How Policies Affect Care in Nursing Homes
Ineffective performance has a long history in nursing homes(NHs) in the United States. Numerous measures have been put in place throughout the years in an effort to solve this issue. The regulatory monitoring has significantly risen after the Omnibus Budget Reconciliation Act of 1987 and currently includes certification, on-site inspection of all facilities, required resident evaluation, and public publication of facility quality metrics. Additionally, through its Quality Improvement Organizations (QIOs), the Centers for Medicare and Medicaid Services (CMS) has significantly increased its funding for quality improvement efforts. Despite these initiatives, quality issues still exist in many facilities, as recent controversies and government reports have shown.
The amount of resources accessible to NHs is mostly influenced by the Medicaid payment rate. Medicaid, the largest consumer of NH services in the US, provides access to NHs by paying them directly for their treatment. Medicaid patients account for 70% of all bed days, while state Medicaid programs fund nearly 50% of all NH payments (Kusmaul, et al., 2017). The Medicaid payment schedule and rates are entirely up to the states. There are several separate federal and state nursing home rules in place to guarantee that healthcare standards are high for patients in nursing homes. These initiatives seek to support residents of senior living homes in preserving their total mental, physical, and social well-being. Inspections are governed by federal laws, which must be followed by all nursing care institutions. The government is also permitted by these regulations to carry out yearly surveys and look into complaints.
Laws Standardizing Work Of Nursing Homes
The Nursing Home Reform Act is a significant piece of legislation that established the rules governing NHs in the United States when it was first put into effect by Congress in 1987. It establishes precise requirements that institutions must meet in order to be eligible for Medicare and Medicaid financing. This act’s laws address several care-related topics. They include everything from personnel needs and functional specifications to resident rights. According to the legislation, citizens’ well-being and health cannot deteriorate unless it is a result of a situation that is medically unavoidable.
First and foremost, all NH facilities are required by federal law to have sufficient staff in order to provide the best care for the patients.
Second, according to the legislation, every nursing home resident has specific rights and is entitled to sufficient diet, social interaction, mental and emotional assistance, and personal hygiene. The following are some of the additional rights to which inhabitants are entitled:
- a proper dental and general care system
- medically necessary social services
- good drug management
- food services
Residents who are mentally ill or physically impaired need special treatment.
Requests for personal, financial, and material privacy are granted.
Appropriate care that respects the resident’s dignity.
Third, a detailed care plan tailored to the individual requirements of each patient has to be provided when they enter a nursing home. All of the patient’s needs, including their psychological, nursing, and medical requirements, must be covered under the plan. The plan must also explain how the facility intends to address the patient’s requirements.
The care plan is often created by a doctor, nurse, or member of the patient’s family. In order to assist the facility in determining the requirements of a patient, it has to include the resident’s ability to manage a number of daily chores. The plan should be updated to account for any changes in the patient’s physical or mental health.
The Code Of Ethics
The Code of Ethics provides clear moral guidelines for the professional activities of a nurse and is designed to promote consolidation and improve the quality of medical care provided (American Nurses Association, 2015). According to Healthy People (2020), many health disparities are caused by low socioeconomic status. Because of the low social status, the nurse could have neglected the patient. However, the Code of Ethics will not allow them to do so. In addition, there is a problem of accessibility for non-English speaking citizens. Since many Hispanic people do not know English, they have a hard time understanding the doctor. Therefore, ANA decided to include the 8th provision, which states, “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. ”
The Code Of Ethics: Issues
However, some ethical problems may arise during a nurse’s duty. For example, what if the patient is a murderer? Should the nurse deal with a criminal or spend that time taking care of other innocent people? To address ethical issues, the government provided provisions. For instance, according to Provision 3, the nurse promotes, defends, and safeguards the patient’s rights, well-being, and security (American Nurses Association, 2015). The nurse protects patients from any harm that the staff and other people may bring about, does not disclose any information about the patient’s private life, and advocates the patient’s right to self-determination. The consequence of the provision is that criminals get quality healthcare without discrimination. The provision makes it possible for nurses to fulfill their obligation to care for patients.
