The term “value addition” refers to the practices undertaken by organizations in order to improve their services. Nursing facilities should offer effective and safe support to their clients. Such homes can “use various value-added support strategies to provide the best care to its clients” (Ginter, Duncan, & Swayne, 2013, p. 36).
The first value-added support strategy is “market research”. Every nursing home can use this strategy to inform more people about its services. The strategy will also monitor the habits of different patients. The second value-added support strategy is the provision of quality services. The targeted facility can use new systems in order to offer the best care. Another powerful value-added support strategy for a nursing home is “follow-up” (Berwick & Hackbarth, 2012, p. 1514). This practice will ensure the facility offers the best medical care.
Three Market Segments for a Walk-In Clinic
Walk-in clinics “offer timely medical support to many patients” (Ginter et al., 2013, p. 65). These clinics can target different segments in order to emerge successful. Walk-in clinics offer appropriate medical support to many individuals with various health needs. Such walk-in clinics can “identify specific market segments in order to achieve their goals” (Ginter et al., 2013, p. 38). The first market segment is a region with many elderly citizens.
These citizens encounter health problems. The walk-in clinic will ensure the facility achieves the best market share (Wong & Beglaryan, 2004). The second segment should be an urban region or city. The targeted city should have a large number of potential clients. The institution can also target a specific gender. Many women encounter various health problems. A market segment characterized by a large number of women will make the walk-in clinic successful (Ginter et al., 2013).
Value-Added Strategies
The identified healthcare organization for this exercise is Memorial Hermann Texas Medical Center (MHTMC). This facility provides effective medical care to different patients. MHTMC can use various value-added strategies in order to achieve its mission. The “first value-added strategy is improving the quality of its medical support (Robinson, 2013, p. 11). The organization can hire competent caregivers in order to deliver quality services.
Such caregivers should provide the best care to every patient. The second value-added strategy entails the use of effective logistical operations. This approach will “ensure the facility acquires the required medical resources in a timely manner” (Wong & Beglaryan, 2004, p. 24). The organization will provide timely support and care to its patients. The third approach can “focus on modern medical tools and equipment” (Robinson, 2013, p. 12). These resources will ensure the facility offers quality medical services.
Implementation and Mapping
The “term implementing a value-added strategy refers to the efforts aimed at improving the competitive advantage of an institution” (Burns, Dyer, & Bailit, 2014). Healthcare institutions should use the best techniques in order to implement the best value-added options (Burns et al., 2014). MHTMC can hire competent nurses in order to offer evidence-based services. The “term mapping for sustainability refers to the best practices aimed at promoting the performance of an organization” (Robinson, 2013).
For instance, a healthcare facility “can redesign the quality of its services” (Berwick & Hackbarth, 2012, p. 1515). This strategy will ensure the targeted facility achieves its mission. MHTMC should consider specific environmental factors in order to remain sustainable. A good environmental factor to consider is technological change (Robinson, 2013). The institution should monitor every technological change in order to achieve the best goals.
Reference List
Berwick, D., & Hackbarth, A. (2012). Eliminating Waste in U.S. Health Care. Journal of the American Medical Association, 307(14), 1513-1516.
Burns, M., Dyer, M., & Bailit, M. (2014). Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care. Web.
Ginter, P., Duncan, W., & Swayne, L. (2013). Strategic Management of Health Care Organizations. San Francisco, CA: Jossey-Bass.
Robinson, J. (2013). Value Added Strategies to Sustain a Successful Value Improvement Program. Web.
Wong, J., & Beglaryan, H. (2004). Strategies for Hospitals to Improve Patient Safety: A Review of the Research. The Change Foundation, 1(1), 1-48.
In 2019, the state of Texas spearheaded the implementation of the Medicaid expansion for promoting affordable healthcare for middle and low Americans. The bill number for the Medicaid Expansion program in Texas is HR584 and was sponsored by Rep. Veasey, Marc A, with other House of Representatives (Sommers, 2016). The cosponsors included Sewell, Terri A., and Cohen, Steve, with many others. The benefit of the Medicaid expansion was strengthening health coverage, increased access to medical care, and promoting better health outcomes by reducing deaths, escalating economic security and opportunities, increased response to Covid-19, and lower care costs (Sommers, 2016).
Advocacy in population health plays a significant role in influencing the public and policy-makers that significantly influence health policies (Artiga et al., 2019). The advocacy in population health has the function of serving as the trusted voice for informing the health department’s population. Advocacy also provides a capacity-building necessary for reporting public health departments and population health and improving public health policies. The advocacy also provides the roles of educating, provisioning patients, and supporting patients by forming the right decision in the exact situation.
ANA codes provide several obligations, including ethics, responsibility, duties, ethical standards, and the nurses’ commitment to society. The ANA codes foster respect for human dignity, interaction with patients, and the nature of health. They also provide the right to self-determination, the nurse’s relationship among colleagues and other providers. It also addresses the conflict of interest, collaboration, and professional boundaries. They provide the right of privacy and confidentiality, the guidelines for research, performance standards and the review mechanism, and practices competencies. The codes promote the protection of the patients and their safety as well as protection from impaired practices.
