Ethical and Policy Factors in Care Coordination

Ethical and Policy Factors in Care Coordination

Hello, and welcome to this PowerPoint presentation. In this presentation, we will discuss how government policies affect the coordination and continuum of care for patients with Alzheimer’s disease and other forms of dementia living in nursing homes. We will also look at the ethical questions raised by these policies and the impact of the nursing code of ethics in coordinating care for this patient group.

Introduction

Due to the progressive nature of Alzheimer’s disease (AD) and other forms of dementia, persons with these diseases will have more care demand and require support as their symptoms worsen. Nursing homes with dementia special care units play a role in caring for these patients. Their roles to these patients include providing physical care and ensuring the emotional well-being of their residents. The significance of these care institutions in handling vulnerable community members underpins the need for oversight by authorities. Several federal and state policies and regulations have been developed to ensure checks on the operationalization of nursing care homes across the country.

How Governmental Policies Affect the Coordination of Care

Federal and state policies considerably impact care coordination and administration in nursing care homes. These policies are mainly targeted at improving operational efficiencies with the overall goal of improving the clinical outcomes of patients in these care facilities and preserving their rights. The Medicare and Medicaid programs are policies that influence the level and quality of care provided in these facilities by directing funding through reimbursements to these institutions. The Health Insurance Portability and Accountability Act (HIPAA) is another important policy targeted at securing protected health information for residents of nursing homes. Other important policies affecting nursing homes include the Nursing Home Reform Act (NHRA), which creates guidelines for nursing homes to abide by, and Resident Rights in Nursing Homes (RRNH), which outlines the rights of nursing home residents.

An Example of an Influential Policy: HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) is an example of a healthcare policy that affects the coordination and continuum of care in nursing homes by directing the handling of health data. It is targeted at protecting patients’ right to privacy. Since most nursing homes are covered entities under HIPAA, they are subject to HIPAA’s regulations for protecting patients’ privacy. HIPAA provides guidelines that help covered entities secure protected health information (PHI) to mitigate legal issues that may arise if breaches occur. These regulations require that all nursing homes abide by their state’s privacy rules, put policies to protect PHI, train staff on HIPAA compliance, and dispose of PHI correctly. Compliance with these regulations helps businesses avoid litigations.

Policy Provisions that Raise Ethical Questions or Dilemmas for Care Coordination

Several federal and state policies sometimes raise ethical questions for care coordination in nursing homes. HIPAA regulations on securing PHI and informed consent may sometimes raise ethical questions in dementia care in nursing homes. This is because patients with these illnesses have cognitive decline, with memory impairment and poor comprehension being apparent. The hospital readmission reduction program (HRRP) under the Medicare value-based system may also raise an ethical question in dementia care. This is because dementia is a progressive disease with limited identifiable prognostic trajectory markers. Readmission for these patients is inevitable (Gai & Pachamanova, 2019). The Resident Rights in Nursing Home Act may also raise an ethical question in nursing homes. While this act requires nursing homes (NH) to preserve residents’ rights, some residents may cease eating or taking medications. This may present a specific challenge in preserving these patients’ rights to dietary services and medications.

Implications and Consequences of Specific Policy Provisions

Policies that raise ethical questions have several implications and consequences for nursing homes. They may influence funding to these care institutions, result in damaged reputations, and attract fines to the NH. Breaches in HIPAA regulations and the provision of privacy and informed consent may sometimes cause a care institution to ruin its reputation. Breaches in patient privacy may also attract fines and other legal measures (Moore & Frye, 2019). Non-conformation to the HRRP under Medicare value-based systems may also reduce reimbursements to a care institution, which may reduce its operational efficiency. Nursing homes must,, therefore, conform to these policy provisions to avoid these consequences.

Impact of the Code of Ethics for Nurses on the Coordination and Continuum of Care

The nursing code of ethics outlines ethical codes that guide nursing practice and help them in their clinical decision-making processes. The major ethical provisions of the nursing code of ethics outlined by the American Nursing Association are beneficence, non-maleficence, justice, and autonomy. These provisions may help nurses navigate the ethical challenges raised by various policies during the coordination and continuum of care (Jakobsen et al., 2017). Beneficence requires that they promote the welfare of their patients, while non-maleficence requires that they do no harm to their patients. Lastly, autonomy requires them to allow their patients to make decisions on their treatment. These provisions will enable them to make decisions that are in the best interest of their patients.

