Ethical and Policy Issues & Care Coordination
Presentation Narrative Script
Hello and welcome to the kick-off presentation on the ethical and policy issues involved in the coordination of care in a nursing home. In this presentation, I will discuss how governmental policies affect the coordination of care in a nursing home. I will also talk about the national, state, and local policy provisions that raise ethical dilemmas in care coordination. Lastly, I will tackle the impact of the code of ethics for nurses on the coordination and continuum of care.
The Health Insurance Portability and Accountability Act (HIPAA) came up with regulations on issues of privacy in healthcare. The purpose is to safeguard the security of individuals’ health information and establish the rights of individuals in regard to health information. In nursing homes, HIPAA plays a key role. Protecting patients’ privacy is important to avoid legal repercussions and because it is the ethical thing to do. The most significant HIPAA complications involve disclosing information to third parties. Most older adults in nursing homes have family members who normally make decisions for them, especially if they suffer from cognitive decline. HIPAA regulations specifically outline that only specific individuals may gain access to the healthcare information of a patient, and it might be quite complicated to determine whether certain family members have the legal right to see the healthcare information of their loved one in a nursing home. Turnover can also cause major concerns for HIPAA. Nursing homes tend to have a hard time retaining staff, and with the increasing growth of older adults, nursing shortage is a key problem. HIPAA might have trouble with entry-level employees since they only have a right to particular information. Furthermore, monitored or poorly trained staff might bring problems with HIPAA. Since some nursing homes fail to provide adequate training on HIPAA rules to their staff members, they might unintentionally violate HIPAA rules at some point (Gallon, 2020). This is likely to affect the care offered to clients, and trust might be broken in the process.
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The Affordable Care Act has various important provisions that have a direct effect on nursing homes. Under the ACA, individuals can now have easier access to more information on nursing homes to help in the selection. Such information as the owner of the nursing home, how much is spent on resident care, hours that residents receive, number of violations and complaints, and staff turnover rates are available. Consumers can also easily file a complaint in regard to the quality of care. There is also a new health law such as the Elder Justice Act that is designed to offer federal resources to help prevent, detect, treat, comprehend, and intervene in and, where applicable, prosecute elder abuse, exploitation, and neglect (Morgan, 2015). In a healthcare facility in San Francisco, employees violated the privacy of patients in a dementia ward and would physically and verbally abuse them while sending pictures of various scenarios, such as a patient being in a bathroom to each other. This invited huge fines, criminal charges, and revoking of licenses. This is a major violation of the HIPAA law, and thanks to the ACA, such information is available to the public and can help individuals demand better quality of care for their loved ones. The ACA provides patient-centered care through community health teams that collaborate to establish a more thorough and personal doctor-patient relationship. It also keeps costs minimal while providing care coordination and community support for the elderly.
Medicare is a key governmental policy with major impacts on the coordination of care. Medicare offers health insurance services to older persons in the US. It boosts care coordination as it proposes to enhance access to care for individuals who are covered. However, Khullar and Chokshi (2018) claim that individuals covered under Medicare tend to record higher rates of readmission and re-hospitalization. Furthermore, Miller et al. (2012) claim that the Medicare policy that disallows simultaneous access to Medicare Part A hospice care for nursing home residents receiving Medicare skilled nursing facility care creates a major problem as it is linked with increased deaths and low quality of life. Given that most individuals covered under Medicare are from low-income backgrounds, there is a likelihood of receiving low-quality care due to nursing shortages, burnout, and medical errors.
Medicare is one of the national health policies that raises major ethical questions in nursing homes. Compared to privately insured patients, those receiving Medicare have a higher probability of obtaining delayed and poor-quality treatment. Allen et al. (2021) claim that Medicaid has reduced the cost of care for patients, but in doing so, it has also lessened the quality of treatment. There is a major ethical dilemma in regard to how to provide high-quality of care at minimum cost. With minimal payments provided to physicians for Medicaid patients, there is a low incentive to provide high-quality care. Furthermore, most health care facilities might refuse to accept Medicare-insured patients hence impacting the willingness to provide quality care. The ACA is said to afford individuals increased access to care that they might have been denied, but at the same time, it does not guarantee access to care (Field, 2015). There is no need to have insurance if one cannot find a healthcare facility to offer services. This shows that both Medicare and ACA might only be beneficial to patients to a small extent, but the issue of access to care and quality care still remains.
The private healthcare industry is considered the largest in the world, accounting for over half of all healthcare expenditures (Field, 2015). It is ironic that the government tends to support the growth of the private healthcare industry by providing low-cost care, which is equated to low-quality care. Private healthcare facilities, therefore, take on this gap to offer high-quality services at high costs. With increasing expenditure on ACA, the government increases the public debt, yet the quality of care remains poor. Furthermore, given the poor pay for Medicare, physicians tend to be demotivated, which implies increased dissatisfaction, high turnover, increased probability of medical errors, and poor communication and coordination in care. All of these impact the quality of care that patients receive.