References
Artiga, S., & Hinton, E. (2018). Beyond health care: the role of social determinants in promoting health and health equity. Health, 20(10), 1-13.
Sommers, B. D. (2016). Medicaid Expansion in Texas: What’s at Stake? Commonwealth Fund.
Long-term care (LTC) constitutes a variety of services available to patients that require care for an extended period. These could constitute recovery from injuries, treatment of extended or chronic disorders, end-of-life care, and so forth (Belchamber, 2021). Long-term care systems in Texas provide a variety of options based on an individual’s needs. The reasons why a system should be equipped to provide a variety of LTC services stem from the fact that equipping a facility to provide every sort of potential service is expensive, meaning that many patients will not be able to afford it. Dedicated facilities are smaller, require less personnel, and could focus on providing the highest quality of service in their selected field.
Some examples of preventative LTC services include screenings, restorative vacation facilities, and vaccination programs. Screenings for various diseases, such as cancer, diabetes, and other potential healthcare issues, take time and allow the prevention of potential negative outcomes (Shi & Singh, 2022). Restorative vacations are recommended for people of all ages to facilitate proper development, reduce stress, and improve general physical and mental wellness. Vaccination programs allow countering dangerous diseases by artificially stimulating immune responses to various viral and bacterial agents (Shi & Singh, 2022). Preventative LTC services, thus, play an important role in reducing the number of incidents that would require much more continuous and expensive care.
The chosen LTCs for this paper is Belmont Village Turtle Creek and Brookdale Lake Highlands. Both of these facilities provide end-of-life care to elderly patients, offering an assortment of services related to non-invasive and preventative care. Belmont Village offers services in housekeeping, linen changing, meal preparation, salon services, maintenance, transportation, and parking (“Belmont Village Turtle Creek,” 2021). In addition, the personnel at the facilities have been trained to administer medications to patients that require them (“Belmont Village Turtle Creek,” 2021). These are relatively basic services that aim to cater to the elderly who do not experience any significant health issues, limited mobility, and other conditions that would require more extensive and qualified standards of care.
Brookdale Lake Highlands offers a similar plethora of services, those being bathing, dressing, grooming, and ambulation. They also offer a variety of restorative and preventative activities for patients, including clubs, swimming, dancing, and sports among others (“Brookedale Lake Highlands,” 2021). The facility does not offer any case management but does seek to tailor the experience and services provided to each patient rather than offering standardized hospitality and treatment to everyone (“Brookedale Lake Highlands,” 2021). The differences between the two companies are slim, as they compete with one another for the same customers. It appears that Brookdale offers a more tailored experience, while Belmont offers a generally higher standard of care.
The patient population appropriate to both of these LTC facilities includes elderly populations for a peaceful end-of-life experience as well as daily care that does not involve complex medical treatments. While these organizations can handle offering assistance in mobility, housekeeping, and restorative entertainment, they are not equipped to deal with serious health issues. It is recommended for these facilities to keep a small number of well-trained medical personnel on hand in case of an emergency and have the contacts of the nearest hospitals to handle acute health problems (Belchamber, 2021). Aging populations require a higher quality of supervision and care, as well as precautions to avoid injuries and exacerbation of existing health issues.
References
Belchamber, C. (2021). Payne’s handbook of relaxation techniques: A practical handbook for the health care professional. Elsevier Health Sciences.
Unlike other countries, the political system of the United States historically developed with power distribution shifted towards the states having some form of autonomy. For instance, the Articles of Confederation were developed and ratified after the US gained independence from Great Britain, which initially included 13 states (United States Department of State, 2020). It outlined how the national government should operate in accordance with its predetermined roles as a consolidator of national interests. In other words, the document ensured national unity among the states with minimal influence, making the central government weak and granting the states a higher degree of autonomy (United States Department of State, 2020). However, the Articles of Confederation were later replaced by the United States Constitution on March 4, 1789 (The Library of Congress, 2017). Therefore, the initial desire for autonomy among states still persisted even after the adoption of the Constitution, which impacts the current events. For example, the most recent example is a ban of COVID-19 vaccine mandates by Texas Governor Greg Abbott, which demonstrates states still retained some form of governmental autonomy compared to other nations, where it would not be possible to operate against the national government (Allen, 2021). Therefore, the history of the American political system is heavily influenced with state autonomy.
In the case of civil rights and civil liberties, the United States political system was also affected by Civil War, slavery, and segregation, which all shaped how the current political system functions. The war was a direct result of states wanting to retain their autonomy, especially in regards to slavery and other economic interests over human rights. Therefore, the American political system’s power distribution is heavily tilted towards states compared to other nations, such as European countries.
References
Allen, R. (2021). Texas Gov. Greg Abbott bans any COVID-19 vaccine mandates — including for private employers. The Texas Tribune. Web.
The Library of Congress. (2017). The Articles of Confederation. Web.
United States Department of State. (2020). Articles of Confederation, 1777–1781. Web.
Care Coordination and Nursing Homes: The Nature of the Issue
Care coordination is a considerable problem for long-term facilities, including nursing homes, due to the amount of interactions between specialists (Primaris, 2015).
Examples of specialists that collaborate with nursing home residents: physicians, nurses, residential staff, certified healthcare assistants, internists (Primaris, 2015).
