Ethical and Policy Factors in Care Coordination

Ethical and Policy Factors in Care Coordination

Hello everyone. I want to take you through the ethical and policy factors related to care coordination. We must learn these factors to uphold ethical standards and navigate various policy issues affecting patient care.

Presentation Outline

The presentation outline is as follows. We will first look at how government policies related to the health and safety of a community affect the coordination of care. We will then identify the national, state, and local policy provisions that raise ethical dilemmas for care coordination. An assessment of the impact of the code of ethics for nurses on coordination and continuum of care will then be done. We will end our presentation by outlining the critical ethical and policy issues affecting the coordination and continuum of care for nursing homes.

Impact of Governmental Policies on Care Coordination

Government policies on healthcare affect the costs citizens pay for care, their access to care, and the quality of care they receive. The Patient Protection and the Affordable Care Act demonstrate how healthcare policies impact individuals’ health and access to healthcare. The ACA was introduced to increase healthcare access, lower healthcare costs, incentivize care coordination, and improve the quality of care (Emmer, 2016). ACA has provisions like the Medicare Community-based Care Transitions Program that assess the models for enhancing care transitions from the hospital to other healthcare sites, lessening readmissions for high-risk Medicare beneficiaries, and saving Medicare funds. Accountable Care Organizations that coordinate health care providers, hospitals, and physicians to generate holistic care for Medicare beneficiaries is also an important government policy.

The government has introduced new bonus payments for primary care practitioners (up to $20 for every patient), funded under the Affordable Care Act to enhance coordination of care under the Comprehensive Primary Care Initiative. Research shows significant improvements in primary care delivery, including enhanced access, improved care management for high-risk patients, and enhanced coordination of care transitions (Peikes et al., 2018). The growth of patients from nursing homes and hospitals to their homes and back to a hospital setting costs Medicare about $15 million a year (National Library of Medicine, 2017). By providing transitional care and enhancing care coordination, re-hospitalizations are lessened, and improved patient outcomes. Furthermore, the initiative helps manage care for high-risk patients, deliver preventive care, engage caregivers and patients, and coordinate care across the medical neighborhood (Center for Medicare $ Medicaid Services, 2017).

Policy Provisions Raising Ethical Dilemmas For Care Coordination

The issue of health care reform is linked to specific critical ethical issues of justice as the legislature, individuals, and communities struggle to provide quality health care for the many without necessarily sacrificing the fundamental rights of the few. The ACA is one of the policy provisions that raises some ethical dilemmas. For one, the ACA requires improved quality of care offered to patients but at a lower cost. Provisions in the act are designed to control costs, expand insurance coverage, and target prevention (Sorrell, 2017). However, the ACA provisions increase the general budget, which might imply more debt for the country, and this effect might trickle down to reduced funding that might affect care coordination and health care in general.

There are still concerns that even though ethnic/racial and income disparity gaps have been narrowed, such differences still exist (Buchmueller et al., 2016). For instance, in 2017, 25% of Hispanics, 14% of Blacks, and 8.5% of Whites are said to have lacked health insurance (Gavin, 2020). Various individuals remain uninsured and underinsured, which might pose a challenge while coordinating care for individuals in nursing homes. Furthermore, for companies with less than 50 workers, insurance coverage is not mandated by the ACA, which might mean an increased cost of care for such employees. For employers, the central ethical dilemma is the extent to which they should avail health coverage to their employees at affordable rates, especially if the state and federal government plans offer little or no range for the residents and the costs of the employer-provided range skyrocket.

Impact of the code of ethics for nurses on coordination and continuum of care

The code of ethics should act as a guide for nursing practice and should be a reminder to the nurses of their commitment to society and their need for evidence-based practice. The code of ethics that usually regulates nurses makes it possible for them to give their patients the best care possible. The principle of ethics allows nurses to communicate and interact with their fellow interdisciplinary team members. This means that the code of ethics enables nurses to know the standards of behavior to uphold in a multidisciplinary team.

The code of ethics also enables them to uphold high levels of professionalism. During care coordination, it is essential to maintain patients’ confidentiality and security. Care coordination involves the patients, their families, and other healthcare practitioners. Guided by the code of ethics, nurses can uphold confidentiality and patient security standards. Bijani et al. (2017) claim that the code of ethics can make it possible for nurses to make ethical decisions that will not cause harm to the patients. Furthermore, it enables nurses to uphold proper conduct with patients, allowing them to make informed care decisions.

The first provision of the code of ethics focuses on practicing with compassion and recognition of the qualities, worth, and dignity of every patient. The principle of ethics enables nurses to focus on the client or patient-centered care, respecting their needs and advocating for better care of patients while maintaining the necessary boundaries. Lastly, the code of ethics allows nurses to accept accountability and responsibility. This is particularly important during the coordination of care, which involves a multidisciplinary team and could also involve delegation of duties. (Eastern Michigan University, 2018). The code of ethics is also essential in enabling nurses to uphold their role as advocates to push for policies that influence better health outcomes. This facilitates reduced health disparities caused by low education, income, and residential segregation.