Factors Contributing to Health

Several factors contribute to health. These factors are mainly categorized into individuals’ behaviors and characteristics, physical environment, and social and economic environment. The social and economic environment encompasses factors such as income, educational levels, social support networks such as family, and access to health. The context of the physical environment includes factors such as access to clean water and air, safe housing, workplaces, infrastructure, and others. Lastly, individual behaviors and characteristics are factors of self that contribute to diseases and illnesses, such as smoking, excessive alcohol consumption, and health-seeking behavior. All of these factors interplay in various illnesses and human suffering.

Factors Contributing to Health Disparities and Access to Care

Health disparity refers to the identifiable variations in health and healthcare between communities and groups. Several factors contribute to health disparity. Some of these factors include health behaviors, community characteristics, gender, race and ethnicity, poverty, and the physical environment. Access to care is another area that remains a topic of discussion in many American societies. Factors that influence access to care include poverty, geographical proximity to care centers, race and ethnicity, disability status, age, sex, and language spoken. These factors inform an individual’s ability to utilize care services and have been implicated in poor access to care among many American communities.

Social Determinants of Health Identified in Healthy People 2020

Social determinants of health (SDOH) are non-medical factors that influence health outcomes. Healthy People 2020 outlines the social determinants of health grouped into five domains. The first domain is economic stability, which encompasses employment, food insecurity, and others. Education entails access to quality education, enrollment in higher education, and others. Another domain is the social and community context that encompasses social cohesion, civil participation, and others. The health and healthcare domain entails health literacy, access to quality healthcare, and access to primary care, while the neighborhood and built environment domain entails crime and violence, access to healthy foods, and others (SDOH, 2020).

Key Ethical and Policy Issues Affecting the Coordination and Continuum

Several ethical and policy issues affect the coordination and continuum of care. The lack of resources and informed consent are some ethical challenges in nursing homes. The nursing code of ethics guides the clinical decision-making process in nursing homes, thus helping nurses in these facilities navigate these challenges. Lack of resources is another challenge that may affect operational efficiencies in these care institutions. Policy issues affecting nursing homes are those on preserving patients’ rights and funding these institutions. HIPAA and Residents Rights in Nursing Home Act aims to protect the privacy of residents of these care homes, and Medicare programs fund these institutions through reimbursements.

Summary

In summary, nursing homes maintain significance in providing physical care and emotional support for patients with AD and other forms of dementia. They are, however, subject to policy regulations. Policies such as HIPAA and the Residents Rights in Nursing Home Act play a role in providing the necessary oversight in these care institutions. These policies aim to direct funding and protect the welfare of residents of these institutions. The implementation of these policies may, however, raise ethical questions such as informed consent. Nonetheless, the nursing code of ethics may help nurses navigate these ethical challenges.

References

Bastani, P., Mohammadpour, M., Samadbeik, M., Bastani, M., Rossi-Fedele, G., & Balasubramanian, M. (2021). Factors influencing access and utilization of health services among older people during the COVID − 19 pandemic: A scoping review. Archives of Public Health, 79(1). https://doi.org/10.1186/s13690-021-00719-9

Gai, Y., & Pachamanova, D. (2019). Impact of the medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4645-5

Jakobsen, R., Sellevold, G. S., Egede-Nissen, V., & Sørlie, V. (2017). Ethics and quality care in nursing homes: Relatives’ experiences. Nursing Ethics, 26(3), 767–777. https://doi.org/10.1177/0969733017727151

Moore, W., & Frye, S. (2019). Review of HIPAA, part 2: Limitations, rights, violations, and role for the imaging technologist. Journal of Nuclear Medicine Technology, 48(1), 17–23. https://doi.org/10.2967/jnmt.119.227827

SDOH. (2020, March 16). Healthy People 2020 – social determinants of health. NCEAS. Retrieved December 19, 2022, from https://sdoheducation.org/resources/ealthy-people-2020-social-determinants-of-health/

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Assessment 2 Instructions: Ethical and Policy Factors in Care Coordination
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Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10-12-slide, 20-minute presentation with audio intended for that audience. Create a detailed narrative script or speaker notes for your presentation, 4-5 pages in length.

Introduction
As coordinators of care, nurses must be aware of the code of ethics for nurses and health policy issues that affect the coordination of care within the context of the community. To help patients navigate the continuum of care, nurses must be proficient at interpreting and applying the code of ethics for nurses and health policy, specifically, the Affordable Care Act (ACA). Being knowledgeable about ethical and policy issues helps ensure that care coordinators are upholding ethical standards and navigating policy issues that affect patient care.