In the context of nursing homes, care coordination can take diverse forms:
Close collaboration with hospitals to get detailed health information pertaining to new nursing home residents.
Timely exchange of information with hospitals to manage and address residents’ need for acute care services.
Focused communication with residents and families in order to develop and improve care plans or keep families updated on their relatives’ health status in case of acute issues (Primaris, 2015).
Dear audience, as those working in long-term care, you definitely know how important it is to practice a patient-oriented approach to care provision. In nursing, the coordination of care is aimed at improving the organization of patient care activities involving different participants in order to facilitate service delivery and maximize positive outcomes for the patient. Without exaggeration, care coordination is the issue of utmost significance for nursing homes since these receiving facilities are to organize effective interactions between residents/families and medical and care staff. In its guide for nursing homes, Primaris (2015) highlights that care coordination is a very broad topic for such facilities since it involves purposeful communication with both hospital service providers and residents and their families. In this presentation, we will delve into the ethical and policy factors affecting the organization of such communication and discuss issues surrounding care coordination in nursing homes.
Care Coordination/Continuum of Care in Nursing Homes and Ethical Standards
The Code of Ethics for Nurses establishes non-negotiable ethical standards that any healthcare institution is supposed to support and implement.
Provision 7.1: nurses should maintain their commitment to patients “throughout the continuum of care” (American Nurses Association, 2015, p. 42).
Provision 3.1 discusses issues at the confluence of patient privacy and teamwork.
Provision 3.1: nursing professionals are responsible for providing necessary and accurate information to those “who have a need to know” (ANA, 2015, p. 21).
Provision 3.1: the principle of patient confidentiality is not absolute and can be modified to promote safety or comply with mandatory reporting requirements (ANA, 2015).
Provision 3.1: data security must be emphasized when sharing data using electronic health records (ANA, 2015).
Provision 3.1: to be disclosed to other parties, patient information should be relevant to the planned task (ANA, 2015).
Provision 1.3: nurse leadership involves planning care in a way that reduces the threat of patient suffering and using unwanted treatments (ANA, 2015).
Provision 1.5: nurses can take on the role of care coordinators and are expected to create “the culture of civility and kindness” regardless of the role that they fulfill (ANA, 2015, p. 15).
Provision 8.3: nursing professionals have to understand specific issues associated with cultural/ethnic diversity and create conditions to facilitate care provision to dissimilar populations (ANA, 2015).
Provision 2.3: nurses are expected to foster collaborative planning (ANA, 2015).
Provision 2.3: collaboration should involve mutual respect/trust and shared decision-making and responsibility; collaborating professionals should provide patients with assistance in sorting out priorities and deciding between alternatives (ANA, 2015).
Provision 2.3: nurses that fulfill different roles are interdependent and are supposed to share responsibility for care outcomes (ANA, 2015).
The ethical value of patient-centeredness finds reflection in the expectation to organize interdisciplinary collaboration in a manner that allows developing care plans within two calendar days of admission (Unroe, Ouslander, & Saliba, 2018).
As you know from everyday practice, care coordination in long-term facilities involves a substantial amount of collaboration. To analyze care coordination from the viewpoint of ethical issues, it is helpful to consult with the foundational document by the American Nurses Association. First of all, the code includes Provision 7.1 which establishes nurses’ commitment to patients as the chief principle related to care continuum (ANA, 2015). Next, Provision 3.1 provides a detailed discussion of nurses’ ethically appropriate approach to sharing confidential and sensitive information (ANA, 2015). From this provision, it is clear that for care coordination efforts to be ethical, data sharing in such activities should be purposeful, compliant with the need-to-know restrictions, and aimed at maximizing patient safety without compromising data security. As professionals caring for specifically vulnerable populations, you are expected to put these national ethical standards into practice on a daily basis.
To continue, from Provisions 1.3 and 1.5, it is clear that non-maleficence and the promotion of kindness are among the basic values pertaining to different roles, including care planning (ANA, 2015). Interestingly, the guide for nursing homes by Primaris (2015) also states that care coordination activities should emphasize the patient and his or her preferences and unique health risks (ANA, 2015). Finally, Provision 8.3 puts a premium on nurses’ ability to recognize the needs of different populations. To some degree, it implies that there should be no ethnicity and race-related differences in satisfaction with care coordination activities among nursing home residents.
Apart from what has been mentioned before, there are other provisions in the Code of Ethics that might have relevance to the organization of care coordination activities. Thus, Provision 2.3 sheds light on specific expectations of nursing specialists, including enabling different parties to participate in collaborative care planning and explaining to patients everything that they need to know about available care options. Moreover, this part of the Code of Ethics highlights the importance of sharing responsibilities and getting involved in intraprofessional collaboration with other nurses, which also has to deal with coordination. Next, patient-centeredness is a common priority that is emphasized in current performance expectations associated with nursing homes’ role.
Social Determinants of Health and Similar Factors
To facilitate care coordination, policies targeted at nursing homes should emphasize practices that reduce health disparities.
Disparities can be related to cultural and linguistic differences, such as lack of interpreters or failure to give due consideration to residents’ culture-specific care needs; also, they stem from prejudice and human rights violations (ANA, 2015).
