Levels of Healthcare: Homecare to ICU

Many people appear truly confused about the various levels of healthcare available to people when they get sick. This blog will help end some of that confusion.

Diagnosis

Providers
There are several options for diagnosing medical problems. The best approach is to have a long-term relationship with a healthcare provider, whether it be a physician, a nurse practitioner or a physician’s assistant. Doctors are the most experienced having gone to medical school for 3 years then several more years of residency within their area of expertise.

Nurses spend 4 years in nursing school and then another 3 years learning how to diagnose and treat common problems. Physician assistants graduate from college from a variety of backgrounds and then spend 2 to 3 years of medical training.

Facilities
Clinics are also another option for care. You may or may not see a different healthcare provider for each visit and are generally more economical.

 Urgent Care centers are satellite emergency rooms that can handle most common, easy to treat problems and are generally cheaper. Hospital Emergency (ER) rooms provide more comprehensive and challenging care. Some ER’s are trauma centers with staff available for very serious acute conditions.

 For rare and unusual medical problems, it’s wise to seek care in a specialty center generally found within larger urban areas. They have physicians who’ve spent a vast number of years dealing with unique, uncommon health concerns.

Treatment
Day Surgery
Many day surgery centers are popping up throughout the US. They typically handle relatively healthy people who need a surgical procedure and is not expected to have serious complications. The operation and discharge usually occur on the same day. It’s much more economical in many cases than a major hospital operating center. However, a hospital is the best place for a major operation needing additional backup or someone who may have serious complications or possible delayed recovery.

Recovery Room 
Whether in a Day Center or Hospital patients will need to recover from the anesthesia while being monitored following surgery. Once awake and stable they’re moved to a holding area in the Day Surgery facility or a surgical floor in the hospital.

 Acute Care
Regular Floor\
When you think of being hospitalized most have visited someone on what’s known as the regular floor. Stable patients who still need registered nurse monitoring and care are admitted until ready for discharge home. The patient may stay overnight or for a few days depending on their procedure and health status.

 Telemetry Unit
This unit is needed when someone has a heart issue or irregular rhythm problem, and needs monitored while recovering. They are generally otherwise stable patients.

Step-Down Unit
Patients discharged from a critical care unit are often sent to the Step-Down unit where there are fewer patients for each registered nurse. These patients are generally monitored for heart irregularities and respiratory complications. They require greater care than the telemetry floor nurses could provide.

 Critical Care (ICU/CCU)
Registered nurses in critical care units generally have 1 or 2 patients who may be very unstable. Some surgical patients following complicated operations may be sent to ICU for monitoring for dangerous complications in the immediate post-op period.

Chronic Care
Long In-house Hospital Care
Some hospitals have a unit for patients with longer term care needs but are not stable enough to be discharged to another center. They work much like a rehabilitation center but with more closely monitoring and nursing care.

 Rehabilitation Care Centers
These centers provide a few weeks or months of nursing care while someone recovers from a medical problem.

Assisted Living Care
Another name for a nursing home is often assisted living. A registered nurse or a technician is available for medication dispensary and nursing support. The patient isn’t able to care for themself at home. All meals are provided, and staff can help with bathing, etc. Some individuals don’t require heavier medical care but need the assistance with meals and medication support.

Independent Living Care
These facilities offer meals while the individual lives in more of an apartment environment. Medication support can be arranged. Rides for activities and social events are available since most people are unable to drive.

In-Home Healthcare Options
Most people would rather remain in their home for as long as possible. Visiting or home healthcare nurses make home visits to assess patients, change dressings, draw blood or even give IV medications. Most insurance covers their time for a while. Physical therapists also make home visits to provide physical therapy. Private companies may supply nursing aide staff for basic care, housekeeping and simple errands.

Palliative Care
Most people are unaware of the palliative care program provided through hospice. When one is suffering from chronic pain nearing the end-of-life palliative nurses can be extremely helpful. They evaluate all medications and work with a doctor to prescribe overall care that improves the quality of life.

My frail mother suffered from anxiety attacks and explosive diarrhea related to her dementia a year before she died. Sometimes she refused to take any medications to help unless a family member was present. The palliative nurse ordered a cream to reduce her anxiety and a Kefir drink for the diarrhea which greatly improved her life.

Hospice
For someone in the last chapter of their life, the hospice team provides excellent care to ease the suffering. The nurses are also highly trained to assist families in the grieving process as well.

On A Personal Note:
The healthcare system in the United States is certainly complicated but there are a few things you can do to simplify your situation. First, the biggest mistake people make is not getting a second opinion when solutions to a problem aren’t getting resolved. Healthcare providers are human. The really good ones that I know are not threatened by another opinion. They welcome it! They want answers to your problem as well.

Secondly, keep escalating the healthcare providers until you get resolution. Reach out to the larger medical centers where they are experienced at dealing with what I call the weird and the rare.

My mother-in-law had miserable abdominal hives for 6 months. None of the specialists within her city could find a cause despite innumerable tests. It was definitely a weird and rare phenomenon. We took her to the Mayo Clinic in Rochester, Minnesota. In one day, she saw a dermatologist for the rash, a hematologist for the dangerously high platelets and a neurologist for her dementia. The high platelets were causing the rash. A new medication reduced them, and the rash disappeared. Her brain scan showed extensive damage and the cause of her frequent accidents. He gave her the news about no further driving.

Finally, while we all want to have our surgery the closest to home as possible, sometimes that makes life more complicated. Smaller hospitals and day surgery centers are staffed for common procedures and problems. But if you are one of those weird and rare situations you may be better off doing more homework and getting your procedure done at a major medical center where they have more experienced staff to care for your strange problem.

May God bless you with wisdom on finding excellent providers to care for you and yours…

If anyone of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him (James 1:5)

I’m a Christian nurse who helps people navigate the murky waters of healthcare.

Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.