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Capella 4050 Assessment 2

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    Capella 4050 Assessment 2

    Capella 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

    Student Name

    Capella University

    NURS-FPX 4050 Coord Patient-Centered Care

    Prof. Name

    Date

    Ethical and Policy Factors in Care Coordination

    Good morning/afternoon everyone. In contemporary society, homelessness represents one of the most poignant reflections of socio-economic disparities, and within this demographic, homeless youth stand out as an especially vulnerable group. Often caught at the intersection of systemic issues such as family instability, economic hardships, and societal stigmatization, these young individuals confront challenges beyond the immediate lack of shelter. Their unique circumstances necessitate a specialized approach in healthcare – one that recognizes the complexities inherent to their status and provides care that is both comprehensive and compassionate (Edwards, 2020).

    Understanding the myriad policies and ethical guidelines governing care delivery is central to achieving this. The Code of Ethics for Nurses, national and local governmental policies, and frameworks such as Healthy People 2020 are pivotal in shaping the healthcare landscape for homeless youth. This assessment seeks to delve deep into the interplay of these factors, understanding their impact, implications, and the challenges they present in care coordination for homeless shelters.

    Impact of Governmental Policies on Care Coordination for Homeless Shelters

    Government policies significantly influence the care coordination landscape, especially within homeless shelters. By dictating the allocation and type of resources available, these policies not only define the structure but also the quality and extent of care that can be provided.  The Affordable Care Act (ACA) is a prime example of how policies can sculpt the care dynamics within homeless shelters. With its primary objective to extend healthcare coverage, mainly via Medicaid expansion, the ACA directly impacts the healthcare services accessible to homeless individuals. Homeless shelters, especially in states that have adopted the Medicaid expansion, are now better equipped to provide comprehensive health services.

    This encompasses primary healthcare and specialized services like mental health and addiction treatment, which are crucial for this vulnerable group. However, the ACA also presents challenges. Not all states chose to expand Medicaid, leading to a troubling disparity in healthcare access for people experiencing homelessness, contingent solely on their geographic location (Thompson et al., 2021). This disparity creates a fragmented care landscape where the level of care a homeless person receives can be vastly different simply based on their state.

    Capella 4050 Assessment 2

    Another pivotal policy in this domain is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA, while primarily established to ensure the privacy and security of patient data, has nuanced implications for homeless shelters. The Act mandates strict guidelines for recording, storing, and sharing patient information. Homeless shelters often work with external healthcare providers, which can mean a meticulous and sometimes slower care coordination process. This stringent requirement of HIPAA might occasionally create barriers, causing a delay in care coordination, especially in urgent scenarios where information sharing becomes cruel for timely intervention. The challenge here lies in balancing the critical need for swift and effective care with the equally vital importance of data privacy and protection (Sloan-Aagard et al., 2022).

    Lastly, the McKinney-Vento Homeless Assistance Act directly affects the resources and support available to homeless shelters. Dedicated to providing federal aid to homeless persons, the Act supports many programs offering essentials from shelter and food to health services. For homeless shelters, this translates to a critical source of funding and resources, enabling them to coordinate holistic care. However, as with many federal programs, resources can be finite.

    Shelters often face the challenge of judiciously allocating these resources to cater to the multifaceted needs of the homeless community they serve (Edwards, 2020).  In sum, while governmental policies like the ACA, HIPAA, and the McKinney-Vento Act provide a robust framework for care coordination in homeless shelters, they come with challenges. Navigating these policies effectively ensures that people experiencing homelessness receive comprehensive and timely care.

    Ethical Implications in Care Coordination Arising from Policy Provisions

    National Policy – The Affordable Care Act (ACA)

    Through its Medicaid expansion provision, the ACA aimed to provide healthcare coverage to millions of uninsured Americans, including many homeless individuals. However, the optional nature of the Medicaid expansion for states creates a significant ethical question: Is it equitable for access to healthcare to be determined by state boundaries? The decision by some states not to expand Medicaid means that many homeless individuals are left without access to essential health services. This policy provision leads to uneven quality and accessibility of healthcare for homeless persons purely based on their geographic location. According to the study, expanded Medicaid under the ACA experienced a more significant decline in their uninsured rates than states that did not. This difference in rates directly affects homeless populations in these states (Thompson et al., 2021).

    National Policy – Health Insurance Portability and Accountability Act (HIPAA)

    HIPAA emphasizes the protection of patient information, ensuring confidentiality. However, in complex care scenarios like those encountered by homeless shelters, where coordination between multiple agencies is often essential, is the strict adherence to data privacy obstructing comprehensive care? While HIPAA ensures data protection, in cases requiring rapid inter-agency communication, it can slow down care provision. This delay could adversely affect patient outcomes, especially in emergencies. A study suggests that strict adherence to HIPAA regulations sometimes hinders timely care delivery in situations involving multiple agencies, notably during inter-hospital transfers or referrals (Sloan-Aagard et al., 2022).

    State/Local Policies – Varied State Regulations on Homeless Shelters

    Different states have varying regulations and standards regarding homeless shelters and the services they should provide. For instance, some states have the “Homeless Emergency Aid Program (HEAP)” that offers funds directly to the service providers, including shelters, allowing flexibility in addressing local homeless challenges. In contrast, other states like Florida have a “Challenge Grant” that requires localities to present specific plans and coordinate with other local entities before disbursing funds. This results in delays and added bureaucratic layers. Moreover, some states may have stringent regulations regarding the structural standards of shelters (like square footage per resident or mandatory facility amenities), while others might emphasize services like mental health counseling or vocational training.

