expel demons.
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Middle Ages:
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Confinement in dungeons for the mentally ill was used; death by disease and starvation was the chief way of dealing with illness; a “plague” mentality prevailed. Religious superstitions were prevalent.
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Enlightenment:
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A more rational approach to illness emerged in reaction to the perception that religious influences were wrong; a humanistic philosophy emerged coupled with the new belief that science could better answer questions than religion; Pioneer approaches to surgery and interest in the psychological aspects of illness marked this period. A return to treatment of the whole person and reforms in institutions were seen.
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Early 20th Century:
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The playground movement highlights this era with its foundation springing from a desire to right social ills of delinquency, child labor, and inner city congestion.
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World Wars I and II:
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As a result of these wars, the Red Cross initiated recreation to address morale; later, recreation workers were hired in government (VA) hospitals across the country giving impetus to a widely growing hospital recreation movement.
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The Modern Psychiatric Movement:
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In the early 1950’s, the Meninger’s opened a psychiatric hospital in Kansas and incorporated recreation as a treatment. Because they believed in the therapeutic benefits of recreation, their influence caused other hospitals to imitate their treatment approaches. Recreation became part of psychiatric services across the nation in the years that followed.
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Advocacy/information non-profit organizational development:
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Following our World Wars and the further development of the field of medicine, specific disabilities became more well known and researched. Over time, non-profit organizations were formed around most serious conditions/illnesses/disabilities, and today, these organizations offer educational services, links to resources, funding for research, lobbying for further legislative help, and a coordination/standardization of care.
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The Civil Rights Movement:
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A tumultuous period in our history, it defined minorities as equal members of society and gave impetus to other minority groups, including the disabled, who followed their lead. Protests, civil disobedience, boycotts, and political lobbying became the chief means for advocating change in laws.
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Disability Rights Movement.
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The Americans with Disabilities Act was a result of the efforts of disability advocates who followed the Civil Rights movement with one of their own
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The development of professional associations:
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Disability groups developed associations to gather political and social forces to educate the public, promote and fund research, and advance the cause of their group to politicians. At the same time, all health related disciplines formed associations of their own to promote their fields, advocate for research funding, obtain acceptance and visibility for their professions, and gather political strength. See your study guide for the history of the development of TR.
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Health Care Reform – the Clinton Presidency:
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One of the key factors in the election of a democratic president in 1992 was the health care crisis. Thirty nine million Americans were without insurance. It was the will of the American people that health care coverage be extended to more citizens and that health care become more efficient and cost-effective. Clinton was unsuccessful in creating a plan for national health insurance, and the private, for profit companies stepped in with managed care to fill the void.
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The managed care movement:
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When the Clinton effort to expand insurance coverage failed to gain the needed support, private industry stepped in an offered an alternative solution: competition based on a business model where costs of health care could be “managed” by companies that controlled both access to care and the delivery systems for care. The idea behind managed care was to create a gatekeeper who screened and referred clients to the most cost efficient systems of care; the purchase of materials in bulk for greater savings; the elimination of waste from unnecessary complex documentation, and a streamlining of services with a primary care physician at the center.
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Health Care in 2002:
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Even more Americans ended up without coverage than was the case in 1992 (up to 42 million by 2002). Managed Care was tried for overt ten years, and criticisms abound regarding its business practices. Health care costs continue to rise anyway, and the Republicans couldn’t pass a Patients’ Bill of Rights, negotiate an agreement on the right to sue health plans, contain costs, or increase coverage for more Americans. Many plans refused to accept elderly patients on Medicare. Some experts believe that another health care crisis is looming with the potential for wide-spread lack of access to insurance even by those who are now insured.