Ethical issues are common in the nursing profession, and for them to be resolved, there is a need for a theoretical comprehension of ethical decision-making (Bijani et al., 2017). Designing ethical codes in nursing is meant to instruct and shape the behavior of individuals in their provision of care and help them express shared responsibilities and values that are specific to their profession. Such values guide the actions and decisions of nurses and offer information to individuals in the nursing community worldwide. Most nurses consider the code of ethics when faced with ethical dilemmas or issues but fail to act upon it (Bijani et al., 2017). Most times, they do not have the support and power to react according to the code, and sometimes it is difficult for them to know what to do. This is because the code does not cover every single ethical scenario that nurses might face during their profession. Furthermore, these codes can limit the creativity of nurses as they might be unable to know how to act when the scenario fails to fit into the code of ethics. It is important to train nurses on ethical performances and issues to help in clinical decision-making while upholding autonomy and accountability in decision-making.
There are so many factors that result in health disparities in the US. Some of them include poor quality of care, access to care, community factors such as inadequate access to healthy foods, poverty, and violence, as well as environmental conditions like poor air quality and congested and polluted air. Language barriers, as well as health behaviors or lifestyles, also play a key role in health disparities. The Healthy People 2020 claims that the major influences on Americans’ health include access and availability of nutritious foods, decent and safe housing, clean water, health insurance, non-polluted air, culturally sensitive health care provision, and affordable and reliable public transportation. Income, employment, and wealth are also key health disparities determinants (National Conference of State Legislatures, 2021).
Almost every person is affected by social health determinants. Healthy people organize these into five domains, namely: education, economic stability, neighborhood and built environment, community and social context, and health and health care. Economic stability encompasses such factors as poverty, housing instability, food insecurity, and employment. Education entails literacy and language, enrollment in higher education, high school graduation, and early childhood development and education. Health and health care involve access to primary and health care as well as health literacy. Neighborhood and built environments involve violence and crime, quality of housing, environmental conditions, and access to foods that support healthy eating patterns. Social and community contexts include discrimination, social cohesion, incarceration, and civic participation (Healthy People 2020).
In nursing homes, there are various ethical issues that arise, which bring major issues for nurses. Some of them include advance directives, competence, and capacity for decision-making, psychotropic medication, decisions related to life-sustaining treatment and resident abuse (Bollig et al., 2015). Other issues involve autonomy, refusal to take medication or food and informed consent. Most nurses claim to face issues linked to informed consent, autonomy as well as refusal to take medication and food or the application of restraints on a daily basis. However, other problems like withdrawing or withholding life-sustaining treatments as well as issues about hospitalization, are not as common, but they are present. With the nurses’ code of ethics, it is possible to deal with some of the ethical problems that are faced in a nursing home.
HIPAA, ACA, and Medicaid are among the key government policies that impact care coordination in nursing homes. These policies enhance privacy and security of care and also enhance access to care for older adults. However, they also raise key ethical issues that need to be resolved, particularly in regard to striking a balance between quality care and low-cost care. The code of ethics provides a set of guidelines on how to deal with various ethical issues in nursing. In nursing homes, some of these ethical issues involve autonomy and informed consent. However, the code of ethics is not all-inclusive, and nurses should be trained on how to act appropriately and be accountable for their actions. Some of the barriers to care include education, economic stability, and health literacy which also need to be addressed to enhance care among older adults
References
Allen, H., Gordon, S. H., Lee, D., Bhanja, A., & Sommers, B. D. (2021). Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults. JAMA network open, 4(1), e2032669-e2032669.
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.
Field, R. I. (2015). The ethics of expanding health coverage through the private market. AMA Journal of Ethics, 17(7), 665-671.
Gallon. (2020). Nursing Home Privacy: Know Your Rights and Limitations of HIPAA Laws. https://www.gallonlaw.com/nursing-home-privacy/
Health People (2020). Explore Resources Related to the Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources
Jotform. (2020). HIPAA regulations for nursing homes. https://www.jotform.com/blog/hipaa-regulations-for-nursing-homes/
Khullar, D., & Chokshi, D. A. (2018). Can better care coordination lower healthcare costs?. JAMA Network Open, 1(7), e184295-e184295.
Miller, S. C., Lima, J. C., Looze, J., & Mitchell, S. L. (2012). Dying in US nursing homes with advanced dementia: how does health care use differ for residents with, versus without, end-of-life Medicare skilled nursing facility care?. Journal of Palliative Medicine, 15(1), 43-50.
Morgan, C. (2015). How the Affordable Care Act is Impacting Nursing Homes. https://www.caitlin-morgan.com/nursing-homes-aca/
National Conference of State Legislatures. (2021). Health Disparities Overview. https://www.ncsl.org/research/health/health-disparities-overview.aspx#:~:text=Many%20factors%20contribute%20to%20health,language%20barriers%20and%20health%20behaviors.
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Question 
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.
Ethical and Policy Issues & Care Coordination
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 in 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.
Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.
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 courseroom.
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 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 health care 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 coo