Nursing homes ethical and policy factors

Nursing homes ethical and policy factors

Introduction

Nursing homes in the United States engulf different care facilities, which includes Administration on Aging (AoA), National Audiovisual Center (NAC), and the American Health Care Association, to mention a few. Running such community and support facilities is not always a walk in the park since they work under the policy and ethical instructions that attract public concerns. Nursing homes require financial support that of late has been relatively high, making them be policymakers center of discussion. Limitation of Medicaid financed by the federal government may see the nursing homes’ operations eligibility cut and termination of long-term care services. Other than the financial constraints, there are other policy factors and ethical concerns that affect nursing home operations and their care continuum.

The Omnibus Budget Reconciliation Act of 1987 statutory requirement defines the quality assurance of nursing homes. For a facility to be approved as a Medicare and Medicaid nursing home provider, it must comply with 42 CFR Part 483, Subpart B, which entails residential rights, the physical environment, and quality of care standards. The compliance policy usually prevents the nursing facilities from carrying out their daily operations since they have to wait for state compliance or noncompliance approval. Additionally, the Center for Medicare and Medicaid Services and state survey agencies levy high sanctions policies against nursing facilities to enact agreement and penalize poor performers. This move makes it difficult for nursing homes to operate effectively.

Following the Obama administration’s mandatory requirement on long-term care facilities, policymakers shifted their role from nursing home oversight to long-term care facilities requirements reforms. The requirements reforms led to the final rule policy, which focuses on how to modernize standards to accommodate changes. Through the final rule policy, nursing home requirements expansion was actualized, taking into account person-centered care, infection control, care planning, and quality improvement activity areas. In as much as the final rule brought positive changes to the nursing facilities, it also ensured there is a restriction on nursing facilities’ residence mandatory entry requirement of pre-dispute arbitration agreements.

Nursing homes are also subject to inspection policies that are punitive, subjective, and do not enhance residential care. Most of the inspection policies are adversarial that do not promote collaboration between regulators and providers. However, a collaborative approach to the inspection policies would contribute immensely to substantial changes from the historical oversight separation to nursing home sector consultation. Such a cooperative inspection policies approach moves in the nursing sector would ensure quality oversight regulations purpose and limits are adequate by specifying market and market-based incentive roles and potential innovation areas.

From the past experiences on the relationship between staffing level and better care outcome, a conclusive approach can be drawn that better care outcome is directly related to staffing level. Although many recommendations to cap the minimum level of staffing are in place, the regulators have not yet acted to come up with policies. They only focus on barriers to nursing home care quality, such as uneven and lax enforcement of already in place standards living a gap to the staffing policies. In response to the federal staffing policies gap, some states have moved swiftly to come up with their staffing requirements. However, the nursing hour requirements of 4.1 hours on average per resident day affect the quality of nursing service since most of the hours are utilized by non-licensed nursing assistance.

The ethical issues that affect nursing homes are generally biomedical ethics. Health related complications that are broad and overarching impacting on policy and the society, organization dilemmas, and problems that affect population and patients form the major ethical concerns affecting nursing facilities. All these ethical issues are faced in either policy or societal level, organizational level, or even clinical level. At the policy or societal level, ethical concerns make nurses to be involved in the discussion as clinicians and policymakers. The organizational level focuses on ethic basing on nursing homes’ moral climate, quality, and safety culture. The clinical level ethical issues include surrogate decision making, advanced care planning, and confidentiality breach.

Market reform policy portrays societal level ethical issues. Some questions arising in the market reform policy is whether the market-driven approach will have a hand in the regulation sector, regulating the dollar value present in the nursing home for a particular illness. The market-driven approach relies on adequate information, families, residences, and patients selecting a provider with perceived high quality. Thus, making the nursing homes to compete on quality improvement to have the highest revenue. Therefore, the nursing facilities will overwork their nurses, which is an unethical practice.

Focusing on barriers to quality nursing home care and leaving staffing minimum requirements reveals clinical level ethical issues. For quality to be achievable, staffing has to be optimum. For barriers to be eliminated, advanced care planning has to be in a place that involves looking at issues in line with nursing home staffing since every patient has a right to be attended to while in nursing homes, limited staff will bring about inattention to patient autonomy, which is unethical.

The final rule policy exhibits organization ethical concerns by bringing about the pre-dispute arbitration agreement requirement to the patients, which is not practical. Since the rule came from the ruling federal government, it could not be objected, thus impeding individual practice. The enactment of the policy posse an ethical dilemma to the nurse as to either respond to a patient with or without the agreement.

Nurses’ code of ethics has a significant impact on the coordination and continuum of care. The code of ethics for nurses helps improve care quality and efficiency balancing. To achieve effectiveness within the nursing homes, the code of ethics will make sure the nurses balance safety and quality with efficiency. The realization of this impact will be guided by the law of ethics that makes the nurse responsible and accountable for their professional actions and the duty to preserve safety and integrity, competence maintenance, and continuous professional and personal growth.

The code of ethics for nurses also contributes to improving access to health care. With full adherence to the first code of ethics provision, a code of ethics will impact the accessibility of health care service to all. The first provision of the code of ethics directs all nurses to serve every patient with dignity, compassion, and worth. The directive also achieves accessibility of care service by committing nurses to serve all citizens irrespective of their socio-economic status-quo or health problem nature.

The code of ethics also contributes to the nurturing and maintaining a future healthcare workforce. This impact of code of ethics translates to a sustainability issue that ensures professional continuity with the nursing environments. To achieve the sustainability impact, code of ethics through provision nine, which entails professional integrity maintenance, elaborates on asserting professional values, inter-professional integrity, and nursing, social reforms. Additionally, professional continuity can also be achieved through provision seven that talks about professional contribution through knowledge development, education, and practice.

Conclusion

To conclude, nursing homes are regulated and affected by both statutory policies and ethical issues. These legislative policies are either adequate or exhibit policy gaps that need to be filled for the effective operation of nursing homes. Even though the systems play regulatory purposes, some have ethical concerns. Some of the policies talked about above include Medicaid financial policy, compliance policy, final rule policy, inspection policy, and staff level policy. However, policies like a final rule, staff level, and inspection have ethical issues that need to be addressed. Finally, improving the accessibility of healthcare, professional sustainability, and health care quality and efficiency balancing are some of the impacts of the code of ethics.

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