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Health care in 2009:
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True to predictions, the crisis in health care has spiraled to new heights with costs more excessive than predicted and data to suggest that even with all the spending done by the American health care system, Americans are way down on the list in terms of health indicators and twice as likely as Europeans to suffer chronic illness. Over 47 million Americans are without health insurance, a figure sure to rise with the increasing unemployment during this period of economic downturn. Obama’s election mirrors the outcry that surrounded Bill Clinton’s election, and it appears that with the selection of Tom Daschle as cabinet head of health and human services, the nation will begin using his framework to flesh out a plan for reforming health care in the U.S.
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The next 20 years:
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Americans will live longer due to advances in technology; the elderly population will increase in such large numbers compared to the middle aged population that sources to care for them will be strained; shortages in health care professionals will continue to mount; costs of care will continue to grow; ethics in gene therapy must be resolved; rehab. may be profoundly affected if spinal cord injuries can be reversed; if dementia treatment is advanced, or a pharmaceutical treatment for preventing common health risks associated with aging is developed, huge strides are possible.
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Generally, the more primitive the society, the greater
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the reliance on mythology and superstition for explanations of cause and effect of disability and illness.
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Historical records reveal a wide range of social and personal responses to disability and illness, from
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nurturing and acceptance to abandonment, euthanasia, and murder.
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The term “prosperity gospel” refers to
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that style of preaching/teaching that implies God’s blessing on those whose lives are without turmoil and who are wealthy and successful.
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misfortune is seen as
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God’s way of teaching a lesson or punishing individuals, no different from some ancient perspectives that seem primitive but get “re-dressed” periodically in newer, more acceptable forms.
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HIV was, for a time, viewed as
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a scourge from God for illicit sexual behavior.
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The term “scapegoating” comes from
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a primitive practice in ancient Israel of releasing a goat, in a ceremony, into the wilderness to carry away the sins of the community.
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when we say someone is a scapegoat, we are
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blaming them for the wrongdoing of others.
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the Hippocratic Oath is named for
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Hippocrates, the Greek physician, who helped lay the foundation for the study of medicine.
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The Hippocratic oath begins with
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“First do no harm,” a principle in health care that is embedded in the codes of ethics of health related professions.
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Some current statistics (2012) on the number of disabled individuals in the U.S
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55 million
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Some current statistics (2012) the number of uninsured Americans:
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48 million
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Americans spend more on
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health care per capita than any other nation,
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Americans have twice the rate of
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chronic illness in individuals over the age of 50.
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In 2012 we ranked in benchmarks of health
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37th out of 191 countries.
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The term, handicapped, came from
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the practice of begging with cap in hand in days when charity was the only way that people with disabilities could survive. Though most people don’t know this history, it is unclear if the word is offensive to everyone, especially since the term has been incorporated into architectural accessibility. It’s common usage may take the edge off the clearly demeaning origin of the term.
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Impairment is a rather neutral term that simply describes
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some physical or psychological feature that prevents ordinary action.
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Disability sounds very negative, since it implies
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an inability to do something, but it has been the most used and accepted term, even as terms like “differently abled” or “physically challenged” have tried to replace it. Perhaps these latter terms are just too cumbersome.
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Hermeneutics is a term that describes
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cultural beliefs or stereotypes that are loaded into words because of historical context.
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the word enable. When first used, the context was
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positive, as in “Our program is enabling John to become independent.” But the term became co-opted by those describing characteristics of addiction, and it took on a negative meaning, as in “Mary is an enabler.”
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Person first language is
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a semantic technique used when discussing disabilities to avoid perceived and subconscious dehumanization of the people ...Example: “This is my friend, Mary. She has spina bifida. “ You would not say, “I’ve got a spina bifida friend named Mary.”
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Avoid using terms that convey pity such as
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“John suffers from cerebral palsy.”
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Don’t overestimate the affect that
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an impairment might have on a person. It’s a common stereotype to believe that if a person has one disability, he/she must have multiple ones; it is common to see people with misperceptions about impairments (if someone is blind, he/she must also be cognitively impaired.)
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Avoid putting people with disabilities on
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a pedestal as if having a disability automatically qualifies them to be a role model.