    This variation raises an ethical concern: Why should the standard and quality of care for people experiencing homelessness vary from one state or locality to another? Due to varying state and local regulations, homeless individuals might receive disparate care services depending on the region. Such inconsistencies can lead to this vulnerable group’s uneven health outcomes and well-being. A study by Fowle (2022) indicates discrepancies in services, funding, and regulations for homeless shelters across different states, as observed from variations in state regulations.

    Impact of the Nurse’s Code of Ethics on Care Coordination

    The Ethical Foundation in Nursing

    The Code of Ethics for Nurses is indispensable in shaping the healthcare landscape, especially in care coordination and continuum. At its core, the Code emphasizes every individual’s intrinsic value and dignity, irrespective of their socio-economic or health status. This ethical foundation becomes even more significant when we examine specialized environments such as homeless shelters.

    The Health Landscape of Homeless Individuals

    Homeless individuals typically confront a multifaceted spectrum of challenges regarding health factors and disparities. These challenges can create pronounced health disparities from tangible health concerns such as increased susceptibility to diseases, chronic health conditions, and mental health disorders to intangible barriers like societal stigmatization. The Nurse’s Code of Ethics recognizes these disparities and mandates nurses to actively work towards bridging this health divide. The principles of autonomy and beneficence guide nurses to engage with homeless individuals, respecting their choices and actively promoting their well-being.

    Additionally, the Code’s emphasis on justice ensures that care is rendered equitably, ensuring that homeless individuals are not further marginalized in healthcare. Supporting these observations, a book by Wakefield et al. (2021) found that when homeless shelters implemented care coordination rooted in the principles of the Nurse’s Code of Ethics, there was a significant improvement in health outcomes. In particular, the book emphasized that adherence to these ethical guidelines fostered greater trust, leading to improved compliance with treatment regimens among the homeless population.

    Interpreting Health Through the Lens of Social Determinants

    Using the Healthy People 2020 framework to delve deeper, we can categorize the challenges faced by homeless individuals into specific social determinants of health. Factors like economic stability influence the very essence of homelessness. The lack of stable shelter and financial constraints directly impact their access to consistent healthcare. Education, another determinant, affects their health literacy and ability to make informed health decisions. The societal context, often marred by isolation and stigmatization, can have significant mental health repercussions.

    The Healthy People 2020 framework provides a structured lens to examine and address these intricacies, ensuring a holistic approach to care. Wakefield et al. (2021) work underscored the importance of utilizing frameworks like Healthy People 2020 to address the multifaceted health challenges faced by people experiencing homelessness. The book posits that shelters that proactively integrate these determinants into their care approaches see a more holistic enhancement in the overall well-being of their residents.

    Conclusion

    In the intricate web of healthcare delivery, the challenges and needs of homeless youth emerge as pressing concerns that demand meticulous attention and tailored interventions. As our assessment underscores, while policies such as the ACA, HIPAA, and the McKinney-Vento Act lay down the structural framework for care, the overarching principles of the Code of Ethics for Nurses provide the ethical compass guiding its delivery. However, beyond the policies and principles, at the heart of effective care coordination lies an inherent recognition of the human dignity of every individual, irrespective of their socio-economic circumstances or housing status.

    Utilizing frameworks like Healthy People 2020, care providers can gain a deeper understanding of the social determinants affecting the health outcomes of homeless youth, enabling them to address these needs holistically. As we move forward, it is paramount that care coordination for homeless shelters, and indeed the broader healthcare landscape, remains rooted in these principles of equity, compassion, and comprehensive care. Only then can we hope to bridge the existing health disparities and ensure that everyone, including the homeless youth, receives the quality healthcare they deserve. Thank you.

    References

    Edwards, E. J. (2020). Young, Black, successful, and homeless: Examining the unique academic challenges of Black students who experienced homelessness. Journal of Children and Poverty, 26(2), 1–25. https://doi.org/10.1080/10796126.2020.1776688 

    Fowle, M. Z. (2022). Racialized homelessness: A review of historical and contemporary causes of racial disparities in homelessness. Housing Policy Debate, 32(6), 1–28. https://doi.org/10.1080/10511482.2022.2026995 

    Sloan-Aagard, C., Helgesen, W., Nañez, J., Law, J., Currey, J. C., Meils, J., Bishop, J., & Hartmann, E. (2022). The value of community-integrated health information exchanges: Three recent examples from El Paso, Texas. Journal of the American Medical Informatics Association, 29(12), 2201–2205. https://doi.org/10.1093/jamia/ocac170 

    Thompson, F. J., Farnham, J., Tiderington, E., Gusmano, M. K., & Cantor, J. C. (2021). Medicaid waivers and tenancy support for individuals experiencing homelessness: Implementation challenges in four states. The Milbank Quarterly, 99(3), 648–692. https://doi.org/10.1111/1468-0009.12514 

    Wakefield, M. K., Williams, D. R., Menestrel, S. L., & Flaubert, J. L. (2021). The Future of Nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982 

    Capella 4050 Assessment 2