Florida National University End of Life in Elderly Case Study

Florida National UniversityPHI1635 Biomedical Ethics: Assignment Week 3
Case Study: Chapter 5
Objective: The students will complete a Case study tasks that contribute the opportunity to produce and
apply the thoughts learned in this and previous coursework to examine a real-world scenario. This
scenario will illustrate through example the practical importance and implications of various roles and
functions of a long-term care settings. As a result of this assignment, students will be better able to
comprehend, scrutinize and assess respectable superiority and performance by all institutional employees.
ASSIGNMENT GUIDELINES (10%):
Students will critically measure the readings from Chapter 5 in your textbook. This assignment is
planned to help you examination, evaluation, and apply the readings and strategies to your of a
long-term care settings
You need to read the PowerPoint Presentation assigned for week 3 and develop a 3-4 page paper
reproducing your understanding and capability to apply the readings to your long-term care
settings. Each paper must be typewritten with 12-point font and double-spaced with standard
margins. Follow APA Style 7th edition format when referring to the selected articles and include
a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each
Chapter and articles you read, in your own words that will apply to the case study presented.
2. Your Critique (50%)
Case study: Patient-Centered Care: Case Studies on End of Life in elderly
Background
Ms. L is an 87-year-old African American woman who was diagnosed with vulvar cancer at the
beginning of 2021. She is also HIV-positive. By the time Ms. L engaged in care, the cancer had
proliferated quite quickly in the setting of a compromised immune system. Upon discovery of
the Stage 4 cancer, doctors recommended a dose of radiation and chemotherapy. However,
during the course of this episode Ms. L was struggling with substance use. During her
hospitalization, she tested positive for a number of substances, including heroin and cocaine. As
a result, care providers had many discussions about pain management and which pain
medications could be given to her. She was not on methadone treatment maintenance at first, so
she was self-medicating to address her pain. While Ms. L wanted to seek help for her addiction
to substances, some of the traditional models were not appropriate given the magnitude of her
physical issues. There were expectations that she would get into outpatient treatment but she did
not follow through, primarily because it was difficult for her to tolerate being in groups for long
periods. (Given the location of her cancer, she could not sit upright for long periods or on the bus
for transportation.) Ultimately, Lawanda Williams, Director of Housing Services at Health Care
for the Homeless in Baltimore, Maryland, and her team were able to provide Ms. L with
transportation and cab vouchers so she could access the full course of radiation that doctors had
recommended. Her pain was never well controlled, because her physician refused to prescribe
her any pain medications, due to the magnitude of her substance use. The radiation center gave
her Percocet while she was there but would not give her anything that could not be directly
supervised. After treatment, they sent her home with prescriptions for Tylenol and instructions to
return and follow up with pain management teams, which she was unable to do because of her
difficulties with transportation and sitting. Ms. L completed radiation and is in a period of
holding to assess effectiveness of the initial course of radiation, but she still does not have a
prescription for her significant pain and, as a result, continues to use substances to manage her
pain. Ms. Williams observes, “I have been able to see how managing withdrawal and managing
substance abuse in the context of a palliative care treatment plan does not always exist for
patients experiencing homelessness. She does not fit very neatly into any mainstream treatment
model.”
CASE STUDY CHALLENGE:
1. Harm reduction: How can care providers best advocate for a harm reduction approach while
seeking to deliver palliative care services, including hospice care?
2. What ethical arguments can you make base on the case study?
3. Why do you think that long-term care and palliative care insurance lacks of popularity among
older Americans.
3. Conclusion (15%)
Briefly summarize your thoughts & conclusion to your critique of the case study and provide a
possible outcome for Aging in America base on Health ethics Context?
Evaluation will be based on how clearly you respond to the above, in particular:
a) The clarity with which you critique the case study;
b) The depth, scope, and organization of your paper; and,
c) Your conclusions, including a description of the impact of these Case study on any Health
Care Setting.