Social determinants of health (SDOH) refer to the various factors that contribute to better or poorer health outcomes and largely determine people’s satisfaction with life.
Policy/ethical factors related to SDOHs and factors contributing to health (HealthyPeople.gov, n.d.):
Access to healthcare – rules regarding the provision of alternative care options in case of nursing homes’ planned closure (Patient Protection and Affordable Care Act, 2010).
Care quality – data transparency rules for nursing homes to facilitate clients’ informed decision-making (PPACA, 2010); HIPAA privacy requirements related to health information technology.
Discrimination – non-prejudiced attitudes to patients (ANA, 2015); respect for residents’ and employees’ linguistic identity (Tex. Health and Safety Code, 2017).
Exposure to crime – mandatory employee background checks; the presence of policies to prevent felons and drug addicts from caring for residents; video surveillance rules to minimize the risks of abuse in nursing homes (THSC, 2017).
National Policies and Care Coordination in Nursing Homes: Impact and Implications
PPACA (2010) contains specific data transparency provisions to be implemented by nursing homes; such provisions are to continue nursing home quality improvement efforts initiated due to the Federal Nursing Home Reform Act of 1987.
Section 6101: nursing homes should publicly disclose personal and job-related information (first/last name, job title, duration of employment, etc.) of anyone in their governing bodies (PPACA, 2010).
Section 6101: nursing homes are expected to publicly disclose information about their directors, partners, and employees that are responsible for managerial tasks (PPACA, 2010).
Section 6101: information on relationships with other disclosable parties (any service providers), as well as such parties’ organizational structures, should also be reported (PPACA, 2010).
Section 6101: nursing home organizations with at least five facilities should implement the proposed ethics programs to reduce both civil and administrative violations and improve ethics education (PPACA, 2010).
Section 6103: nursing homes should provide accurate and regularly updated information on their performance (service quality, staffing levels, turnover rates, staff training, etc.) for the Nursing Home Compare website (PPACA, 2010).
Section 6103: such information should be in a clear format and include official complaint forms (PPACA, 2010).
Section 2717: better quality of care should be ensured through measures and programs to reduce hospital readmission rates (PPACA, 2010).
Section 6113: if a facility has to be closed, the administrative staff should develop and submit a detailed resident relocation plan beforehand (PPACA, 2010).
Health Insurance Portability and Accountability Act enacted in 1996 establishes strict privacy and data security requirements for EHRs and EMRs.
As of 2018, more than 80% of U.S. nursing homes had EMR systems (Powell et al., 2020).
In 2016, around 30% of nursing homes used EHRs to exchange patients’ health information with other providers (Alvarado, Zook, & Henry, 2017, p. 8).
Nursing home administrators recognize security concerns and fears of lawsuits as significant barriers to the implementation of health information technology (Powell et al., 2020).
The use of health IT for data sharing is among the most promising approaches to better care coordination in nursing homes (Primaris, 2015).
Apart from officially expressed expectations peculiar to nursing ethics, it is critical to stay informed of national policies that outline the key rules and priorities that nursing homes are supposed to consider in care coordination. Particularly, PPACA (2010), the law that is more commonly known as Obamacare, contains provisions that impact nursing homes’ activities in the United States with special attention to the transparency of information. Section 6101 is entirely devoted to data reporting requirements aimed at facilitating the control of nursing homes’ patient care activities and establishing the need for ethics programs. Basically, these requirements can contribute to residents’ satisfaction with care coordination activities by increasing nursing homes’ accountability.
To continue on healthcare policies that affect all nursing homes in the United States, it is essential to look at Section 2717 that refers to the ultimate need for better care coordination activities to reduce hospital readmissions (PPACA, 2010). Unnecessary readmissions are an essential care coordination issue for nursing homes, and the latter may sometimes be required to start offering new post-acute care services to minimize avoidable readmissions (Primaris, 2015). Next, Section 6103 of PPACA (2010) might contribute to patient safety in care coordination activities by enhancing residents’ and families’ access to credible information about nursing homes’ actual human resources and performance. Finally, Section 6113 refers to coordination activities peculiar to relocation (PPACA, 2010). Thus, nursing homes that are about to close are supposed to coordinate efforts with other providers to make sure that all residents will be accepted by appropriate facilities. This may increase the complexity of coordination activities undertaken by nursing homes since the relocation options need to be selected with special attention to individual residents’ care needs.
Similarly to other types of facilities, nursing homes are affected by HIPAA provisions regarding the security of patients’ health information. As the recent study by Powell et al. (2020) indicates, the majority of U.S. nursing homes make use of at least basic EMRs in order to improve the coordination of activities. Due to their technical characteristics and opportunities for data integration, EHRs are much better for care coordination, but only 30% of nursing homes use them to improve interprofessional collaboration (Alvarado et al., 2017). Despite the promise of health IT for care coordination, nursing homes are not entirely confident in their ability to use technology without facing risks to the safety of patient data, which is an important ethical concern.
State/Local Policies and Care Coordination in Nursing Homes: Impact and Implications
The City of Houston does not have very specific local policies for nursing homes – such facilities are supposed to comply with THSC (2017).
