Care coordination is defined as the deliberate organization of activities involved in patient care between two or more participants to ensure appropriate health care delivery. The participants include health care providers like nurses, the patient and the caregivers of the patient. The activities involve mobilizing of necessary resources and personnel with subsequent information exchange among them. It aids in ensuring information is delivered to the right person at the right time. Care coordination improves care quality for patients with a reduction in health care costs. Ethical and policy factors play major roles in impacting the success of care coordination activities. This write up discusses the ethical and policy factors affecting care coordination with specific examples involving homeless shelter individuals.
National, state and local policies largely influence the safety and health of community members. These policies may be favourable or unfavourable in determining the success of care coordinating plans. The policies vary from one geographical region to another depending on community needs and requirements. Such policies include payment of health services, criminal justice, housing, land use and education (Lamb et al., 2015). Community members should be involved in policymaking decisions to ensure their success. Payment policies for health care workers largely determine the success of care coordination activities. It is necessary to have favourable payment policies by the government for health care professionals involved in care coordination activities. All health care providers (HCP) involved in the delivery of care coordination programs should be paid adequately. This will entail having payment provisions that defined by similar tasks that qualify providers for pay after ensuring there is supporting documentation(Lamb et al., 2015). This motivates the HCPs to continue with care coordination practices. Accountability and transparency should be done through a teamwork approach. The advanced practice registered nurses (APRNs) should be able to practice full-scope without unnecessary restrictions. The bachelor prepared nurses should also be recognized as qualified care coordination providers and paid accordingly. An example of such a policy is the Medicare payment for care coordination and registered nurses. The Centers for Medicare and Medicaid Services (CMS) has initiatives like Transitional Care Management (TCM) and Chronic Care Management (CCM) to encourage effective payment of various medical services in care coordination.
Another one is policies to encourage the use of care coordination measures. The Care Coordination Task Force (CCTF) provides some policy recommendations that encourage care coordination. This will involve the inclusion of experienced nurses in national care coordination measure panels. The nursing community can provide useful care coordination measures because they interact with patients daily at a personal level. This policy will involve national groups can come up with strategies to increase funds for testing care coordination measures. CCTF recommends the use of health information technology, expansion of best practice models, providing incentives for patient and caregiver engagement, defining terms and scope of service and payment of all qualified health care providers (Lamb et al., 2015).
Some national and local policies may pose ethical questions and dilemmas in care coordination. An example is the Health Insurance Portability and Accountability Act (HIPAA) which is a law that advocates for the protection of sensitive information of patients. The act, however, places sensitive patient information in the hands of several individuals hence breaching confidentiality to some extent. The entities include health care providers, health care clearinghouses, business associates and agencies that pay for medical services. HIPAA mandates that sensitive patient information should not be disclosed against their knowledge or consent. The HIPAA privacy rule involves a set of standards that talks about using and disclosing protected health information. The privacy rule applies to individuals and organizations termed as covered entities. It also has provisions for individuals to understand the rights and control usage of their personal medical information. The main of the privacy rule is to ensure quality care is offered to patients while their information is kept confidential.
Various ethical factors influence the delivery and success of care coordination activities in nursing. Code of ethic was developed to aid nurses to know how to act professionally in their day to day work activities. The scope of as the code of ethics defines relationships between nurses and people, nurses and practice, nurses and profession, nurses and their co-workers, nurses role in education and research activities. Ethics entails a group of principles that describe the relationship between nurses and patients, their colleagues, the family of the patient and society. The American Nurses Association (ANA) developed a code of ethics for nurses in 1950 to them deal with day to day nursing ethical dilemmas. The main principles include; beneficence, non-maleficence, autonomy and justice. Non-maleficence will involve doing no harm to patients by participants (Tønnessen et al., 2017). The participants are mandated to do what is only within their practice scope. The confidentiality of the patient should be preserved. There should be no dual relationships. Informed consent should be obtained. There should be a continuing education of professionals. Health care workers who are unethical or incompetent should be penalized. The code of ethics is beneficial to the success of care coordination activities. It advocates for the respect of patients with the preservation of human dignity and being compassionate and kind to them. When nurses and other health care providers act respectfully towards patients they will be able to gain their trust and hence easily communicate with them on their treatment expectations and goals. They should also communicate. Patient information confidentiality is also required to boost this trust. The code of ethics promotes mutual respect among health care providers as they communicate on how to have continuum care for patients (Tønnessen et al., 2017).
The chosen support groups for discussing ethical and policy factors for care coordination are homeless shelters. These are service agencies that are set up to temporarily provide basic needs to individuals who are homeless. Homelessness in many countries is caused mainly by poverty, lack of employment and reduction in affordable housing. These are worsened by mental disorders, substance use, disabilities, trauma, domestic violence, death of partners and divorces (Jego et al., 2019). Programmes for homeless shelters are useful in providing recovery support services like mental health treatment, substance use disorder treatment. Ethical challenges faced in homeless shelters entail; lack of policies to protect patient information and falsifying patient information to get funds.
There are various policies affecting coordination care for homeless shelters. This includes policies on access to health and social services (Lamb et al., 2015). These patients need an easy platform to access these services through care coordination of professionals in health and socials services. The policy should encourage placing all required services in a single building so that homeless people do travel long distances to access them. They are financially vulnerable and this may discourage them from engaging in care coordination activities. Another one is the discharge policies of homeless individuals from the hospital. Lack of care coordination during the discharge of homeless individuals from the hospital by hospital staff and the homeless shelter can lead to impaired care coordination. The individuals tend to become anxious, lose confidence since their recovery process is impaired (Canham et al., 2018).
Ethical issues affecting such individuals are lack of respect and autonomy, lack of trust and information confidentiality and poor communication between hospital staff and caregivers in the homeless shelters. Homeless people rely on a few individuals and may fear being disrespected by different health care providers (Tønnessen et al., 2017). This makes it paramount for the staff of the program to continue with the care coordination services so that they can build trust with their clients in the long run. Some home shelters may forge patient information to get funds. This may be detrimental to the patients because they may end up receiving wrong or substandard care (Tønnessen et al., 2017).
In summary, care coordination is an emerging activity that has numerous benefits to health care providers and their patients. Its success is influenced by government policies of involved personnel and ethical factors like confidentiality. HIPAA is an example of a government policy that breaches ethical concerns. Homeless shelters are examples of support groups that can benefit from care coordination practices.
References
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Acha.org. (2020). Retrieved 7 November 2020, from https://www.acha.org/documents/Programs_Services/webhandouts_2017/79_Himmell_Slides.pdf.
Canham, S., Davidson, S., Custodio, K., Mauboules, C., Good, C., Wister, A., & Bosma, H. (2018). Health supports needed for homeless persons transitioning from hospitals. Health & Social Care In The Community, 27(3), 531-545. https://doi.org/10.1111/hsc.12599
Jego, M., Abcaya, J., Calvet-montredon, C., & Gentile, S. (2019). Improving Health Care Management in Primary Care for Homeless People: A Literature Review. European Journal Of Public Health, 29(Supplement_4). https://doi.org/10.1093/eurpub/ckz186.005
Lamb, G., Newhouse, R., Beverly, C., Toney, D., Cropley, S., & Weaver, C. et al. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521-530. https://doi.org/10.1016/j.outlook.2015.06.003
Tønnessen, S., Ursin, G., & Brinchmann, B. (2017). Care-managers’ professional choices: ethical dilemmas and conflicting expectations. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2578-4
Sears, J. (2019). Integrated approach to complex Heath needs of homeless populations. International Journal Of Integrated Care, 19(4), 531. https://doi.org/10.5334/ijic.s3531