Ethical And Policy Issues Affecting the Coordination of Care for Nursing Homes

Various ethical and policy issues affect the coordination of care in nursing homes. Some everyday ethical challenges include using restraints, autonomy, and informed consent. In contrast, other ethical issues involving decision-making and end-of-life care, such as questions regarding hospitalization, withdrawal, or withholding of life-sustaining treatment, among other things, are common. Care coordination can be complex without proper policies and guidelines outlining issues to do with life-sustaining treatment.

Care coordination can also be affected by poor communication and cooperation between the healthcare workers and the family’s next of kin; these could affect the quality of care offered to nursing homes. Lastly, coercion can cause significant damage to care coordination, given that nursing homes usually have no proper codes of ethics and behavior to guide nurses in their care of older adults. Furthermore, given that informed consent is essential in protecting the patient’s autonomy, dignity, and privacy, in nursing homes, there are cases where patients are unable to make such consent due to physical cog, native, or mental incapability. This could involve issues about end-of-life care and withdrawal of treatment, resulting in poor care coordination for the patients.

Research by Bollig et al. (2015) shows that the significant ethical challenges in the provision of end-of-life care in nursing homes involve a lack of resources as well as breaches of the autonomy of the patient. Even though there are provisions in the ACA about senior care, ethical issues about lack of resources, end-of-life care, and patient independence remain significant. Furthermore, covert medication is considered one of the major ethical dilemmas for nurses. Most home residents tend to receive covert medication without discussion and documentation with relevant parties, and this causes major ethical and policy issues in nursing home care coordination.

Conclusion

To summarize our study today, we have seen that governmental policies are essential for facilitating access to care and improving the general quality of patient care. This is mainly observed in the provisions of the ACA that enhance healthcare accessibility and focus on quality improvement. We have also studied that the significant ethical dilemma for the ACA policy provisions involves improving quality while lowering healthcare costs without necessarily raising the cost of living, particularly for the economically disadvantaged. A discussion on the code of ethics has also been made, outlining that this code of ethics provides the general provisions and guidelines to enable nurses to provide quality care for patients. Lastly, regarding the policy and ethical issues that affect the coordination of care in nursing homes, lack of resources pat, patient autonomy, and informed consent have been identified as the significant factors influencing care coordination. Knowledge of the general ethical considerations to be made in caring for older adults in nursing homes is essential to facilitate improved patient outcomes.

References

Bijani, M., Ghodsbin, F., Fard, S. J., Shirazi, F., Sharif, F., & Tehranineshat, B. (2017). An evaluation of adherence to ethical codes among nurses and nursing students. Journal of medical ethics and history of medicine, 10.

Bollig, G., Schmidt, G., Rosland, J. H., & Heller, A. (2015). Ethical challenges in nursing homes–staff’s opinions and experiences with systematic ethics meetings with participation of residents’ relatives. Scandinavian journal of caring Sciences, 29(4), 810-823.

Buchmueller, T. C., Levinson, Z. M., Levy, H. G., & Wolfe, B. L. (2016). Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. American journal of public health, 106(8), 1416-1421.

Center for Medicare $ Medicaid Services. (2017). Fact Sheet: Comprehensive Primary Care Initiative. Retrieved from https://innovation.cms.gov/files/fact-sheet/comprehensive-primary-care-initiative-fact-sheet.pdf

Eastern Michigan University. (2018). Importance of Ethics in Nursing. Retrieved from https://online.emich.edu/articles/rnbsn/importance-of-ethics-in-nursing.aspx

Emmer, S. (2016). Care Coordination Under the Affordable Care Act: Opportunities and Challenges for Geriatric Care Managers. Journal of Aging Life Care.

Gavin, K. (2020, March 4). ACA Helped Make Health Insurance Access More Equal, But Racial and Ethnic Gaps Remain. Retrieved from https://labblog.uofmhealth.org/industry-dx/aca-helped-make-health-insurance-access-more-equal-but-racial-and-ethnic-gaps-remain

National Library of Medicine. (2016). Programs and Policies to Improve Access and Quality of Care for Beneficiaries. National Academies Press: Washington (DC).

Peikes, D., Dale, S., Ghosh, A., Taylor, E. F., Swankoski, K., O’Malley, A. S., … & Brown, R. S. (2018). The comprehensive primary care initiative: effects on spending, quality, patients, and physicians. Health Affairs, 37(6), 890-899.

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Ethical and Policy Factors in Care Coordination

Select a community organization or group that you feel would be interested in learning about ethical and policy issues affecting care coordination. 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, four pages long.