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Avoid praying for someone with
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a disability to be cured because you assume they’d want divine intervention in order to be “normal.”
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The most common stereotype we face as professionals is
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the belief that people with disabilities are “broken,” and our job is to “fix” them.
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people with disabilities want access to
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information, adaptation and treatment that they deem necessary for a quality life, and an equal playing field so they have the same chances as the general population for a successful, enjoyable lives.
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The Rehabilitation Act of 1973
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P.L. 93-112 Comprehensive rehab. law; Section 504 prohibits discrimination in programs receiving federal funds; Established the Architectural and Transportation Barriers Compliance Board
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The Rehabilitation Act amendments of 1978;
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P.L. 95-602 Authorized funds for integrating handicapped persons into existing programs (including recreation) and provided rehab. services for the severely disabled
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Public Law (PL) 94-142 of 1975;
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P.L. 94-142 Granted all handicapped children the right to a free and appropriate education in the least restrictive setting
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The ADA – 1990
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The Americans with Disabilities Act Mandated access to all publicly used facilities, transportation, employment, services for the deaf
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IDEA - 1990;
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P.L. 101-476 IDEA: Individuals with Disabilities Education Act An update of P.L. 94-142 Enlarged the scope of service including recreation to children with disabilities
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The Mental Health Parity Act of 1996;
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The concept is affirmed, and Congress becomes pressured to pass a version that applies to all insurance providers; says that the coverage for mental illness must be in line with coverage for physical illness
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The 1997 amendments to IDEA;
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Amendments appear to emphasize parental rights; IEP requires more narrative input and feedback and less reliance merely on test scores.
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The Newborns and Mothers' health Protection Act of 1997;
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Says that mothers can remain in the hospital for 48 hours after childbirth if the physician verifiers need.
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HIPAA, the Health Insurance Portability and Accountability Act of 1997;
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Health Insurance Portability and Accountability Act Allows individuals to change jobs without losing benefits by extending insurance coverage for 18 months under a provision called COBRA.
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The Olmstead Act of 1999
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Mandates that states create plans to better assess people who are at risk for institutionalization, re-view how people are place in institutions, improve care in institutions, find better, more accessible community housing for persons with disabilities, and improve access to transportation; wants communities to identify funding sources for all of the above.
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The Wellstone Act of 2008
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Approved by both the senate and house and ready to be signed into law by President Bush before leaving office, this bill finally gives mental health care the respect it is due.
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PPACA (Obamacare) 2010
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The Patient Protection And Affordable Care Act resulted from health care reform legislation that was the Culmination of wrangling between the senate, House, and the President. It attempted to make Affordable health care available to more Americans, eliminate the pre-existing condition Condition, and extend coverage to adult children Up to age 26.
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1. What is the name of the program that provides health insurance for the very poor?
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Medicaid
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2. What is the name of the program that provides health insurance for the elderly and disabled?
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Medicare
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3. Which of these health care insurance plans charges a monthly premium for that service that is then deducted from a person’s social security?
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Medicare
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4. Under Medicare, which part pertains to drug coverage?
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Part D
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5. Under Medicare, which part covers outpatient surgery, rehabilitation and subacute care?
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Part B
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6. Under Medicare, which part pertains to in-patient surgeries hospital procedures?
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Part A
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1. The U.S. government created an agency that sets the regulations governing health care for the elderly and the poor. What is the name of that agency?
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CMS, the Centers for Medicare and Medicaid Services
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2. Under Medicare there’s a term that describes the way that in-patient services are categorized. Payment for surgeries and other hospital procedures, then, is determined by looking at these categories to see what Medicare is going to pay. What is this system called?
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DRG’s Diagnotistic related Groups or Usual and Customary Reimbursement rate (UCR)
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3. Under Medicare there’s a term that describes the same system only in out-patient and sub acute service settings. What is the name of this system?
