Ethical and Policy Factors in Care Coordination
Hello, and welcome to this PowerPoint presentation, where we will discuss ethical and policy factors in care coordination. We will also discuss the nursing code of ethics and its impact on the coordination and continuum of care.
Introduction
Let’s start the presentation by defining the significance of nursing homes in the broader healthcare system. Nursing homes are residential care facilities for vulnerable persons in society. These may be older people or people with disabilities. Nursing care facilities maintain significance in providing nutritional counseling, primary healthcare, social work services, hospice, respite, and end-of-life care. Due to their criticality in promoting and preserving the lives of vulnerable community members, there is a need for transparency and oversight of nursing homes. Several policies that oversee care operationalization in nursing homes have been developed. The COVID-19 pandemic unearthed longstanding deficiencies in nursing homes that highlighted diminished support and poor oversight in these care facilities (Stevenson & Boner, 2020). For this reason, we will discuss ethical and policy factors in coordinating care in nursing homes.
How Government Policies Affect Care Coordination
Several federal policies affect care coordination in nursing homes. Such policies include the Nursing Home Reform Act (NHRA), Medicaid and Medicare programs, the Health Insurance Portability and Accountability Act (HIPAA), and the Hospital Readmissions Reduction Program (HRRP). These policies aim to improve the quality of care provided in these facilities. NHRA, for instance, sets quality standards for all nursing homes. These policies also direct funding to these facilities to ensure that these facilities have the necessary resources required to provide care. Such is the case for the Medicare and Medicaid programs available for nursing homes. Federal policies such as HIPAA aim to protect the rights of patients in these homes.
Example of Influential Policies: HIPAA
HIPAA is one of the most influential policies in the modern healthcare landscape. Its use in the context of nursing homes maintains significance because of the defining characteristics of persons residing in nursing homes. HIPAA directs the handling of protected health information (PHI) and defines the privacy rule that requires care organizations to protect the privacy of patient medical data. As per HIPAA provisions, entities such as HIPAA-compliant nursing homes must provide residents with their personal health information upon request. HIPAA prohibits the disclosure of protected health information by entities covered under the rule, such as healthcare providers. Violation of these provisions may attract litigations.
Policies that Raise Ethical Questions
Despite their effectiveness in guiding care provisions in nursing homes, some policies often raise ethical questions. Federal policies that may raise ethical questions include HIPAA, the Hospital Readmissions Reduction Program (HRRP), and Medicaid. HIPAA’s provision of informed consent and patients’ privilege to access personal health information may sometimes present ethical challenges. HRRP that penalizes healthcare organizations that have higher hospital readmissions may also present ethical challenges. This program strains the nursing home workforce due to the fear of incurring high readmission rates (Gai & Pachamanova, 2019). The Medicaid program expands insurance coverage for low-income earning Americans. Ethical concerns may arise when financial and logistical factors in disease management place barriers to the best possible but expensive care interventions that cannot be fully catered for by the program.
Implications and Consequences
As directed by this rule, HIPAA policies on personal health information and the privileged access to this information upon request may sometimes present an ethical dilemma. This is mainly true in the event of advanced care planning, such as the everyday end-of-life care in nursing homes. A dilemma may exist when the patient’s advances are not aligned with those of their immediate family members or the available care protocol. HIPAA may also raise the ethical question of informed consent. While it is obligatory for caregivers to obtain informed consent from their patients, some patients in nursing homes may not have the mental capacity to make informed consent. Munkeby et al. (2021) assert that informed consent remains an ethical issue in long-term care facilities and is sometimes a result of poor cognitive functionalities of the affected patients. The Nursing code of ethics helps nurses navigate through these challenges, thus ensuring that quality care is maintained.
Nursing Code of Ethics
The American Nursing Association (ANA) outlines the nursing code of ethics that guides nursing professionalism and assists nurses in clinical decision-making. The nursing code of ethics maintains significance in defining standards of nursing practice and addressing individual and collective nursing actions and expectations. The ethical principles ANA explains include beneficence, non-maleficence, justice, integrity, autonomy, fidelity, and accountability. The nursing code of ethics impacts the coordination and continuum of care in several ways. For example, they help nurses navigate clinical complexities and the care continuum by guiding their clinical decision-making and advocating for patients’ welfare by giving them the right to make their own clinical decisions. These codes also support nurses in their professional practice and reduce moral distress that may be brought about by ethical dilemmas that often characterize the care continuum.
