Assessment 3

By using the following power point and research papers, complete the following guidelines of a case study:

Objective: The students will complete a Case study tasks that contribute the opportunity to produce and apply the thoughtslearned in this and previous coursework to examine a real-world scenario. This scenario will illustrate through example the practical importance and implications of various roles and functions of a long-term care settings. As a result of this assignment, students will be better able to comprehend, scrutinize and assess respectable superiority and performance by all institutional employees.

ASSIGNMENT GUIDELINES (10%):

Students will critically measure the readings from Chapter 5 in your textbook. This assignment is planned to help you examination, evaluation, and apply the readings and strategies toyour of a long-term care settings
You need to read the PowerPoint Presentation assigned for week 3 and develop a 3-4 page paper reproducing your understanding and capability to apply the readings to your long-term care settings. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA Style 7thedition format when referring to the selected articles and include a reference page.

EACH PAPER SHOULD INCLUDE THE FOLLOWING:

1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words that will apply to the case study presented. 

2. Your Critique (50%)

Case study: Patient-Centered Care: Case Studies on End of Life in elderly

Background

Ms. L is an 87-year-old African American woman who was diagnosed with vulvar cancer at the beginning of 2017. She is also HIV-positive. By the time Ms. L engaged in care, the cancer had proliferated quite quickly in the setting of a compromised immune system. Upon discovery of the Stage 4 cancer, doctors recommended a dose of radiation and chemotherapy. However, during the course of this episode Ms. L was struggling with substance use. During her hospitalization, she tested positive for a number of substances, including heroin and cocaine. As a result, care providers had many discussions about pain management and which pain medications could be given to her. She was not on methadone treatment maintenance at first, so she was self-medicating to address her pain. While Ms. L wanted to seek help for her addiction to substances, some of the traditional models were not appropriate given the magnitude of her physical issues. There were expectations that she would get into outpatient treatment but she did not follow through, primarily because it was difficult for her to tolerate being in groups for long periods. (Given the location of her cancer, she could not sit upright for long periods or on the bus for transportation.) Ultimately, Lawanda Williams, Director of Housing Services at Health Care for the Homeless in Baltimore, Maryland, and her team were able to provide Ms. L with transportation and cab vouchers so she could access the full course of radiation that doctors had recommended. Her pain was never well controlled, because her physician refused to prescribe her any pain medications, due to the magnitude of her substance use. The radiation center gave her Percocet while she was there but would not give her anything that could not be directly supervised. After treatment, they sent her home with prescriptions for Tylenol and instructions to return and follow up with pain management teams, which she was unable to do because of her difficulties with transportation and sitting. Ms. L completed radiation and is in a period of holding to assess effectiveness of the initial course of radiation, but she still does not have a prescription for her significant pain and, as a result, continues to use substances to manage her pain. Ms. Williams observes, “I have been able to see how managing withdrawal and managing substance abuse in the context of a palliative care treatment plan does not always exist for patients experiencing homelessness. She does not fit very neatly into any mainstream treatment model.”

CASE STUDY CHALLENGE:

1. Harm reduction: How can care providers best advocate for a harm reduction approach while seeking to deliver palliative care services, including hospice care?

2. What ethical arguments can you make base on the case study?​

3. Why do you think that long-term care and palliative care insurance lacks of popularity among older Americans.

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique of the case study and provide a possible outcome for Aging in America base on Health ethics Context?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the case study;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these Case study on any Health Care Setting.

Chapter Five

Older People and Long-Term Care: Issues of Access

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Why the new interest in long-term care?
The Baby Boomers are adding to the growth in the population over 65.
There is increasing fear of dependency on long-term care.
Adult children of the elderly having to find care for their parents.
Healthcare reform promises great changes that are not well understood.
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The Growing Population Needing Care
The need for ADL and IADL assistance continues to grow.
Table 8-1 presents the broad range of services needed by the disabled.
Most of the population needing long-term care do not live in nursing homes.
Many factors contribute to the inability to predict the exact number needing services in the future.
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The Growing Population Needing Care
Future populations may be better educated which is associated with lower levels of disability.
Ethnic composition suggests a greater need for care and government support.
Boomers will bring greater numbers of people needing services.
The number of those over 75 will greatly increase.
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The Growing Population Needing Care
Disability rates will increase among those who are not in nursing homes.
The most common disability is physical.
In addition, the nursing home population is expected to have profound increases until it triples by 2030.
The number of younger persons with disability has also increased.
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Issues of Access
The current system is far from ideal.
There is not an adequate supply particularly for the poor.
The system itself continues to be so fragmented that many are not aware of what is offered.
Financing is an underlying problem.
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The Costs of Care
Expenses for this care are sizable and will increase in the future.
Private insurance only pays for a small percentage of the care.
Medicaid pays for over 85% of nursing home care.
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The Costs of Care
Annual costs of nursing home care can average $58,000 per year and may exceed $100,000. For many, the costs of this care is just not affordable.
With the addition of the Baby Boomers, costs will most certainly increase in the future.
The effects of reform are not currently known.
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The Care-giving Role of Families
About 74% of dependent community-based elders receive care from family members.
The majority of caregivers are women.
The number and willingness of family caregivers may decline as the Boomers become in need for assistance.
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The Role of Private Insurance
Private insurance for long-term care is a relatively new product.
Improvements in coverage are being made, but only an estimated 20% of the population will use it.
CCRCs and LCAHs hold promise for the future.
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The Role of Medicaid
Medicaid is changing under PPACA to include more eligible adults who will receive benchmark coverage.
Medicaid is used for those elders who meet certain criteria.
Medicaid does not pay for the full range of services including home-based care.
Some states are using a waiver to offer non-medical home-care services.
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The Role of Medicaid
Some elders qualify for Medicaid once they are institutionalized and have used all of their assets.
Other elders are trying to shelter their assets so that they can be poor without really being poor.
Healthcare reform requires an office within CMS to address the issue of dual edibility.
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Forces for Improving Access
Advocates for Alzheimer’s disease patients and for others have worked for changes.
The Pepper Bill and other legislation recommended changes.
Attempts to limit the growth of Medicaid are part of the national health care debate.
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Future Prospects
Baby Boomer numbers and healthcare reform will result in changes to the system.
Government involvement will increase as demand increases without the funding for access.
Government involvement may not be the only or best answer.
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Future Prospects
Future elders are concerned about what their care will be like under healthcare reform.
The political climate must be willing to address future concerns.
Ethical questions such as beneficence, autonomy, and justice need to be part of policy discourse.
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Future Prospects
Issues of the elderly and non-elderly disabled need to be addressed.
Given the cost and complexity, the medical model is not the only one to be considered.
Long term care needs to be part of health care.
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Update from a Practitioner’s View
Even with healthcare reform the trends and issues for long-term care are the same.
Barriers to real change are driven by the political climate that controls funding.
What will be America’s legacy about the treatment of its elderly?
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In Summary…
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