Chapter 242 of THSC (2017) states that:
To provide high-quality care, licensed nursing homes must meet a range of requirements related to services (coordination, accessibility, care continuity, professionalism, etc.);
Regardless of the purpose of such actions, it is not appropriate to impose language requirements on residents and employees with native languages other than English and prevent them from communicating in these languages;
The freedom of language use has to deal with the requirement to respect patient dignity and individuality (ACA, 2015).
To promote safety and patients’ active participation in care decision-making, it is essential to provide residents and their families with the opportunity to control the quality of services.
In nursing homes, video camera surveillance is a popular measure used to respond to the threats of elder abuse.
In Chapter 242 of THSC (2017), the following provisions regarding electronic surveillance are presented:
The guardians and other representatives of residents have the right to request electronic monitoring;
Such representatives can file complaints to the Texas Department of Human Services in case of nursing homes’ failure to comply with their requests;
Nursing homes in Texas cannot deny services to new clients or try to remove any residents because of the requests to conduct electronic monitoring;
All residents living in the room to be monitored should be informed about the planned activities and give their consent in a written form.
Potential ethical issues: patients’ right to privacy.
Chapter 250 of THSC (2017) states the following:
Nursing homes should have effective employee testing policies in place;
Such facilities cannot allow new employees to work with residents without implementing policies to check their criminal background and test for drug use;
Upon request from any parties, nursing homes should provide them with access to full statements that describe policies used to select employees that will care for residents.
Provision 2.2 of the Code of Ethics – nurses’ actions and decisions should help to promote patient safety (ANA, 2015).
The inability to comply with other healthcare organizations’ and team members’ requests would be a violation of ethical standards and state policies affecting nursing homes in Houston, Texas.
Nursing homes’ efforts to check employees’ background are important to make sure that all parties involved in care planning and coordination are professional and employable.
Chapter 250 of THSC (2017) contains the following provisions regarding criminal background checks in nursing homes:
Facilities and employers can request information pertaining to employees’ criminal history;
Such checks can be conducted when an individual applies to a job or in other instances specified by employers and facilities;
If the employee turns out to have criminal convictions, the facility should review the case to make an informed decision concerning this person’s ability to work with residents.
Provision 2.2 of the Code of Ethics: healthcare professionals are to recognize situations involving the risks of conflicts between personal and professional values and avoid such situations (ANA, 2015).
Some facilities give preference to inexpensive employee background checks, which can affect patient safety (Harney & Kennon, 2018).
State policies, such as THSC (2017), can also have implications on local nursing homes’ care coordination efforts. For these institutions, coordination is about effective communication between multiple parties (Primaris, 2015). Potentially, the provisions of the code regarding residents’ and employees’ freedom of language can give rise to conflicts and misunderstanding between providers and linguistic minority patients. This can create barriers to effective exchange of information regarding preferred treatment options and key health issues, which is crucial for effective care coordination efforts. Basically, the question of whether or not restrict one’s language freedom may introduce the dilemma of respecting patients’ identity and individual decisions versus facilitating easy and timely collaboration between those to participate in care coordination.
Effective collaboration between residents’ representatives and nursing homes is a prerequisite to proper care coordination, but conflicts related to monitoring can serve as barriers to it. As you can see from the bullet points, the law of Texas protects the right of residents’ representatives to monitor the process of care provision to prevent abuse. Despite helping to promote safety, such provisions also involve the risks of ethical issues and dilemmas, such as the need to provide necessary surveillance assistance to specific patients without infringing upon their roommates’ privacy rights.
To continue, Chapter 250 of THSC (2017) impacts nursing homes by implementing rules to control their collaboration with other parties involved in the care process, including patients. To make sure that patients will be safe, different parties may wish to check nursing homes’ internal policies prior to engaging in professional partnerships. Nursing homes are obliged to offer this opportunity to external organizations and individuals to prove their ability to carefully select employees, thus promoting resident safety. In the context of coordination efforts involving nursing homes, it means that such facilities are required to grant access to information on their internal rules to potential care coordination partners if such need arises. As for the ethical issues and concerns, this requirement is aligned with the expectation to prioritize patient safety and put it first in any conflicting situation (ANA, 2015).
Finally, it is important for nursing homes to bring together qualified professionals with a good reputation to organize successful care coordination and provision activities (Primaris, 2015). Employee selection policies play a huge role in achieving this goal. This slide summarizes state-level requirements that all nursing homes are expected to meet. The potential problem is that facilities are granted some power in evaluating the cases of employees with the criminal past. Of course, Chapter 250 of the discussed code provides a large list of offenses related to violent behaviors that completely bar anyone from working in nursing home settings (THSC, 2017). At the same time, personal relationships with employees/job applicants or severe personnel gaps may sometimes affect facility managers’ decision-making. Poor employee choices can also stem from conflicts between facilities’ financial interests and ethical obligations (Harney & Kennon, 2018). Thank you very much for attending the presentation, this is it for the main policy and ethical issues affecting nursing homes.
References
Alvarado, C. S., Zook, K., & Henry, J. (2017). Electronic health record adoption and interoperability among US skilled nursing facilities in 2016. ONC Data Brief, (39), 1-14.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.