This assessment provides an opportunity for you to develop a presentation for a local community organization of your choice, which provides an overview of ethical standards and relevant policy issues that affect the coordination of care. Completing this assessment will strengthen your understanding of ethical issues and policies related to the coordination and continuum of care and will empower you to be a stronger advocate and nursing professional.

It would be an excellent choice to complete the Vila Health: Ethical Decision-Making activity prior to developing the presentation. The activity provides a helpful update on the ethical principles that will help with the success of this assessment.

Preparation
Your nurse manager at the community care center is well-connected and frequently speaks to a variety of community organizations and groups. She has noticed the good work you are doing in your new care coordination role and respects your speaking and presentation skills. Consequently, she thought that an opportunity to speak publicly about contemporary issues in care coordination would be beneficial for your career and has suggested reaching out to a community organization or support group to gauge their interest in hearing from you as a care center representative on a topic of interest to both you and your prospective audience.

You have agreed that this is a good idea and have decided to research a community organization or support group that might be interested in learning about ethical and policy issues related to the coordination of care. Your manager has suggested the following community organizations and support groups but acknowledges that the choice is yours.

Homeless shelters.
Local religious groups.
Nursing homes.
Local community organizations (Rotary Club or Kiwanis Club).
To prepare for this assessment, you may wish to:

Research your selected community organization or support group.
Review the Code of Ethics for Nurses With Interpretive Statements and associated health policy issues, specifically the ACA.
Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
Allocate sufficient time to rehearse your presentation before recording the final version for submission.
Recording Equipment Setup and Testing
Check that your audio speaker and PowerPoint software are working properly. You can record audio directly to your slides using PowerPoint or other presentation software.

Note: Technical support about the use of PowerPoint, including voice recording and speaker notes, can be found on Campus’s Microsoft Office Software page.

If using Kaltura, refer to the Using Kaltura tutorial for directions on recording and uploading your presentation in the course room.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.

Instructions
For this assessment:

Choose the community organization or support group that you plan to address.
Develop a PowerPoint with typed speaker notes (the script for your voice recording) and an audio voice-over recording intended for that audience. Video is not required.
Note: PowerPoint has a feature to type the speaker notes directly into the presentation. You are encouraged to use that feature, or you may choose to submit a separate document. See Microsoft Office Software for technical support about the use of PowerPoint, including voice recording and speaker notes.

For this assessment, develop your presentation slides and speaker notes, then record your presentation. You are not required to deliver your presentation to an actual audience.

Presentation Format and Length
You may use PowerPoint (recommended) or other suitable presentation software to create your slides and add your voice-over. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues.

Be sure that your slide deck includes the following slides:

Title slide.
Presentation title.
Your name.
Date.
Course number and title.
References (at the end of your presentation).
Your slide deck should consist of 10–12 slides, not including a title and references slide with typed speaker notes and audio voice-over. Your presentation should not exceed 20 minutes.

Create a detailed narrative script for your presentation, approximately 4–5 pages in length.

Supporting Evidence
Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation. Include your source citations on a references page appended to your narrative script.

Grading Requirements
The requirements outlined below correspond to the grading criteria in the Ethical and Policy Factors in Care Coordination Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

Explain how governmental policies related to the health and/or safety of the community affect the coordination of care.
Provide examples of a specific policy affecting the organization or group.
Refer to the assessment resources for help in locating relevant policies.
Be sure influential policies include the Health Insurance Portability and Accountability Act (HIPPA).
Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.
What are the implications and consequences of specific policy provisions?
What evidence do you have to support your conclusions?
Assess the impact of the code of ethics for nurses on the coordination and continuum of care.
Consider the factors that contribute to health, health disparities, and access to services.
Consider the social determinants of health identified in Healthy People 2020 as a framework for your assessment.
Provide evidence to support your conclusions.
Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included for a proficient score; both speaker notes and the audio voice-over are included for a distinguished score.
Present a concise overview.
Support your main points and conclusions with relevant and credible evidence.
Additional Requirements
Before submitting your assessment, proofread your presentation slides, and speaker notes to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your presentation.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 4: Defend decisions based on the code of ethics for nursing.
Assess the impact of the code of ethics for nurses on the coordination and continuum of care.
Competency 5: Explain how healthcare policies affect patient-centered care.
Explain how governmental policies related to the health and/or safety of a community affect the coordination of care.
Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.
Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over is included.