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Capella 4050 Assessment 2

Capella 4050 Assessment 2: Ethical and Policy Factors in Care Coordination

Name

Capella university

NURS FPX 4050 Coordinating Patient-Centered Care

Prof. Name

Date

Ethical and Policy Factors in Care Coordination

Hello everyone, I am _____ a registered nurse as well as a care center representative at Family Health Centers of San Diego. I welcome you all and thank you for joining me on this presentation. Today, I will be discussing some major ethical and policy factors that impact care coordination in nursing homes. Furthermore, I will highlight some national, state, and local policies that raise ethical questions or dilemmas for care coordination in nursing homes along with the nursing code of ethics on care coordination. The purpose of this presentation is to raise awareness of ethical and policy considerations on care coordination so that patients receive coordinated care according to the Code of Ethics for nurses.

What is Care Coordination?

Before jumping to our topic of concern, I would like to describe care coordination shortly so that some of the fresh nurses among you do not confuse at all with this term due to their knowledge gaps. So, AHRQ has defined care coordination as the deliberate organization of patient care activities and sharing of information among all of the participants who are concerned with patient care to achieve safer and more effective care (Agency for Healthcare Research and Quality, 2018). Care coordination is the provision of care to patients with collaboration and coordination among health professionals. This practice leads to improved quality of care delivered to patients and enhances patient safety.

Governmental Policies that Affect Coordination of Care

Now, in this section, I would like to highlight some of the major governmental health policies that affect care coordination in nursing homes. Some of these governmental policies include Nursing Home Reform Act (NHRA), the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPPA), and Health Information Technology for Economic and Clinical Health (HITECH) Act. Now, I will discuss these health policies one by one in detail in the subsequent sections to find out how these governmental health policies affect the coordination of care in nursing homes.

Nursing Home Reform Act

The Nursing Home Reform Act of 1987 has provided standards and policies for nursing homes to participate in Medicare and Medicaid programs. This binding policy of care planning, involvement of interdisciplinary teams, and delivering collaborative care ensures care coordination in nursing homes. This enhances the quality of care provided to the patients improves the patient’s health and safety (Werner et al., 2022).

Affordable Care Act

The Affordable Care Act (ACA) has expanded Medicaid and Medicare which have established several policies on care coordination. These Medicaid and Medicare policies for the participation of nursing homes to acquire their services include care coordination in the form of creating care plans, procuring interdisciplinary team communication, referral and discharge planning, and inhabitant’s autonomy in care decisions. Therefore, it is mandatory for nursing homes to implement care coordination in order to get benefit from provisions of this Act and its expanded programs (Harrison et al., 2023).

HIPAA and HITECH Act

The HIPAA and HITECH Act that promote the adoption and implementation of health information technologies affect care coordination in a number of ways. For example, The HITECH Act provides nursing homes and health professionals working for nursing homes with some financial aid to adopt electronic health systems. These EHR systems improve care coordination by enabling effective and secure sharing of residents’ health information such as care plans, diagnostic and laboratory test data, prescribed treatment, and medication lists, etc. among healthcare professionals involved in delivering care treatment. Moreover, protected health information (PHI) is another major concern of residents in nursing homes. The HIPAA act ensures that nursing homes must comply with privacy, security, and confidentiality regulations to secure PHI that can enhance resident’s trust in nursing home services and promotes information sharing with healthcare individuals for care coordination (Pierre-Francois & Guzman, 2020).

Ethical dilemmas related to Health Policies

I hope everything is understood so far. Now I would like to throw light on ethical dilemmas associated with the implementation of national, state, and local health policy provisions. Every healthcare community organization including nursing homes require to follow ethical principles and regulations that include privacy and confidentiality, informed consent, equity and justice, patient autonomy, and shared-decision making. Implementing these ethical principles in different healthcare policies may raise ethical questions and dilemmas. For example, the National level policy of the Nursing Home Reform Act (NHRA) can present ethical dilemmas like balancing resident autonomy and safety.

This policy mandates residents’ rights such as their right to make decisions on their care treatment and related health plans. In some cases, residents may refuse the prescribed care treatment or plan which may pose health deterioration by avoiding it, creating an ethical dilemma in care coordination for nursing home staff (Kopar et al., 2021). This policy leads to several implications such as nursing home staff will reach out to the residents to investigate their health concerns to make a shared decision following this health policy provision.  

Capella 4050 Assessment 2

Another ethical dilemma related to HIPAA and HITECH policy on care coordination is the extent to which residents’ health data and information is shared. As HIPAA and HITECH Act emphasizes the adoption and implementation of health technologies like EHR, this may create an ethical dilemma in care coordination in terms of maintaining privacy or confidentiality and effective care coordination due to the presence of conflict between principles of residents’ privacy and need for effective information sharing for care coordination (Cooke et al., 2022). The implications of this provision are the effective sharing of resident medical and health information and promote care coordination & interdisciplinary collaboration.

