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Ethical and Policy Issues that Affect the Coordination of Care

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Ethical and Policy Issues that Affect the Coordination of Care

Slide 1: Title page

Slide 2: Objectives

Hello, I am (Name). This presentation will address various modern issues experienced in

the coordination of care in nursing homes. I will also discuss how particular government

regulations associated with health affect care coordination in these homes. The ethical questions

and dilemmas arising from specific local, state, and national policy provisions are also among the

topics covered in today's presentation. Other issues include the code of ethics for nurses and how

it influences coordination and continuum of care and the social determinants of health. To

analyze the social determinants of health, I will use Healthy People 2020 as a primary

framework.

Slide 3: Care Coordination

According to the Agency for Healthcare Research and Quality, coordination refers to

organized procedures for care among caregivers and patients to achieve the desired healthcare

outcomes. Proper care coordination comprises comprehending the patient preferences, needs,

and adequate communication among involved parties for higher quality outcomes (Lin et al.,

2017). There are two ways of achieving coordinated care, through the use of specific care

coordination activities and broad care coordination approaches. Examples of comprehensive care

coordination techniques include patient-centered medical home and care management. Particular

care coordination activities include the assessment of patient needs and goals, the development

of pro-active care plans, and the establishment of accountability.

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Slide 4: Government Policies

In the United States, the government improves care coordination in various ways, such as

establishing federal actions to enhance patient safety and reduce medical errors. Some of the

federal actions include the provision of healthcare, the regulation of healthcare markets, and

ensuring access to adequate care for vulnerable populations. The government also monitors

healthcare quality and plays a role in developing and analyzing health practices and technology.

The United States government established the Affordable Care Act (ACA) on June 22, 2010.

ACA has ensured care continuum and coordination in various ways, such as protecting

individuals with pre-existing illnesses from discrimination.

Slide 5: Specific Government Policies

Nursing homes are designed to provide the required long-term care to their patients

beyond the traditional hospital setups. They are supposed to ensure that a patient lives well and

recovers, albeit their old age or health conditions. Specific policies impacting the coordination of

care in nursing homes include the Medicaid payment rate and the Omnibus Budget

Reconciliation Act of 1987. The Medicaid payment rate influences the level of resources

available at the nursing home (Alexander & Schnell, 2017). Medicaid provides financially

disadvantaged individuals access to nursing home services by reimbursing these homes for their

care. In the United States, Medicaid programs offer at least 50% of all the nursing homes

compensations with a population of at least 70% recipients of all bed days. Various studies have

also associated Medicaid payment rates to resident outcomes, although a direct link has not been

created between the changes in those rates to influence care.

Slide 6: Government Policies Continued

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Since the development of the Omnibus Budget Reconciliation Act of 1987, there has

been an increase in regulatory oversight. This act set forth other provisions for Medicaid and

Medicare sections associated with developing standards for care in the nursing home set up.

These include on-sight inspection and certification of all facilities, public reporting of facility

quality measures, and a mandatory assessment of residents. A significant condition required that

the nurse aid get trained among other provisions such as 75 hours for nurse aide training,

competency assessment for nurse aids both already providing care and the newly introduced, and

a registry for the nurse aids (Popp, 2018). These requirements impact healthcare coordination in

nursing homes regarding an increased responsibility of the individual nurse or the entire nursing

home in ensuring effective implementation of these provisions.

Slide 7: The Health Insurance Portability and Accountability Act (HIPPA)

The Health Insurance Portability and Accountability Act was founded to ensure privacy

and maximum protection of health information and develop confidentiality systems beyond and

within healthcare setups. Based on the fact that HIPPA aims at protecting the public’s well-

being, it has led to a general increase in care coordination in nursing homes (Brief, 2018).

Security risks under the act include potential hackers and potential virus infection. Under the

HIPPA act, all the employees undergo annual training with compulsory updates.

Slide 8: National, state, and local policy provisions

According to the Agency for Healthcare Research and Quality (AHRQ), the national and

state policy provisions that raise dilemmas and ethical questions for care coordination include the

National Conference of State Legislatures (NSCL) drug policy. It causes high costs of

prescription drugs despite the legislation establishment of generic medicines with spending of up

to 20% of Medicaid funds on drugs. There is also the ethical question on access to healthcare and
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wellness by poor people, the criteria for qualification to subsidized care, and whether they should

acquire medical attention. There is also the national ethical issue on medical access for

employees with no or limited health insurance coverage. These issues have raised various moral

problems with employees lacking a chance for appropriate health care (Ferrell et al., 2018). For

instance, the Affordable Care Act sets an opportunity for health insurance coverage. However,

based on its complexity and annual revisions, the plan remains unfair with extremely unworkable

subsidies.