Harney, A., & Kennon, K. (2018). Need for stricter screenings of nursing home workers. Sociology International Journal, 2(6), 833-837.
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).
Powell, K. R., Deroche, C. B., & Alexander, G. L. (2020). Health data sharing in US nursing homes: A mixed methods study. Journal of the American Medical Directors Association. Web.
Primaris. (2015). Coordinating care: A guide for nursing homes. Primaris: Healthcare & Business Solutions.
Tex. Health and Safety Code § 242 (2017).
Tex. Health and Safety Code § 250 (2017).
Unroe, K. T., Ouslander, J. G., & Saliba, D. (2018). Nursing home regulations redefined: Implications for providers. Journal of the American Geriatrics Society, 66(1), 191-194.
The expansion of medical coverage for Americans under the provisions of the Affordable Care Act entails the increase of insurance rates and the improvement of overall public health due to the extended coverage. However, not all of the states have implemented this change to the healthcare legislation, which restricts their economic and healthcare system benefits in the short- and long-term perspectives. In particular, the state of Texas is one of those that have not yet implemented the Medicaid expansion decisions. This paper demonstrates that the state’s medical sphere is characterized by higher costs of treatment and uninsured populations than states where expansion has been implemented.
Texas has not implemented Medicaid expansion yet, which has implications for the healthcare and economic spheres. In particular, the decision not to expand Medicaid has impacted Texas’ healthcare system in a manner that limits its opportunities to minimize treatment costs. Indeed, as found by Saygili (2022), states with Medicaid expansion have 4.71% lower costs of treatment than Texas. Furthermore, since Texas shares borders with several states, patients from those states obtain services in Texas hospitals, which exposes the population of other states to the disadvantages of non-expanded Medicaid coverage. Moreover, the limited access of particular populations to Medicaid insurance has adverse long-term impacts on the public health of the citizens.
Thus, when tackling the question of whether to expand or not, the states take different positions, which in the case of Texas, demonstrates the lack of willingness of the state authorities to do so. However, the negative manifestations of the lack of expansion, such as low insurance rates and high treatment costs, demonstrate the risks for people that might be avoided. Therefore, Texas should expand its Medicaid coverage to benefit from the program.
Reference
Saygili, M. (2022). How would Medicaid expansion affect Texas hospitals? Evidence from a retrospective quasi-experimental study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 1-8.
Based on the Texas Board of nursing consequences are taken by a DWI 9 license obtained by an RN on an annual renewal form in Texas within nine months. In Texas, handling such a scenario requires the Texas Board of Nursing (TBON) to think that not all complaints about a nurse’s capacity to practice safely will need the same level of board involvement or result in disciplinary action. Furthermore, the TBON thinks that substance use disorders are curable diseases and that nurses who have made a stable recovery may safely offer care to patients in specific circumstances (Bettinardi-Angres, 2020). In this case, the Registered Nurse should expect a Tex. Occ. Code 301.4521.
The board of nursing considers all of the details surrounding the specific incidents in the issue. In some situations, there may be a need for occasional drug tests, letters of recommendation, assessments from current and previous employers, and signed records of support groups. Individual participation in a Texas Board of Nursing-approved peer help program may be one of the fines. Because this is a second infraction, it may subject the nurse’s license to probation and other limitations (Bettinardi-Angres, 2020). If the RN follows the board’s ruling and suggestion, the outcome will be good, with the board giving the nurse’s license. However, the decision might go either way based on the situation.
The RN with a current New York license that has moved to Texas and applied for a Texas license. On application, she wrote that she was convicted of Medicaid fraud ($ 5,230.00) four years ago be off probation in six months. In this circumstance, the nursing board will examine the case as if it were any other. According to Texas Board of Nursing policies on fraud, will thoroughly investigate various factors surrounding this event. However, the board clearly defines fraud over $5,000 as a felony (Stowell et al., 2020). In such a situation, the board will advise the nurse because it will most likely deny the practice license based on this information. If the nurse license is approved, it will very certainly come with conditions, such as the nurse not being allowed to work with Medicare patients.
References
Bettinardi-Angres, K. (2020). Nurses with substance use disorder: Promoting successful treatment and reentry, 10 years later. Journal of Nursing Regulation, 11(1), 5-11.
Stowell, N. F., Pacini, C., Schmidt, M. K., & Wadlinger, N. (2020). Senior health-care fraud under investigation. Journal of Financial Crime.
The primary purpose of the current Emergency Management ESF-5 Annex (ESF-5), approved in March 2020, is to designate coordination mechanisms, the responsibilities, and actions required from stakeholders involved in emergency operations. The purpose, as stipulated, is that the successful response to accidents across the state necessitates the coherent coordination of efforts of federal, state, and local agencies and organizations to react and assist in an affected area (Kidd, 2020). The scope of the purpose expands to all possible natural, anthropogenic, and technological disasters that entail the heightened readiness of the State Operations Center (SOC), Regional Emergency Operations Center (REOC), and other entities.