Now, I will be discussing the last ethical dilemma related to ACA policy which is resource allocation. The ACA has expanded healthcare coverage by establishing Medicaid and Medicare health policies which have resulted in a higher number of residents seeking care through limited resources. Prioritizing certain patients to provide care coordination services through ACA-expanded policies and leaving others is a major ethical dilemma that requires the principles of justice and equity in making care coordination decisions (Scott et al., 2019). The implications of ACA and Medicaid & Medicare provision of covering health insurance will be enhanced access to care coordination for low-income residents of nursing homes.

Impact of Code of Ethics for Nurses 

Now, I will discuss the last part of my presentation which is the impact of the code of ethics for nurses on the coordination and continuum of care. The American Nursing Association has established a code of ethics for nurses to guide them in providing ethical and morally suitable care treatment. This Code of Ethics guides nurses on various aspects of ethical care provision such as enabling care coordination and patient-centered care, ensuring collaboration and communication in interprofessional care approach, and protecting patient confidentiality and privacy from health perspectives.

Moreover, nurses are enabled to make ethical decisions to avoid ethical dilemmas which lead to improved quality of care and effective provision of coordinated care. Through these ethical guidelines and standards, nurses are capable of providing resident-centered care in nursing homes considering every individual deserving of require care and treatment without considering social determinants of health i.e. social, cultural, ethnic, and religious factors, and without any health disparities (World Health Organization, 2021). This promotes the delivery of an equitable and just care treatment through the implementation of a Code of Ethics. Therefore, these governmental health policies must be implemented to provide a direction to nurses and relevant healthcare professionals on providing care coordination while considering the ethical principles of clinical practices. 

Conclusion

Thank you all for your patience and active listening. We have reached the conclusion of our presentation. To sum up, we have discussed what is care coordination and how is it followed by the health policies NHRA, ACA, and HIPAA & HITECH that affect care coordination in nursing homes. Moreover, we talked about the ethical dilemmas associated with the aforementioned policies and the implications of the provisions of each health policy. Lastly, we talked about the impact of the code of ethics for nurses on the coordination of care and continuum through the implementation of ethical standards provided by ANA. If you have any questions, you may ask.

References

Agency for Healthcare Research and Quality. (2018, August). Care coordination. https://www.ahrq.gov/ncepcr/care/coordination.html#:~:text=Care%20coordination%20involves%20deliberately%20organizing 

Cooke, E., Perkins, M. M., Doyle, P., Kinlaw, K., Wack, K., & Vandenberg, A. E. (2022). Ethics of health information sharing and social relationships at end of life in assisted living. Journal of Applied Gerontology : The Official Journal of the Southern Gerontological Society, 41(4), 1153–1166. https://doi.org/10.1177/07334648211053308 

Harrison, J. M., Sheng, F., Josberger, R. E., Liu, H. H., Stone, P. W., Luchsinger, J. A., & Dick, A. W. (2023). Changes in nursing home use following medicaid-supported expanded access to home- and community-based services for older adults with dementia. JAMA Network Open, 6(7), e2322520. https://doi.org/10.1001/jamanetworkopen.2023.22520 

Kopar, P. K., Kramer, J. B., Brown, D. E., & Bochicchio, G. V. (2021). Critical ethics: How to balance patient autonomy with fairness when patients refuse coronavirus disease 2019 testing. Critical Care Explorations, 3(1). https://doi.org/10.1097/CCE.0000000000000326 

Capella 4050 Assessment 2

Pierre-Francois, W., & Guzman, I. (2020). Factors that influence HIPAA secure compliance in small and medium-size health care facilities. KSU Proceedings on Cybersecurity Education, Research and Practice. https://digitalcommons.kennesaw.edu/ccerp/2020/Research/6/ 

Scott, P. A., Harvey, C., Felzmann, H., Suhonen, R., Habermann, M., Halvorsen, K., Christiansen, K., Toffoli, L., & Papastavrou, E. (2019). Resource allocation and rationing in nursing care: A discussion paper. Nursing Ethics, 26(5), 1528–1539. https://doi.org/10.1177/0969733018759831 

Werner, R. M., Konetzka, R. T., Grabowski, D. C., & Stevenson, D. G. (2022). Reforming nursing home financing, payment, and oversight. New England Journal of Medicine, 386(20), 1869–1871. https://doi.org/10.1056/nejmp2203429 

World Health Organization. (2021). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health 

Capella 4050 Assessment 2

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