Ethical and Policy Factors in Care Coordination

Narrative Script

Slide one: introduction of the presenter

Slide 2: This presentation aims at addressing various ethical, legal, and policy aspects of care coordination in a nursing home setting. Firstly, I will define ethics, policy, and care coordination. This presentation also addresses the government policies related to the health of the community that affects the coordination of care in nursing homes.

Ethical and Policy Factors in Care Coordination

Thirdly, I will also describe the national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination in nursing homes. The fourth objective is to explain the impact of the code of ethics for nurses on the coordination and continuum of care in nursing homes. Lastly, I will summarize the key ethical and policy issues affecting the coordination and continuum of care in nursing homes.

Slide 3: The agency for healthcare research and quality defines care coordination as the process of planning patient care activities and communicating information to all parties involved in a patient’s care to provide safer and more efficient care. It includes a series of actions that help patients and their families better self-manage their medical conditions and associated psychosocial issues, coordinate their care across various medical and community providers, close care gaps, and receive the right quality of care.

Slide 4: Care coordination in a nursing home involves these key processes: information sharing, effective communication, monitoring, and interprofessional collaboration. The roles of nurses in these facilities concerning care coordination are nursing leadership, patient advocacy & education, communication, and referral to community resources.

According to a journal article by Weaver et al. in 2018, care coordination in most nursing homes requires a coordinator who is usually a nurse; plans and rules that include protocols of care; routines such as meetings where teams are updated; and defined roles for all stakeholders.

Slide 5: Ethics in healthcare, as defined by Buka (2020), refers to the rightness and wrongness of a clinician’s actions. There are four basic ethical principles: autonomy, nonmaleficence, justice, and benevolence. According to the American Nurses Association, there are nine provisions in the code of ethics for nurses, which were last revised in 2015. These codes guide nurses’ decision-making that require an ethical rather than clinical or legal basis. Laws, legislation, and policies govern the nursing practice from the legal perspective, according to Tingle & Cribb (2021)

Slide 6: Nursing homes, just like other long-term care facilities, must abide by government policies and legislation in healthcare. Nurses working in nursing homes are liable to legal implications of nursing home care that can result in imprisonment, criminal penalties, licensure restriction, or cancellations, among other disciplinary proceedings.

Government policies regulate various care coordination aspects in nursing homes, such as communication, information sharing, health assurance, and end-of-life care. Some of the key policies relating to care coordination in nursing homes are the affordable care act (ACA), Medicaid, Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Nursing Homes Act of 1987

Slide 7: These illustrations highlight the aforementioned key government policies concerning care coordination in nursing homes. Medicaid provides insurance coverage to patients in nursing homes. Their issue reimbursements to facilities based on their eligibility criteria. ACA, enacted in 2010, has improved information access to consumers and thus improved utilization of nursing homes and consumer participation. HIPAA, enacted in 1996, protects sensitive patient information, and this impacts care coordination through information sharing.

Slide 8: Ethics and legislations overlap in some instances. The Nursing Home Reforms Act Of 1987 created the residents’ bill of rights. Residents in nursing homes have the freedom to leave these facilities at will. Attempts to involuntarily restrain them can legally lead to false imprisonment. Keeping these residents can be to their own advantage, which can interfere with patient autonomy. Nursing homes, as opposed to mental health units, are liable to false imprisonment policies.

At admission to nursing homes, most facilities have their residents consent to these involuntary holds. The use of physical, chemical, and emotional restraints is unlawful in nursing homes. This creates an ethical dilemma when the nurse or the doctor must ensure residents’ safety in cases of risk of harm to self or others. Cases of cognitive decline among residents with Alzheimer’s disease result in aggression, agitation, or anxiety and may need the use of restraints.

Slide 9: Violation of the bill of rights from the Nursing Homes Act can lead to legal action, loss of licensure, disciplinary action by the state board of nursing, or even deterioration in care quality. Nursing actions can sometimes aim in the patient’s best interest, but the consequences may be remotely interpreted as a violation of federal policies and statutory laws.

