Summary of Key Ethical and Policy Issues Affecting Care Coordination in Nursing Homes
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 qual