N108: Transition to the Registered Professional Nurse Role Study Guide Classification According to Ownership The second method of classifying healthcare agencies is according to ownership. Agencies may be classified as governmental (public) or proprietary (private profit making) or nonprofit. An important consideration is that all healthcare agencies, regardless of their ownership, need to have income sufficient to meet the costs of the care provided, as well as to maintain and upgrade the equipment and physical facilities that support the care. No agency can continue to exist if it is not adequately funded. • Government : Local, county, state, or federal (includes military and veteran facilities) • Nonprofit organization : Religious and philanthropic groups and community organizations • Proprietary organizations : Stockholders own a share, and the agency is managed for the benefit of stockholders • Sole proprietorship: Individual person/family owns and operates the agency Classification According to Type of Care Healthcare agencies may also be classified according to the type of care provided. Many agencies provide more than one type of care. The type of care is based on the acuity, which is the seriousness of the illness and the rate of change that is occurring. Higher acuity signifies that the illness is more serious and/or changing more rapidly and will demand a greater intensity of services. • Acute care: An illness needing immediate hospitalization and provision of diagnostic tests, treatments, and/or monitoring that requires the continuous availability of skilled nursing care. Goals are recovery from the illness or injury and restoration to the previous level of function. • Long-term acute care: An illness that has stabilized but still needs the ongoing provision of highly skilled care, such as ventilator support or care for major unhealed wounds. Goals are correction of the underlying problem and an eventual move to a less skilled level of care. • Subacute care: This is care provided after initial recovery from an acute illness needing inpatient care. Skilled care is needed, but on a less frequent and intense basis. The goals are to restore function for patient discharge to home. It is usually provided on a separate unit in an acute care hospital. • Skilled nursing care: This is care provided after initial recovery from an acute illness needing inpatient care or following subacute care. Skilled care is still needed, but on a less frequent and intense basis. The goals are to restore function for discharge to home. It is usually provided in a nursing home. • Custodial care: Care is needed because of a functional deficit in ADLs rather than due to the illness itself. Care may be provided in an assisted living setting, an adult family home (board and care home), or a nursing home. The goals of care are maintenance of functioning and maximum wellness in the face of disability. • Hospice care: This care is provided for the terminally ill in the last six months before expected death. Care may be provided in the home or an inpatient hospice. Goals are patient autonomy and relief of symptoms while supporting the patient toward a peaceful death and the family and others in their mourning processes.