Thinking and reasoning skills in healthcare

HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit III

Upon completion of this unit, students should be able to:

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.
2.1 Evaluate a current critical issue in health care.

Course/Unit

Learning Outcomes
Learning Activity

2.1
Unit Lesson
Chapter 5
Unit III Assessment

Required Unit Resources

Chapter 5: Ethics and Aging in America

Unit Lesson

In this unit, we will discuss competency, decision-making, ethics, and an aging population in the United
States. This unit covers the population needing long-term health care and the different types of services that
are currently offered and will be needed in the future. Further, topics and issues related to access, cost,
insurance, and future improvements for the entire system will be addressed.

A large number of U.S. citizens are elderly and have a large number of health care needs. Consequently,
there has been an increase in the need for long-term care services. It is expected that the number of elderly
individuals diagnosed with chronic diseases will increase significantly over the next several years. The
increased necessity for long-term care services will continue to hurt our health care delivery system and the
increased utilization of long-term health care services has had a negative impact on government spending
(Morrison & Furlong, 2014).

Growing Population Needing Care

The Baby Boomer population is getting older and with this, the number of Americans over the age of 65 years
old is projected to more than double the elderly population: 40.2 million in 2010 to 88.5 million in 2050
(Vincent & Velkoff, 2010). Because of mental or physical limitations or both, the long-term care necessity is
functionally dependent upon a long-term basis. Limitations can be assessed into two categories by health
care clinicians: activities of daily living and instrumental activities of daily living (Morrison & Furlong, 2019).
The number of individuals needing long-term health care has grown and will continue to substantially grow in
the future; however, it is hard to predict the makeup and size of the population. This can be due to new
medical technologies and treatments that could help delay, prevent, and compensate for different functional
difficulties. Further reasoning may be that disability injuries and diseases could be lowered by environmental
protection measures and health-related lifestyle changes (Morrison & Furlong, 2019).

In the 1980s, as a result of advancements in health care, long-term health care services began to emerge
(Morrison & Furlong, 2014). Individuals with chronic diseases began to live longer because of medical
advancements. For example, if the death rate from heart disease is lowered from such factors as new
technologies and a healthier lifestyle, people may live longer, which could create a pathway of late onset
illness such as Alzheimer’s disease (Morrison & Furlong, 2019). Demographic factors also play a role in the
future needs of an aging population through access and financing. Some continued concerns regarding

UNIT III STUDY GUIDE
Ethics and Long-Term Care

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long- term care services include poor quality, a shortage of long-term care workers, strict eligibility
requirements, and social and demographic factors.

Long-term health care services can be available in many different settings:

• from a home health agency that comes to an individual’s home,
• from friends or family,
• from an adult day services center in a community,
• through assisted living communities in a residential setting, or
• from nursing homes in health care institutions (Harris-Kojetin rt al., 2013).

Assisted Living

Assisted living is a part of long-term health care that provides care for adults who need assistance with daily
activities. These daily activities may include bathing, dressing, taking medications, and cooking meals. In the
1980s, assisted living emerged to accommodate elderly individuals who did not need 24-hour nursing
services but wanted medical assistance in a home-like setting. Assisted living has been a preferred care
alternative for some elderly individuals because of the privacy and independent living that is offered to the
individuals (Morrison & Furlong, 2014). Assisted living is relatively cheaper than nursing homes but can still
be expensive and not affordable for many individuals. In addition, the ethical principles of beneficence and
nonmaleficence are disrupted when there is an inadequate number of staff available to provide necessary
care.

Palliative Care

Palliative care is an option for an individual living with an illness (National Institute on Aging, n.d.). Palliative
care can assist individuals with knowing and understanding their options for treatments as well as improve the
quality of life and manage symptoms for an individual with an illness; in addition, it can be given with curative
treatment, and prognosis does not matter. Palliative care is aimed at providing a seriously ill patient with relief
from stress, pain, or symptoms (Colo. Rev. Stat., 2016). Its goal is to improve the quality of life for the family
of the patient and the patient. Several issues concerning access to quality health care for an elderly
population, like long-term palliative care, have arisen and need to be addressed. A palliative care consultation
team can help an individual, his or her family, and the health care team with emotional and practical support.
This type of care can be provided in outpatient facilities, nursing homes, specialized clinics, at home, or in
hospitals (National Institute on Aging, n.d.). In some cases, Medicare and Medicaid may cover palliative care.
Although there are exceptions to this, the majority of palliative care cases are for an elderly population
(Morrison & Furlong, 2019).