Concepts of Operation
ESF-5 Emergency Management is organized following the National Incident Management System (NIMS) and the Incident Command System (ICS). The present emergency management plan embraces all core activities, including prevention, protection, response, mitigation, and recovery. Furthermore, it requires thorough plans and procedures, material and human resources, effective collaboration, and the availability of operational facilities. Emergency management is coordinated by the Texas Division of Emergency Management (TDEM) and supervised by an emergency management director (EMD) accountable for preparing and supporting emergency operations plans (Kidd, 2020). In case of need for additional resources, and EMDs can appeal to their TDEM district coordinator (DC), SOC, or REOC, depending on a calamity’s severity. In particular, SOC is responsible for coordinating the statewide response to incidents, satisfying resource requests, and maintaining contact with the state leadership. Besides that, SOC also coordinates volunteer groups.
Organization and Responsibilities
Emergency activities are executed under six emergency management objectives utilized to all hazards, including severe weather disasters, earthquakes, flooding, and nuclear or radiological incidents. The first objective requires TDEM to develop respective plan templates, guidance, procedures, and agreements for assistance to react to accidents appropriately. In addition to TDEM, the Texas Emergency Management Council (TEMC) also participates in the planning process, providing advice on preparedness, disaster mitigation, and recovery (Kidd, 2020). The second objective aims at maintaining the state emergency management structure linked to state and local decision-makers responsible for meeting the state’s needs. Besides, under this goal, REOC supports a Disaster District Emergency Operations Center (DDEOC) in performing its functions, namely, planning, command, finance, logistics, and recovery. SOC serves as a warning point and communications hub, allowing stakeholders to collect, assess, and distribute critical information (Kidd, 2020). Finally, the responsibilities of the State Management Team comprise collecting, evaluating, and propagating necessary information about incident development, work with the TEMC, and other organizations, monitoring state resources, and reporting on the overall situation.
The third objective is directed at developing and maintaining situational awareness by gathering critical information and detecting needs. In this regard, the awareness is provided by local jurisdictions assisted by the TDEM and SOC via situation reports, WebEOC maintenance, and conference calls. WebEOC is a browser-based crisis information management system intended to create and share immediate-need data (Kidd, 2020). The fourth objective assumes coordinating resources requests by TDEM and o the federal government and supported by the private and voluntary sectors. The fifth objective involves recording and documenting the financial expenditures of all participated agencies to ensure valid justification for federal compensation. The final objective aims at providing response resources, including technical guidance and administrative, personnel, and equipment support, based on operational capabilities and needs.
Emergency Support Functions
Emergency support functions (ESF) are assigned to all necessary organizations and entities and consider many vital areas of activity. For instance, Texas Voluntary Organizations deliver a supportive role in Emergency Management, Mass Care, Logistics, Public Health, and Public Information (Kidd, 2020). TDEM has primary responsibilities in Communications, Emergency Management, Mass Care, and Logistics and offers assistance in all possible activities. Accordingly, the leading roles of the Texas Department of Transportation are related to Transportation and Public Works and Engineering.
References
Kidd, W. N. (2020, March 19). State of Texas emergency management plan: Emergency management annex (ESF-5). The Texas Division of Emergency Management, Preparedness Division.
Texas Clean Air Act (TCAA) was established in 1965 by the Texas House of Representatives Committee following the rise in air pollution due to the massive industrialization of the state.
Legislative Bill Summary
The prominent roles of the act include protecting the physical property of Texas citizens, their welfare and resources, and ultimately, their wellbeing. The TCAA law is divided into seven subchapters, each performing a specific function. While Subchapter A outlines the general provisions and definitions of air pollutants, subchapter B defines the powers of the Texas Committee of Environmental Quality (TCEQ). Additionally, subchapter C outlines the permitting process, which includes issuing operating permits to organizations. The fourth section, subchapter D, establishes how local governments can enforce air protection. Besides, the fifth component, subchapter E, specifies the authority present in the local government that will act as a watchdog of air quality regulation (Committees and subject search results, n.d.). Lastly, whereas subchapter G addresses issues concerning vehicle emissions, subchapter H elaborates on the obligations in the Early Action Compact. This legislative act focuses on ozone layer depletion, vehicle emissions, and emissions of gases such as nitric oxide from factories operating in Texas.
Potential Impact of the Legislation on the Community
The main effect of the legislation on the Texas community is the promotion of healthy living. Based on my opinion, TCAA has reduced health emergencies in Texas since the law has reduced the number of toxic gases such as sulfur and nitric oxides released into the atmosphere. Additionally, the law has reduced children’s predisposition to air contaminants since air pollution mainly affects children due to their surface area to volume ratio. Lastly, the legislation has promoted the construction of efficient cooking and heating systems, preventing the creation of high-emitting-fuel-based technologies, which often result in air pollution.
Agreement or Disagreement with the Legislation
I agree with TCCA due to the paramount role the legislation plays in Texas state. Firstly, TCAA establishes the authorities that are involved in the protection of air quality. Its subchapters, such as subchapter D, outline components that are likely to pollute the atmosphere and even prescribe some of the methods to reduce such constituents in factories. In addition to stating pollutants, the legislation has promoted the building and assembly of sustainable vehicles that emit less carbon blueprint.