Slide 9: The impact of the code of ethics for nurses on the coordination and continuum of

care

The nursing code of ethics serves as a guide; the nurses use it as a standard for ethics in

their performance. There are four stated fundamentals in the code of ethics, including preventing

illnesses, alleviating suffering, promoting health, and restoring health. Through the code of

ethics, nurses are obligated to conduct evidence-based practice and respect the patients

unrestricted of gender, race, age, and creed. The code requires the nurses to only use judgment in

sharing a patient's confidential information; this promotes care coordination. The code of

conduct also requires that nurses illustrate professional values such as integrity and compassion,

all of which ensure the continuum and coordination of care.

Slide 10: Factors that Contribute to Health, Health Disparities, and Access to Services

Health disparities may be defined as the lack of equality in the quality of health, health

outcomes, and healthcare experienced by various individuals based on race, social aspects,

environmental and economic factors. Health is influenced by physical, environmental, and

behavioral characteristics, among other elements such as genetics, social factors, and medical

care. Access to health services is limited based on the language used for communication,
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geographical region of residence, sex, age, disability status, and race (Stormacq et al., 2019). In

the case of disability, the disabled often demonstrate worse overall health status, have a higher

prevalence for poor lifestyle choices such as smoking, and are more impoverished. These

individuals may also experience limited access and disparities based on provider discrimination

and inefficient communication with providers.

Slide 11: The Social Determinants of Health Identified in Healthy People 2020

According to Healthy People 2020, there are five aspects used in determining health.

These aspects impact each individual based on a category; education, economic stability, health

and healthcare, social and community context, neighborhood, and the established environment

factors. Financial stability, in this case, comprises elements such as housing and poverty, which

have also been proven by other studies to impact health. Education contributes to securing better

and higher-paying jobs, hence access to health insurance and better care (Sokol et al., 2019).

Health is also among the social determinants, and it impacts an individual's health based on their

health literacy and access to primary care. In a neighborhood with high crime and poor

environmental conditions, it is more likely that the residents will suffer from poor health; crime

is associated with poverty. Social cohesion causes better health outcomes by avoiding

marginalization and disparities; all the members achieve welfare.

Slide 12: The Impact of the Code of Ethics on Care Coordination

The code of ethics guides nurses on morals and reminds the nurses of their commitment

to society. It also illustrates the best conduct for the nurses and develops a legal standard for the

profession. Care coordination is also achieved based on the code of conduct as it also provides a

basis to attain compliance requirements for nursing. The code requires nurses to practice
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evidence-based and accord respect to the patients. The code of ethics also encourages nurses to

respect human rights such as the right to choice and cultural rights hence eventual proper care

coordination.
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Slide 13: References

Alexander, D., & Schnell, M. (2017). Closing the gap: The impact of the Medicaid primary care

rate increase on access and health. https://ssrn.com/abstract=2987730

Brief, A. D. L. (2018). The Health Insurance Portability And Accountability Act.

https://www.ncbi.nlm.nih.gov/books/NBK500019/

Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National consensus project

clinical practice guidelines for quality palliative care guidelines. Journal of palliative

medicine, 21(12), 1684-1689.

https://www.liebertpub.com/doi/abs/10.1089/jpm.2018.0431

Gusmano, M. K., Maschke, K. J., & Solomon, M. Z. (2019). Patient-centered care, yes; patients

as consumers, no. Health Affairs, 38(3), 368-373.

https://doi.org/10.1377/hlthaff.2018.05019

Lin, M. P., Blanchfield, B. B., Kakoza, R. M., Vaidya, V., Price, C., Goldner, J. S., & Schuur, J.

D. (2017). ED-based care coordination reduces costs for frequent ED users. Am J Manag

Care, 23(12), 762-766. Dec;23(12):762-766. PMID: 29261242.

Popp, L. (2018). The Nursing Home Reform Act of 1987: A Policy Analysis. California State

University, Long Beach. ISBN 0438179366, 9780438179363

Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., ... & Shanahan, M.

(2019). Screening children for social determinants of health: a systematic

review. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-1622

Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the

relationship between socioeconomic status and health disparities? Integrative

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review. Health promotion international, 34(5), e1-e17.

https://doi.org/10.1093/heapro/day062