An example is emotional restraint use, where a nurse can explain to the patient the consequences of leaving the nursing home against medical advice. This can force the patient to stay against their will and can have a legal implication on the nurse’s actions.

Slide 10: Recently, nursing homes have been facing closures at very high rates. An article by McSweeney-Feld & Braunstein in 2020 presented a case study of nursing home closures in Maine. In their review article, Medicaid policies play an important part in these closures. Inadequate reimbursements from Medicaid, among other policy factors, have been implicated.

Recent policies have also emphasized shorter stays for Medicare residents in these facilities. Therefore, this shows that there was a great need for care coordination at the state and federal levels of care governance. Collaborative consultation with nursing homes and all stakeholders should be emphasized to sustain nursing homes.

Slide 11: The Code of Ethics for nurses by the American Nurses Association, last revised in 2015, is the backbone of ethical nursing decision-making in nursing care facilities. The majority of residents in nursing homes lack the independence or capacity to make decisions for themselves. As such, the nurses, as care coordinators, the code of ethics acts as an essential guide to decision making. Residents deserve quality care that can be achieved through care coordination. Enhancing care safety, patient-centeredness, effectiveness, efficiency, timeliness, and equity must be considered by coordinators.

Healthy people 2020 and 2030 presented various social determinants of health, some of which apply greatly to nursing home settings. Discrimination, violence, racism, housing, education, literacy, income, and transportation are some of the critical determinants that must be addressed in care coordination in these settings. Disparities that arise from these determinants must be addressed during care coordination. Careful interpretation of the code of ethics for nurses can assist the nurses in decision-making while caring for various patients who are disadvantaged in nursing homes.

Slide 12: Ethical issues related to social determinants of health in nursing homes are discrimination, abuse, and access to quality care. Nurses and social workers must collaborate to minimize these disparities and ensure ethically just care and service distribution. Discrimination that arises in nursing homes is usually related to ageism, racism, disability, low decisional capacity, religion, and ethnicity. Violence and abuse are also common in nursing homes especially elderly abuse and psychomotor agitation from discrimination or cognitive issues among the elderly.

Slide 13: This presentation has highlighted key ethical and legal aspects of care coordination in nursing homes. Key processes in care coordination in nursing homes are information sharing, interprofessional collaboration, communication, and monitoring. Highlighted policies are Medicaid, ACA 2010, HIPAA 1996, and the nursing Homes Act 1987. Highlighted ethical issues are discrimination, access to care, and violence.

References

  • American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. American Nurses Publishing.
  • Buka, P. (2020). Essential law and ethics in nursing: Patients, rights and decision-making. Routledge.
  • Centers for Disease Control and Prevention. (2022, June 28). Health Insurance Portability and Accountability Act of 1996 (HIPAA). Cdc.gov. https://www.cdc.gov/phlp/publications/topic/hipaa.html
  • Healthy People 2030, U.S. Department of Health and Human Services, & Office of Disease Prevention and Health Promotion. (n.d.). Social Determinants of Health. Health.gov. Retrieved August 6, 2022, from https://health.gov/healthypeople/priority-areas/social-determinants-health
  • McSweeney-Feld, M. H., & Braunstein, N. (2020). The dilemma of nursing home closures: A case study of rural Maine nursing homes. Maine Policy Review29(1). https://doi.org/10.53558/mlqr9643
  • Scott, P. A. (Ed.). (2018). Key concepts and issues in nursing ethics. Springer International Publishing.
  • Tingle, J., & Cribb, A. (2021). Nursing law and ethics (2nd ed.). Wiley-Blackwell.
  • Weaver, S. J., Che, X. X., Petersen, L. A., & Hysong, S. J. (2018). Unpacking care coordination through a multiteam system lens: A conceptual framework and systematic review. Medical Care56(3), 247–259. https://doi.org/10.1097/MLR.0000000000000874

Assessment 2 Instructions: 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 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 speakers notes for your presentation, 4-5 pages in length