The purpose of this assignment is for you to identify an issue of concern for your role as an advanced practice nurse and to formulate a potential policy change to address that issue. There are many potential issues which can influence your practice setting or other issue which may negatively affect the patients with whom you work.
All of the course reading will help you to identify a topic for this assignment. You can think about the issue as related to your health promotion project. The policy you consider may be in reaction to the health promotion issue or something larger that is still related to that issue. There are hundreds of possible issues, but here is a list of a few to consider:
Child and elder care
Native American and migrant workers’ health
Legislative issues affecting advanced practice nursing
Barriers to practice
Access to care
As you begin to work on the possible policy change: the following ideas and steps should be considered:
Definition and description of the issue
Exploration of the background of the issue
Issue statement or statement of clarity
Possible methods of addressing the issue
Goals and options for changes
Risks and benefits of the changes
Recommendation or solution
Identify the type of legislation, such as state, federal, scope of practice, reimbursement, loan repayment, or others.
Review of the literature consists of a minimum of 3–4 peer-reviewed articles and 6–7 other outside sources.
Describe the current policy or health policy issue and specify how it would impact nursing or healthcare.
Describe the specific aspects of the proposed policy or policy change.
Identify the individuals who would benefit from the policy change and explain where support for the change would be
Describe the impact of the policy change on nursing practice and health care.
Provide an analysis of the policy from your point of view and how this will influence your practice.
Health Policy Presentation-Long-term Care
Definition and Description of the Issue
Long-term care refers to the continuum of social and medical services provided to those living with chronic health issues. Long-term care services are a combination of medical services, housing, and social services. Long-term care is considerably different from acute medical care – the latter aims at returning an individual to the state he or she was before the appearance of the medical condition. On the other hand, long-term care aims at helping individuals adjust to their new situation. Long-term care is much broader in terms of the services provided to individuals. While acute medical care focuses on medical services, long-term care also involves social services. The provision of long-term care involves a wide range of specialists or care providers. These include physicians, community caregivers, nursing home care providers, home care agencies, friends, and family members.
Exploration of the Background of the issue
According to Frank (2012), the lifespan of most Americans has tremendously improved owing to better nutrition and improved medical care. In addition, the Baby Boomers (born between 1946 and 1964) have increasingly aged, causing a rise in demand for acute care. Over the next 10 years, the demand for support and long-term care services will significantly increase due to the aging of this generation. In 2010, approximately 10 million Americans were in need of long-term care and support. Surprisingly, only about 20 percent of those in need of long-term care services receive professional care, the rest depending on family and friends. Projections indicate that the number of those seeking long-term care services will reach 15 million by 2020 (CDC, 2013). With the high number of those requiring long-term care and support, it becomes obvious that the cost of providing such services will likely increase in the future – a cost that is already extremely high for most American families.
There are a number of stakeholders directly affected by the issue. The baby boomers, or those born between 1946 and 1964, are currently entering old age (Bowser, 2013). As they advance in age, majority are increasingly requiring long-term care services due to various conditions such as Alzheimer’s condition associated with aging. These are the main stakeholders. Others stakeholders involved are the caregivers. These range from hospitals to physicians that provide medical services to those in long-term care facilities. Home care agencies are directly involved in providing care to those requiring long-term care. Assisted living facilities and nursing homes are also major stakeholders in long-term care. Family members, friends, and hospice caregivers are also important stakeholders.
Related: Nursing Sensitive Indicators
The current long-term care system is in a crisis owing to capacity issues. With the current projected increase in the number of individuals requiring long-term care, the future situation may be dire. About 77 million Baby Boomers will retire over the next 10 years. Only a few have enough savings to pay for long-term care (Calmus, 2013). Long-term care is currently expensive and out of reach for majority of Americans. The average annual cost for a typical room in a nursing home will average $90,000. To make it worse, majority of Americans do not have adequate cover or funds for long-term care. According to Butler (2016), the cost of long-term care will rise in the next few years, which will average $138,000 per individual. It has become difficult to acquire private insurance to cover these costs since most private insurance firms either have increased their premiums or have withdrawn their services due to high costs. Currently, government programs have underserved the needs of most Americans, with Medicaid program covering only 40 percent of the total costs and Medicare covering only 23 percent of the total costs. This leaves most individuals with huge financial burden.