Factors contributing to Health
Health defines a state of physical, mental, and social wellness. Several factors can influence Health; biological factors such as genetics, access to medical care, behavior, social factors, and physical influences may all influence Health. Social factors that influence Health encompass economic and social contexts in which an individual lives. These include their social interactions and the neighborhood in which they live. Physical factors detail all factors of the physical environment, such as pollution and harmful substances that may affect an individual’s Health. Behavioral factors detail individuals’ behaviors that have an impact on their Health. Such behaviors include but are not limited to smoking, excessive alcohol consumption, and physical inactivity. All these factors influence Health and have been implicated in various illnesses (Dawkins et al., 2021)
Factors Contributing to Health Disparities and Access to Care Services
Health disparity refers to preventable differences in Health and healthcare usually experienced by socially disadvantaged communities. Factors contributing to health disparity include but are not limited to genetics, access to care, language barriers, community features such as poverty and lack of access to healthy foods, health behaviors, and environmental conditions such as air pollution. Now, let’s focus on factors contributing to access to care services. Access to care service remains a traditional problem in the U.S. Factors contributing to poor access to care services in the U.S include lack of insurance coverage, high cost of healthcare, physical barriers such as geographic location, language barriers, illiteracy, healthcare staffing shortages, and others. These factors affect the utilization of care services and have been implicated in low quality of life for the affected communities (Gómez et al., 2021).
Social Determinants of Health
The social determinants of Health refer to conditions in the human environment that affect their Health, functionalities, and quality of life. Healthy People 2020 outlines the five domains of SDOH and defines the objectives for each. These domains are economic stability, neighborhood and built environment, access to quality health services and education, and social and community contexts. The goal of Healthy People 2020 on financial stability is to help people and communities earn steady incomes that meet their healthcare and personal needs. On access to quality healthcare and education, the goal of Healthy People 2020 is to increase educational opportunities for children and adolescents and increase access to comprehensive and high-quality healthcare. Another goal is to create neighborhoods that support Health and safety. In the social context, Healthy People 2020 aims to increase social and community support.
Summary of Key Ethical and Policy Issues Affecting Care Coordination in Nursing Homes
The clinical complexities of nursing homes may sometimes bring ethical issues in care provision. Ethical issues in nursing homes include informed consent, advanced care planning, and patient access to privileged information. Federal policies such as the Nursing Homes Reforms Act (NHRA), Medicare and Medicaid, HIPAA, and Hospital Readmission Reduction Program play a role in nursing home oversight and significantly influence care coordination in these care facilities. These policies are mainly targeted at enhancing the quality of the care provided in these care facilities, directing funding, and protecting the rights of nursing home residents. Policy issues that may be present in nursing homes include breaches of privacy and confidentiality in PHI and deterioration of quality of care (Bowblis & Ghattas, 2019).
References
Bowblis, J. R., & Ghattas, A. (2019). The impact of Minimum Quality Standard Regulations on nursing home staffing, quality, and exit decisions. Review of Industrial Organization, 50(1), 43–68. https://doi.org/10.1007/s11151-016-9528-x
Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D., & Meads, D. (2021). What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health, 26(10), 1177–1188. https://doi.org/10.1111/tmi.13651
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
Gómez, C. A., Kleinman, D. V., Pronk, N., Wrenn Gordon, G. L., Ochiai, E., Blakey, C., Johnson, A., & Brewer, K. H. (2021). Addressing health equity and Social Determinants of Health Through Healthy People 2030. Journal of Public Health Management and Practice, 27(Supplement 6). https://doi.org/10.1097/phh.0000000000001297
Munkeby, H., Moe, A., Bratberg, G., & Devik, S. A. (2021). ‘ethics between the lines’ – nurses’ experiences of ethical challenges in long-term care. Global Qualitative Nursing Research, 8, 233339362110600. https://doi.org/10.1177/23333936211060036
Stevenson, D. G., & Boner, A. (2020). The importance of nursing home transparency and oversight, even amid a pandemic. Forefront Group. https://doi.org/10.1377/forefront.20200511.431267
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Question 
Select a community organization or group 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, 4-5 pages in length.
Ethical and Policy Factors in Care Coordination
Introduction
As care coordinators, nurses must be aware of the code of ethics for nurses and health policy issues that affect care coordination within the community context. 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, precisely, the Affordable Care Act (ACA). Knowledge of ethical and policy issues helps ensure that care coordinators uphold ethical standards and navigate policy issues affecting patient care.
This assessment allows you to develop a presentation for a local community organization of your choice, which provides an overview of ethical standards and relevant policy issues affecting care coordination. Completing this assessment will strengthen your understanding of ethical issues and policies related to the coordination and continuum of cars. It will empower you to be a more vigorous advocate and nursing professional.
Completing the Vila Health: Ethical Decision-Making activity would be an excellent choice before 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 organizations and groups. She has noticed you are working well 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 interested in learning about ethical and policy issues related to care coordination. 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 correctly. Using PowerPoint or other presentation software, you can record audio directly to your slide.