The given case analysis will focus on the Uri Snow Storm in Texas, which happened from February 13, 2021, to February 17, 2021. The Winter Storm had impacted the whole territory of the United States, yet the most damage was done to the State of Texas and Houston city in particular (TDEM, 2022). Besides the high levels of snow, freezing, and extreme icicle, the city had experienced the biggest lighting outage in the history of the United States. The case shows that the state HSEM was critical in ensuring collaboration among agencies, such as ERCOT, but the response was highly self-reliant with minimal involvement of the federal resources, such as FEMA.
The emergency management steps were taken in six major areas by the Homeland Security and Emergency Management(HSEM), Federal Emergency Management Agency (FEMA), and Electric Reliability Council of Texas (ERCOT). These included transportation, health, medical, shelter, water, food, as well as leadership and coordination (Austin-Travis County, 2021). It is important to note that the Uri Snow Storm was not a regular emergency because it was significant within the overlapping emergency framework. The emergency management was taken in four steps. Firstly, the warning and notification phase was activated, where “On February 11, Austin Energy published a news release offering cold weather tips and advising customers of the upcoming weather and possible power outages” (Austin-Travis County, 2021, p. 9). This is followed by notifications through a Winter Storm Watch about freezing rains, sleet, and snow (Austin-Travis County, 2021). In other words, the public was thoroughly informed about the upcoming crisis and how to prepare for these stressful events.
Secondly, the activation phase of emergency management was initiated. It is reported that “the State of Texas issued a Disaster Declaration, and the City and County activated Cold Weather Sheltering Plans for cold-weather overnight shelters and warming centers” (Austin-Travis County, 2021, p. 9). The latter was accompanied by community mobilization, especially among the most vulnerable. Due to large-scale power outages, the warming centers were quickly redesigned from short-term shelters to more long-term sustaining ones (Austin-Travis County, 2021). Therefore, the management showed miscalculations about the duration of the storm, but the center adaptation was immediate.
Thirdly, the response phase has activated a state of emergency declared by both the city and county. Documents state: “during the initial 48 hours of the response, the need for shelter space outpaced adherence to COVID-19 social distancing requirements. On February 15, 2021, the number of residents without electricity grew to over 200,000” (Austin-Travis County, 2021, p. 10). The Electric Reliability Council of Texas (ERCOT) was mandated to shut down the supply of power to the majority of its consumers for four consecutive days in order to prevent the collapse of the power grid (Austin-Travis County, 2021). Austin Water was experiencing with water supply, which is why it asked to boil the water for further drinking. The local government purchased “one million gallons of drinking water and began distributing water, and later food, at locations throughout the City and County” (Austin-Travis County, 2021, p. 11). The President issued a Federal Disaster Declaration to further strengthen the support networks for the impacted populations (Austin-Travis County, 2021). The impact of the storm was severe on a multitude of fronts.
Fourthly, the emergency management initiated the recovery transition phase. The shelters and warming centers were demobilized, and Austin Water lifted the boiling water notice completely. The State of Emergency ended on February 21, 2021, which left the only problem (Austin-Travis County, 2021). The latter was the repair and reconstruction of damaged infrastructure, which included plumbing systems, pipelines, power grids, and water delivery networks (Austin-Travis County, 2021). The key agent in all of these processes was the ERCOT, which kept its active efforts due to COVID-19.
The interagency collaboration theory that can be applied to this scenario is the Common Pool Resources framework. It states that “specific patterns of interaction include the history of previous relationships, the presence of one or more champions, and legal and contractual interaction” (Ward et al., 2018, p. 855). It applies by showing that agencies interact through history, leadership, and legal connections. For the former, the Texan government was historically distant and less reliant on the federal government, which shows how the majority of emergency response actions were carried out in a self-sufficient manner. The leadership of the emergency management was run primarily by the ERCOT with strong collaborative support from the City and County. Lastly, the legal connections were most prominent with Austin Water, which shut down its delivery systems completely to prioritize the water distribution towards the affected areas.
The agencies that responded to the emergency were the Homeland Security and Emergency Management (HSEM) Federal Emergency Management Agency (FEMA). The communication and interaction of these agencies determined the effectiveness of emergency resolution in a critical situation. The connection between agencies was caused by the complexity of the issue. Due to the winter storm and cold wave, the power grids were not able to sustain the needed energy levels and failed, which caused a massive outage.
Thus, the effectiveness of interactions and collaborations between different government agencies was unified and united. This was partly driven by the desire to contain the response to the state itself without excessive reliance on the federal government. Although the latter was inevitably involved in the process, the majority of efforts and resources were coming from the local government itself. The advantage of such a localized response is speed and responsiveness since it implies less bureaucracy, but it constrained the scale of the emergency management’s capabilities. In other words, if FEMA was involved more, the response would be larger in scale but slower.
The agencies communicated as a single task force under the leadership of the ERCOT with the support of the local government. Communication was especially critical during the first notification phase, where the public needed to be informed and prepared for coming crises. The interagency collaboration was achieved through self-reliance and localized response. For example, the water shortage was accompanied by an immediate reallocation of water toward affected areas (Austin-Travis County, 2021). The recommendation is to have a strong leadership enforced on all key parties. In addition, communication needs not to be hindered by excessive bureaucracy.