Possible Methods of Addressing the Issue
There are a number of possible ways to improve on this issue. First there is need to develop private insurance to increase their contribution to coverage of individuals requiring long-term care. Private insurers have the potential to cover more Americans compared to the state and federal governments. Plans should involve ensuring that those in employment receive automatic enrolment with an insurer of their choice. The second method of addressing the issue is through revamping the Medicaid program. Currently, the program covers 40 percent of the costs. The federal government should develop ways of increasing coverage of the program to about 60 percent of the total costs. This can greatly help individuals requiring long-term care. The next way to address the issue is by developing personal and community initiatives. There is need to educate the public on issues relating to health and financial planning. This can enable them prepare for the future. Lastly, home and community based services can help reduce costs in the sector.
Goals and Options for Changes
The major goals of the changes should be to reduce the current costs of long-term care services. The high cost of long-term care delivery is currently leaving families with huge financial burdens. The changes should aim at lessening the financial burden incurred by families in long-term care. Another goal is to create awareness among individuals about the need to invest in long-term care. According to Freundlich (2014), majority of individuals harbour misconceptions about coverage of long-term care costs. Individuals lack adequate knowledge on what costs are covered by Medicaid and Medicare programs. The next goal is to create awareness among individuals on the need to lead healthier lifestyles. There is need to create awareness on the need to adopt healthier lifestyles even at an advanced age.
Risks and Benefits of the Changes
There are certain inherent risks in the proposed changes. For instance, there is risk of increased taxes associated with increasing the coverage of Medicaid program to 60%. This might be counterproductive to growth. Engaging the private insurance firms may also lead to reduced savings among workers (Freundlich, 2014). Private insurance firms may charge high and unaffordable premiums. The cost of private insurance may be high discouraging majority of workers. There is also risk of failure by the legislature to pass the amendments required to effect the changes. The process may take long worsening the current crisis further. Lastly, there is risk of inadequate information to back up the proposals (Bray, Ren, Masuyer, & Ferlay, 2013). For instance, the actual costs of the proposed changes are not yet known. The major benefit from these changes will be reduced costs of long-term care among individuals.
The evaluation methodology will lay emphasis on cost. It is important that an appropriate strategy should keep costs down (Nicolle, 2014). An appropriate strategy should aim at reducing costs of long-term care and ensuring that individuals are able to access long-term care without overburdening their loved ones. The appropriate strategy should be able to reduce private spending from personal savings or bond and instead utilize insurance services.
Recommendation or Solution
This research recommends involving the private sector in reducing the high burden of long-term support care cost among families. Long-term insurance plans can help individuals reduce their dependence on the government sponsored Medicaid and Medicare programs. Individuals should start buying insurance premiums while young, which can enable them purchase cheaper premiums or receive discounts (Donald et al., 2013). The government should also work with private insurance firms to ensure that they reduce premium costs to those taking cover for long-term care support. Currently, private insurers are wary of providing comprehensive coverage to the poor. Payroll tax can be used to finance a catastrophic plan or even a short-term plan that can pay benefits up front.
- Bowser, B. A. (2013). Why long-term care for U.S. seniors in headed for crisis. PBS News Hour. Retrieved from http://www.pbs.org/newshour/rundown/americas-looming-long-term-care-crisis-and-what-can-be-done/
- Bray, F., Ren, J. S., Masuyer, E., & Ferlay, J. (2013). Global estimates of cancer prevalence for 27 sites in the adult population in 2008. International Journal of Cancer, 132(5), 1133- 1145.
- Butler, S. M. (2016). Consensus plans emerge to tackle long-term care costs. The Journal of the American Medical Association, 315(14): 1-9.
- Calmus, D. (2013). The long-term care financing crisis. Center for Policy Innovation Discussion Paper 7 on Health Care. Retrieved from http://www.heritage.org/research/reports/2013/02/the-long-term-care-financing-crisis
- Centers for Disease Control and Prevention (CDC). (2013). Long-term care services in the United States: 2013 overview. Retrieved from http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf
- Donald, F., Martin‐Misener, R., Carter, N., Donald, E. E., Kaasalainen, S., Wickson‐Griffiths, A., ..& DiCenso, A. (2013). A systematic review of the effectiveness of advanced practice nurses in long‐term care. Journal of Advanced Nursing, 69(10), 2148-2161.
- Frank, R. G. (2012). Long-term Care Financing in the United States: Sources and Institutions. Applied Economic Perspectives and Policy, 34(2), 333-345. doi:10.1093/aepp/pps016
- Freundlich, N. (2014). Long-term care: What are the issues? Robert Wood Johnson Foundation. http://www.rwjf.org/en/library/research/2014/02/long-term-care–what-are-the-issues-.html
- Nicolle, L. E. (2014). Antimicrobial stewardship in long term care facilities: what is effective?. Antimicrobial resistance and infection control, 3(1), 1.