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PPS, Prospective Payment System
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4. The above federal agency hands down regulations on nursing homes and each state interprets these regulations and then surveys all its nursing homes. What is the name of that agency that surveys nursing homes?
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State Department of Health
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5. The national non-profit organization that contracts with the US government to survey and accredit hospitals and clinics and focuses on the quality of the total facility is called:
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JCAHO - Joint Commission for the Accreditation of Healthcare Organizations
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6. Another surveying organization has stricter guidelines and accredits programs within hospitals and clinics. That organization is called:
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CARF The Commission for Accreditation of Rehabilitation Facilities
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7. States must now provide insurance for kids of families that are poor. That program is called:
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SCHIP – State Children’s Health Insurance Program
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8. If you lose your job, for 18 months you can keep your insurance coverage, though you have to pay the entire premium yourself. That regulation allowing you to keep your coverage is called:
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COBRA under the HIPAA law
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9. When a child with a disability is born and referred for services, a specialist comes to the home and works to create a special document called:
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IFP – Individualized Family Plan
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10. Once the child is old enough to attend preschool and beyond, the above becomes a document called:
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IEP - Individualized Education Plan
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11. How old is the child when these services end?
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22
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12. In the university setting, students with special needs can ask for accommodations. What regulation allows them to do that?
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Section 504 standards of the Rehabilitation Act of 1973
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Medicare and Medicaid were created by
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the Older Americans' Act of 1965.
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what agency of the federal government runs both Medicare and Medicaid
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CMS, the Centers for Medicare and Medicaid Services
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how are Medicare and Medicaid different:
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One covers the elderly and the other covers the poor and children of parents who earn below a certain income level
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MEDICARE : This is government supported health insurance for
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the elderly (over age 65) and the totally disabled of any age following a waiting period.
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Medicare requires that the person
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pay a premium deducted from the person’s social security (SS) if they are elderly, or supplemental security income (SSI) if they are disabled, or paid out of pocket by those who reach 65 before they claim SS benefits.
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parts of Medicare: A =
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in-patient care;
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parts of Medicare: B =
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outpatient and rehabilitation services;
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parts of Medicare: C =
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supplemental care (more than basic Medicare available with an additional fee but not required);
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parts of Medicare: D =
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pharmacy coverage
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Each part has
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a limitation on days or amount of service and/or a deductible that must be paid out of pocket by the recipient before help begins.
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Medicare and You, is
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a publication that is updated annually, can be accessed on the internet, and explains everything that one needs to know about the program.
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Medicare’s regulations are
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sent to each state which then writes up a publication of standards that have to be put into action by all agencies serving medicare patients.
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Medicare has determined that they will pay for procedures via
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a Usual and Customary Reimbursement rate (UCR)
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under Medicare, part A, in-patient care, there is
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a system for determining how much money and services a hospital will receive for treatment.
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DRGs are
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diagnostic related groups
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DRG’s bundle services by
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illness category. This was done to get control of spiraling costs of surgeries and very different charges from different hospitals.
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What resulted from the DRG’s system of payment
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It created one national set of fees.
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The creation of one set of national fees applies to Medicare PartB, outpatient surgery and rehabilitation services. T or F
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True
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The payment system for Medicare part b is called
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PPS, Prospective Payment System, and standardized the payment of services by illness.
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T or F All Physicians accept Medicare?
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False Some physicians won’t take Medicare patients because they won’t accept a UCR that is less than what they want paid to them for procedures.
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What is the new Health Care Reform Act (2010) set to reduce
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medicare payments to physicians, something that may cause protests as it unfolds.
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SSI, supplemental security income, is granted to
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those who are permanently medically disabled from either a mental or physical condition.
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If eligible for SSI, a person is
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automatically enrolled in Medicaid.
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MEDICAID: Is available as a health care resource to
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those who are very poor and to children of parents who earn a certain annual level of income determined by the number of children and salary of the parents.