ASSIGNMENT RUBRICS
Assignments Guidelines
1 Points
10%
Introduction
2.5 Points
25%
Your Case Study Critique
6 Points
50%
Conclusion
1.5 Points
15%
Total
11 points
100%
ASSIGNMENT GRADING SYSTEM
A
90% – 100%
B+
85% – 89%
B
80% – 84%
C+
75% – 79%
C
70% – 74%
D
60% – 69%
F
50% – 59% Or less.
Dr. Gisela Llamas
Chapter Five
Older People and
Long-Term Care:
Issues of Access
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Why the new interest in longterm care?
• The Baby Boomers are adding to the growth in the
population over 65.
• There is increasing fear of dependency on longterm care.
• Adult children of the elderly having to find care for
their parents.
• Healthcare reform promises great changes that are
not well understood.
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The Growing Population Needing
Care
• The need for ADL and IADL assistance continues
to grow.
• Table 8-1 presents the broad range of services
needed by the disabled.
• Most of the population needing long-term care do
not live in nursing homes.
• Many factors contribute to the inability to predict
the exact number needing services in the future.
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The Growing Population Needing
Care
• Future populations may be better educated which
is associated with lower levels of disability.
• Ethnic composition suggests a greater need for
care and government support.
• Boomers will bring greater numbers of people
needing services.
• The number of those over 75 will greatly increase.
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The Growing Population Needing
Care
• Disability rates will increase among those who are
not in nursing homes.
• The most common disability is physical.
• In addition, the nursing home population is
expected to have profound increases until it triples
by 2030.
• The number of younger persons with disability has
also increased.
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Issues of Access
• The current system is far from ideal.
• There is not an adequate supply particularly for the
poor.
• The system itself continues to be so fragmented
that many are not aware of what is offered.
• Financing is an underlying problem.
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The Costs of Care
• Expenses for this care are sizable and will increase
in the future.
• Private insurance only pays for a small percentage
of the care.
• Medicaid pays for over 85% of nursing home care.
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The Costs of Care
• Annual costs of nursing home care can average
$58,000 per year and may exceed $100,000. For
many, the costs of this care is just not affordable.
• With the addition of the Baby Boomers, costs will
most certainly increase in the future.
• The effects of reform are not currently known.
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The Care-giving Role of Families
• About 74% of dependent community-based elders
receive care from family members.
• The majority of caregivers are women.
• The number and willingness of family caregivers
may decline as the Boomers become in need for
assistance.
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The Role of Private Insurance
• Private insurance for long-term care is a relatively
new product.
• Improvements in coverage are being made, but
only an estimated 20% of the population will use it.
• CCRCs and LCAHs hold promise for the future.
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The Role of Medicaid
• Medicaid is changing under PPACA to include more
eligible adults who will receive benchmark
coverage.
• Medicaid is used for those elders who meet certain
criteria.
• Medicaid does not pay for the full range of services
including home-based care.
• Some states are using a waiver to offer non-medical
home-care services.
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The Role of Medicaid
• Some elders qualify for Medicaid once they are
institutionalized and have used all of their assets.
• Other elders are trying to shelter their assets so
that they can be poor without really being poor.
• Healthcare reform requires an office within CMS to
address the issue of dual edibility.
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Forces for Improving Access
• Advocates for Alzheimer’s disease patients and for
others have worked for changes.
• The Pepper Bill and other legislation recommended
changes.
• Attempts to limit the growth of Medicaid are part
of the national health care debate.
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Future Prospects
• Baby Boomer numbers and healthcare reform will
result in changes to the system.
• Government involvement will increase as demand
increases without the funding for access.
• Government involvement may not be the only or
best answer.
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Future Prospects
• Future elders are concerned about what their care
will be like under healthcare reform.
• The political climate must be willing to address
future concerns.
• Ethical questions such as beneficence, autonomy,
and justice need to be part of policy discourse.
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Future Prospects
• Issues of the elderly and non-elderly disabled need
to be addressed.
• Given the cost and complexity, the medical model is
not the only one to be considered.
• Long term care needs to be part of health care.
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Update from a Practitioner’s View
• Even with healthcare reform the trends and issues
for long-term care are the same.
• Barriers to real change are driven by the political
climate that controls funding.
• What will be America’s legacy about the treatment
of its elderly?
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In Summary…
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