General Rights Policies Affecting Nursing Homes
Residents in nursing homes do not give up their human rights because they require care. Federal law in the USA grants residents of nursing facilities a number of rights. By exploring federal resident rights in the context of the National Association of Social Workers Code of Ethics and the Universal Declaration of Human Rights, there is a larger perspective for comprehending federal resident rights in the United States. In the USA, the social worker is often in charge of educating residents, families, and staff members on resident rights. The use of substances and violent conduct between residents are two issues that are examined since they both have the potential to cause moral difficulties and human rights breaches.
In order to prevent disputes when feasible and to resolve them when required, social workers play a critical role in the development of strong organizational policies that promote resident rights as well as in teaching and assisting staff, relatives, and residents in recognizing these rights. The home is their world, where their rights must be respected and honored, as many long-term NH patients will spend their final months or years there.+
Nursing homes are communal environments where vulnerable individuals get care, frequently in trying situations. Inadequate resources, such as a lack of qualified people at various levels of the institution, might contribute to difficulties. The social worker is frequently involved in these interpersonal difficulties. The capacity of the social worker to comprehend, evaluate, and solve problems in a respectful and equitable manner can be improved by having a solid understanding of resident entitlements within the larger framework of human rights and possessing the NASW Code of Ethics to guide social work practice. Social workers at nursing homes are crucial in informing employees, families, and patients about their rights.
The Health Insurance Portability and Accountability Act (HIPAA) Affecting Nursing Homes
Regarding privacy, there are several legal and moral problems in nursing homes that are connected to the Health Insurance Portability and Accountability Act. The HIPAA and Nursing Home Care case turned on whether the Florida legislation allowing PHI disclosure had to be superseded by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which mandates that PHI be preserved for 50 years after a patient’s death, with some exceptions.
In this case, Florida legislation compelled nursing facilities to give certain people who requested them access to the medical data of dead patients. The court concluded that it was not possible to comply with both laws since one (HIPAA) law required the contrary to the other one (Compliancy Group, 2020). It is crucial that state laws do not conflict with federal laws and certain measures must be implemented in these regards, yet the process of doing this is relatively slow, as such cases can still occur.
SDOH Issues Regarding Nursing Homes
People’s health, well-being, and quality of life are significantly impacted by social determinants of health (SDOH). SDOH examples include:
- safe areas, transportation, and housing
- racial bias, prejudice, and violence
- education, employment prospects, and income
- possibilities for engaging in physical exercise and access to healthy meals
- contaminated water and air
- reading and language abilities
Widespread health inequalities and inequities are also a result of SDOH. People who lack access to grocery shops with healthful meals, for instance, are less likely to be well-nourished. Compared to those with access to nutritious meals, this increases their chance of developing illnesses like diabetes, heart disease, and obesity and even reduces their life expectancy.
The primary issues that can be identified with SDOH in nursing homes are strongly related to the quality of care provided by a specific nursing home. Nevertheless, the policies do not address the social aspect properly – organizing proper access to communication and social well-being is not mentioned in the policies (ODPHP, 2022). Therefore, an SDOH regarding community and social context is not addressed properly in current policies and should be modified. A significant SDOH about health care access and quality is addressed in the policies in terms of requiring proper care for patients in nursing houses. This SDOH is crucial for nursing homes, as it is necessary to have such conditions in them.
References
American Nurses Association. (2015). Code of ethics with interpretative statements.
Kusmaul, N., Bern-Klug, M. & Bonifas, R. (2017). Ethical issues in long-term care: A human rights perspective. Journal of Human Rights and Social Work, 2, 86–97.
Office of Disease Prevention and Health Promotion.(2020). Healthy People. Web.
Office of Disease Prevention and Health Promotion (2022). Social Determinants of Health.
Compliancy Group. (2020). Issues with HIPAA and Nursing Home Care: HIPAA Goes to Court.