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Medicaid will pay for
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long term nursing home care (LTC) after patients have exhausted most of their personal income. It can even put a lein against the home of an elderly person so that it can collect from the sale of a home later. Medicaid will pay for home health or home attendant care, a preferred avenue of care for most patients. Medicaid will also issue “waivers” to agencies to pay for care that is cheaper than residential care (assisted living, day care). Medicaid has its own set of regulations that are increasingly more and more stringent, making it very difficult for profit or non-profit agencies/ programs to help provide services. The State Health Dept. oversees inspection of service providers.
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Why are churches exempt from the ADA and don't have to be accessible
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because of the separation of church and state,
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Who does IDEA provide services to
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newborns, children, and adults with developmental disabilities.
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What does IDEA stand for
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Individuals with Disabilities Education Act
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An IFP is
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an individualized Family Plan
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When a child is very young, before school age, he/she sees a specialist who creates
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an IFP, an individualized Family Plan to outline care and services needed.
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At the age of 3, when it is time for pre-school, the child gets an
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IEP, an individualized Education Plan
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An IEP is revised and follows him/her until
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age 22.
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An IEP is
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an individualized Education Plan
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What is COBRA
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an opportunity to pay for your insurance coverage once you've lost your job. You can do it for 18 months, but you will be paying the premium without help from an employer. It's supposed to help hold you over until you get another full time job and insurance benefits from the new employer
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What does HIPAA initials stand for
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The Health Insurance Portability and Accountability Act developed in 1997
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What is HIPAA
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the law that provides COBRA coverage.
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HIPAA is also
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the law that instituted stringent privacy rules for hospitals and insurers.
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What is SCHIP
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the State Children's Health Insurance Program.
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What is the history of SCHIP
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Obama signed legislation, twice vetoed by Bush, providing extended Medicaid coverage to children of the working poor, those not poor enough to all qualify for Medicaid, but not wealthy enough to pay for it themselves or not insured by the parents' employers.
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the Architectural Barriers Act of 1968 was the precursor to what current law
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the ADA.
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The ABA of 1968 was the first time that
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any accessibility standards were mandated. But the standards only applied to buildings built with federal funds. It would be five years before compliance was mandated, and 22 years before all buildings (except churches) had to be accessible.
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Section 504 standards of the Rehabilitation Act of 1973 mandate adaptations for persons
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accessing publicly funded venues (schools, playgrounds, etc.)
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At all universities, what section of the Rehab act of 1973 requires accommodations for students in classrooms.
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Section 504
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there are two main agencies, both non-profits, that contract with the U.S. government to oversee or “accredit” hospitals and other health care facilities.
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JCAHO and CARF.
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What do the initial JCAHO stand for
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The Joint Commission for the Accreditation of Healthcare Organizations
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What is the focus of JCAHO
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This non-profit agency has long been under contract with the Federal government to inspect hospitals and acute care facilities, rehabilitation facilities, and psychiatric and addictions facilities. This organization accredits the entire facility and sometimes goes on “focus surveys” if they are concerned about a particular topic, like infection control, or safety. Hospitals have a general but not specific time for their visit, and the visit can last for days. Sometimes hospitals do a “mock survey” to get ready for an inspection.
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What do the initals CARF stand for
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The Commission for the Accreditation of Rehabilitation Facilities
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What is the focus of CARF
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a non-profit that takes a slightly different approach to accreditation. It has tougher standards, it is unique in that it accredits programs within an agency rather than the whole agency.
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Which Rehabilitation accreditation agency has the tougher standards
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CARF
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Which rehabilitation accreditation agency will accredit a program within an agency rather than a whole agency
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CARF
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Which agency will honor the others inspection and not come out to do their own
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JCAHO
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Some insurance companies favor
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CARF accredited agencies, so that’s the incentive for agencies to reach for higher standards demanded by CARF
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Every state also has an oversight office for health care facilities, particularly for nursing homes, assisted living, and group homes. What state agency is the oversight office part of
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each State Department of Health.
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