A 45-year-old female has requested a copy of her 80-year-old father's health record. She has presented POA and has a legal right to access his records. You provide a copy to the woman, but she has many questions regarding documentation of her father's diagnosis. He has a Living Will but the daughter does not have the right to make medical decisions. He was admitted to the ICU last week from the skilled nursing facility. When discharged, he was transferred to a long-term care facility that is part of the same healthcare system.
Explain the continuum of healthcare delivery across systems and services. Use the case scenario to provide examples of the continuum of care in a healthcare system.
Evaluate the case and impact of policies on healthcare delivery.
Determine at least one (1) federal level, one (1) state level, and one (1) local level healthcare policy that may impact the case.
Interpret each policy, in relation to the case. (Explain how each policy is relevant to the case scenario) and justify your rationale for applicable policies.
Evaluate and discuss the impact of the patient’s age, relationship with the requestor, and POA for health record access.
Assess the impact of a Living Will and explain in detail why the daughter may/may not have the right to make medical decisions.
Evaluate how the policy affects national and global health delivery systems, both directly and indirectly.
Full Answer Section
Policies Impacting Healthcare Delivery:
- Federal Level:
- HIPAA (Health Insurance Portability and Accountability Act): Ensures patient privacy and allows access to medical records by individuals with POA like the daughter.
- Medicare and Medicaid: Government insurance programs providing coverage for skilled nursing and long-term care, impacting the availability and affordability of these services.
- State Level:
- Certificate of Need (CON) programs: Regulate the construction of new healthcare facilities, impacting access to care in specific areas.
- Medicaid expansion: Determines the eligibility and scope of Medicaid coverage, affecting access to long-term care for low-income individuals.
- Local Level:
- Zoning regulations: Influence the location and density of healthcare facilities, impacting patient access and healthcare workforce distribution.
- Public health initiatives: Focus on preventive care and community health education, contributing to overall population health and reducing long-term healthcare needs.
Interpretation of Policies in the Case:
- HIPAA: Allows the daughter access to her father's records with POA, enabling informed decision-making.
- Medicare and Medicaid: May cover the father's skilled nursing and long-term care, depending on his eligibility and financial needs.
- State Medicaid expansion: If applicable, expands coverage for father's long-term care, enhancing access to services.
- CON programs: May impact the availability of long-term care beds in the daughter's preferred location.
- Local public health initiatives: Potentially relevant if the father has conditions addressed by community programs (e.g., fall prevention).
Patient's Age, Relationship, and POA:
- Age: 80 years old puts the father at higher risk for chronic conditions and dependence on long-term care, emphasizing the importance of accessible and coordinated services.
- Relationship: The daughter's concern and involvement highlight the vital role of family caregivers in patient advocacy and navigating the healthcare system.
- POA: Empowers the daughter to access medical records and potentially participate in healthcare decisions on the father's behalf, ensuring his wishes are respected.
Living Will and Decision-Making:
- A Living Will specifies a patient's end-of-life care preferences but does not automatically grant decision-making power to anyone.
- Without a designated healthcare proxy, state laws determine who makes medical decisions, often favoring spouses or adult children.
- In this case, the daughter may not have full decision-making rights unless she is officially designated as the father's healthcare proxy.
Global and National Impact:
- The case reflects challenges faced by aging populations worldwide, highlighting the need for robust, coordinated healthcare systems.
- Policies promoting integrated care and patient-centered approaches can improve care quality and efficiency across different settings.
- Sharing best practices and advocating for equitable access to healthcare can benefit older adults globally.
By examining the case through the lens of the continuum of care and various policies, we gain a deeper understanding of the complex landscape of healthcare delivery and the importance of advocating for comprehensive, coordinated, and patient-centered systems that effectively serve individuals like the 80-year-old father and his daughter.
Sample Answer
The case scenario exemplifies the continuum of care, which refers to the seamless transition of a patient between various healthcare delivery settings across their lifespan. In this case, the 80-year-old man navigated:
- Skilled nursing facility: Providing post-acute care following hospitalization.
- ICU admission: Acute care for a critical illness.
- Long-term care facility: Offering support for chronic conditions requiring assisted living.
This movement showcases the interconnectedness of different healthcare systems:
- Acute care hospitals: Focus on diagnosing and treating immediate medical emergencies like the ICU stay.
- Post-acute and long-term care: Provide ongoing medical and non-medical services for chronic conditions or age-related decline.