Hospice

Hospice provides comprehensive comfort care and support, but it does not attempt to cure the individual’s
illness and is given to an individual with a terminal illness who is believed to have six months or less to live
(National Institute on Aging, n.d.). It is similar to palliative care. Although hospice centers and staff do exist,
hospice is an approach to care, and it may not be tied specifically to a place. Hospice is typically provided at
a patient’s home or at hospitals, long-term care facilities, hospice centers, or nursing homes. Hospice brings
together a skilled team who provide the dying individual and his or her family with emotion, medical, and
spiritual support. Hospice works by using a team of health care professionals, volunteers, clergy, or
counselors to develop a care plan that deals with symptom control and pain management for the terminally ill
person (National Hospice and Palliative Care Organization, n.d.). Usually a family member cares for the
terminally ill person, and hospice staff make regular visits to see and assess the patient. In times of an
emergency or need, hospice staff are on call 24 hours a day, 7 days a week.

Costs of Care

Current costs for long-term health care are large and likely to increase in the future (Morrison & Furlong,
2019). Discovering a method to pay for long-term health care services is an increasing issue for elderly adults
and individuals with disabilities and their families and is a large obstacle for federal and state governments
(Reinhard et al., 2011; U.S. Senate, 2013). The cost of long-term health care if paid out-of-pocket can be
financially straining for an individual and his or her family. For some elderly individuals, long-term health care

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is out of reach because it is unaffordable. There are government programs available to assist with funding for
long-term health care and palliative care services: Medicaid, the Veterans Health Administration, the Older
Americans Act, and Social Security’s Title XX (DeNavas-Walt et al., 2006). Frequently, elderly individuals find
themselves ineligible for long-term health care to be covered by these funding sources.

Private, long-term health care insurance is another option for funding long-term health care needs. However,
private insurance is still limited in its scope and duration for long-term health care, as well as it being
expensive, especially for an elderly individual (Morrison & Furlong, 2019). Private insurance companies that
offer long-term health care benefits often have limitations that may prevent individuals from receiving
necessary services. Continuing care retirement communities (CCRCs) are a variation of private insurance
that provide comprehensive health care services including long-term health care. Typically, residents of such
a community are relatively healthy and are middle- and upper-income individuals who pay a hefty entrance
fee as well as monthly fees in order to receive life care (Morrison & Furlong, 2019).

Medicaid is a federal-state funding program for individuals who are below a specified income threshold and is
used to finance health care. Medicaid does not pay for all home health care services that may be needed for
individuals but provides reimbursement for the most medicalized services that are necessary to maintain long-
term health care individuals in a home environment (Morrison & Furlong, 2019). Medicaid also includes a
special waiver program that allows states to offer a bigger range of non-medical home care services.

Conclusion

The tremendous future growth of an older population is expected to include millions more disabled elderly
individuals. The number of younger disabled individuals has also grown, and this trend may continue to
increase (Morrison & Furlong, 2019). Long-term health care services offered through assisted living, palliative
care, and hospice are great options for elderly individuals if they are in need of such care and can afford the
health care services.

References

Colo. Rev. Stat. § 1011-1 (2016).

DeNavas-Walt, C., Proctor, B. D., & Lee, C. H. (2006). Income, poverty and health insurance coverage in the

United States: 2005. U.S. Census Bureau. https://www.census.gov/prod/2006pubs/p60-231.pdf

Harris-Kojetin, L., Sengupta, M., Park-Lee, E., & Valverde, R. (2013, December). Long-term care services in

the United States: 2013 overview (DHHS Publication No. 2014–1040). Centers for Disease Control
and Prevention. https://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf

Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning.

Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning.

National Hospice and Palliative Care Organization. (n.d.). Hospice care overview for professionals.

https://www.nhpco.org/hospice-care-overview/

National Institute on Aging. (n.d.). What are palliative care and hospice care?

https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care#palliative

Reinhard, S. C., Kassner, E., Houser, A., & Mollica, R. (2011, September). Raising expectations: A state

scorecard on long-term services and supports for older adults, people with physical disabilities, and
family caregivers. American Association of Retired Persons.
https://assets.aarp.org/rgcenter/ppi/ltc/ltss_scorecard.pdf

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U.S. Senate. (2013, September 18). Commission on long-term care: Report to Congress.
https://www.medicareadvocacy.org/wp-content/uploads/2014/01/Commission-on-Long-Term-Care-
Final-Report-9-18-13-00042470.pdf

Vincent, G. K., & Velkoff, V. A. (2010). The next four decades: The older population in the United States: 2010

to 2050 (U.S. Census Bureau Report No. P25-1138). U.S. Census Bureau.
https://www.census.gov/prod/2010pubs/p25-1138.pdf