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.
Florida National University
PHI1635 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%)
A CASE STUDY: THE LONG TERM CARE OF OLDER PEOPLE
In December 2017 a Royal Commission was appointed by the present Labor government to
exam the options for a supportable system of financing the long-term care of older people. The
forms of care considered included care in the community, in a person’s own home, and care in
residential or nursing homes. Older people receiving long-term care in these settings may also
require acute medical care so it was relevant to also look briefly at the general health provision
for older people. Since the creation of the NHS older patients have been seen as a drain on
resources diverting services away from other patient groups (Wilkinson and Hughes, 2006).
Elderly care has always been one of the Cinderella services within the NHS, receiving less than
adequate resources despite repeated attempts to ensure it was given priority in resource
allocation (Ibid.). Numerous studies have focused on the social deprivation and abuse suffered
by people in elderly care homes (Barton, 2009; Biggs et al., 2005; Robb, 2007; Townsend,
2002). The current debates about health care and older people focus on rationing, and on
standards of care for the old both in hospitals and in residential and nursing homes. Evidence
exists that older people are denied access to treatments provided for younger patient. (Aaron and
Schwartz, 2004; Age Concern, 2007). The continuing poor quality of care for older people
within the NHS has been the focus of considerable media attention (Abrams, 2008; Brindle,
2007; Evans 2007). In October 2007 The Observer newspaper launched a campaign to ensure
that older people in hospital are treated with dignity, following reports of neglect. In the same
month The Sunday Times launched a campaign for better care for the elderly in long-term care
and highlighted abuse and indignity routinely suffered by people in residential and nursing
homes. Both campaigns generated a large public response. It is important to note that long-term
care is not free, but is means tested, the state paying only for those who cannot pay for
1.1 The Findings of the Royal Commission
According to the Royal Commission Report, With Respect to Old Age: A Report by the Royal
Commission on Long Term Care (2009), the present system of long term care is characterized by
complexity and unfairness. The diversity of providers and funders may operate against the
interests of R. ter Meulen, W. Arts, and R. Muffels (eds.), Solidarity in Health and Social Care in
Europe, 417-422. © 2001 Kluwer Academic Publishers. 418 A. CAMPBELL AND S. JONES
individual clients. More importantly the Commission found evidence of bewilderment, ‘a strong
sense of loss of control, a sense of actually losing a loved individual to a system that is beyond
understanding and which makes individuals feel beyond help. No amount of statistics or cool
analysis can take away the human despair which individuals feel when confronted with the
system as it is’ (PA2). Although the Commissioners recognize that the Welfare State has
considerably improved the lot of older people, they claim that as a society we have ceased to
value old age. Many older people now live twenty to thirty years beyond retirement. The
financial position of pensioners is variable but many are considerably poorer than those in other
groups are, and this is a threat to their security in old age. The present NHS is performance led,
resulting in earlier discharges. Discharge from hospital is a critical point for many older people,
which, along with other crises can result in the perceived need for residential care. Older people
can be forced to sell their homes and cut off their links with local communities by decisions,
which are often hastily taken. Although residential and nursing homes may be caring and
supportive, older people are then removed from sight and from society. The result is social
exclusion of a whole section of society.
1.2 The Commission’s Recommendations
The Commission Report sets out in the first chapter the values that have guided its deliberations.
The recommendations begin from the position that old age should not be seen as a problem, but
as a time of life with fulfilment of its own. According to the Commissioners older people do
continue to play a positive role in society by acting as careers, supporting families, by providing
wisdom and advice and by playing an active part in society. However, these positive images are
often over shadowed by negative ones. Underlying much of the political language about old age
is assumption that old age is a problem. With the expected rise in the numbers of elderly and the
rise in their proportion of the population this is thought to be a problem which will become
increasingly insoluble in future years. However, such an approach treats the old as a homogenous
group, which clearly they are not, and fails to recognize people as individuals with their own
needs aspiration and perceptions. Moreover the Commission found that for the UK there is no
‘demographic timebomb’ as far as long-term care is concerned, and as a result costs of care would
be affordable. Against these negative images, the Commission suggests a new understanding:
older people should not simply be seen as the passive recipients of welfare, rather society should
recognize the value inherent in older people, and the value in helping them to continue to realize
their potential. The department of Education and Employment’s commitment to lifelong learning
should mean learning for life beyond work and into the retirement years. Old age should be seen
as a special time when we have the gift of time to develop interests.
CASE STUDY CHALLENGE:
1. Why is Long Term Care important to our overall health care system?
2. What is long term care for the elderly?
3. What percentage of elderly live in nursing homes?
4. What percentage of individuals over 65 will require long term care?
3. Conclusion (15%)
Briefly summarize your thoughts & conclusion to your critique of the case study and provide a
possible outcome for Long-term Care setting for elderly. How did these Chapters influence your
opinions about Health Economics in a 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
ASSIGNMENT DUE DATE:
The assignment is to be electronically posted in the Assignments Link on Blackboard no later
than noon on Sunday, March 22, 2020.
Your Case Study Critique
ASSIGNMENT GRADING SYSTEM
90% – 100%
85% – 89%
80% – 84%
75% – 79%
70% – 74%
60% – 69%
50% – 59% Or less.
Dr. Gisela Llamas
Older People and
Issues of Access
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
• Healthcare reform promises great changes that are
not well understood.
The Growing Population Needing
• The need for ADL and IADL assistance continues
• 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.
The Growing Population Needing
• 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
• The number of those over 75 will greatly increase.
The Growing Population Needing
• 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
• The number of younger persons with disability has
Issues of Access
• The current system is far from ideal.
• There is not an adequate supply particularly for the
• The system itself continues to be so fragmented
that many are not aware of what is offered.
• Financing is an underlying problem.
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.
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.
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
The Role of Private Insurance
• Private insurance for long-term care is a relatively
• 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.
The Role of Medicaid
• Medicaid is changing under PPACA to include more
eligible adults who will receive benchmark
• Medicaid is used for those elders who meet certain
• Medicaid does not pay for the full range of services
including home-based care.
• Some states are using a waiver to offer non-medical
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.
Forces for Improving Access
• Advocates for Alzheimer’s disease patients and for
others have worked for changes.
• The Pepper Bill and other legislation recommended
• Attempts to limit the growth of Medicaid are part
of the national health care debate.
• 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
• Future elders are concerned about what their care
will be like under healthcare reform.
• The political climate must be willing to address
• Ethical questions such as beneficence, autonomy,
and justice need to be part of policy discourse.
• 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.
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?