Capella 4050 Assessment 2

Assessment 2 – Ethical and Policy Factors in Care Coordination

Name:

Capella University

School of Nursing and Health Sciences, Capella University

FPX-NURS 4050: Coordinating Patient-Centered Care

Prof. Name:

Date

Ethical and Policy Factors in Care Coordination – Homeless Shelters

Hello everyone, my name is Student Name, and I am a care coordinator at the local community care center. It’s an honor to be here with you today to explore the ethical and policy issues that play a crucial role in the coordination of care, with a specific focus on homeless shelters. Gaining a deeper understanding of these challenges is essential for enhancing the health and well-being of vulnerable populations, such as individuals experiencing homelessness, and ensuring that they receive equitable access to quality healthcare services. As we delve into this important topic, we will examine the impact of various policies and ethical considerations on care coordination, as well as how we, as professionals working in this field, can collaborate to address these issues and promote positive change within our community.

Governmental Policies and Their Impact on Care Coordination

Governmental policies play a significant role in shaping the health and safety of our communities, directly affecting the coordination of care for vulnerable populations (Betts, Easton-Calabria & Pincock, 2021). For instance, the “Health Insurance Portability and Accountability Act (HIPAA)” ensures the privacy and security of individuals’ health information. This policy impacts homeless shelters by requiring them to safeguard residents’ personal health information and coordinate care with other healthcare providers while maintaining confidentiality (Bhatia-Lin et al., 2019).

Another example of a policy affecting care coordination is the “Affordable Care Act (ACA)”, which expands access to healthcare coverage for millions of Americans, including homeless individuals (Crews & Novick, 2020). The ACA has provisions for Medicaid expansion, allowing states to cover more low-income individuals, including those who are homeless. With increased access to insurance, homeless shelters can better coordinate care with healthcare providers, ensuring that their residents receive necessary medical services (Chen & Ghaly, 2022).

Capella 4050 Assessment 2

Additionally, the “McKinney-Vento Homeless Assistance Act” provides funding for homeless services and housing programs, directly affecting the resources available for care coordination in homeless shelters (Sullivan, 2022). This act supports the “Continuum of Care (CoC)” Program, which aims to promote community-wide efforts to end homelessness by providing funding to nonprofit organizations, states, and local governments. The CoC Program fosters better care coordination for homeless individuals by promoting access to mainstream services and optimizing self-sufficiency (Mosley, 2021).

These policies demonstrate the interconnectedness of health and safety in communities, as they directly influence the availability and coordination of care for homeless individuals. By understanding the implications of these policies, care coordinators can better navigate the challenges of providing comprehensive care to vulnerable populations.

Ethical Questions and Dilemmas in Care Coordination Policies

As we navigate through various national, state, and local policies, we may encounter ethical questions or dilemmas that directly impact care coordination. At the national level, the variation in Medicaid expansion under the Affordable Care Act (ACA) raises ethical concerns. While some states have chosen to expand Medicaid, others have not, resulting in a coverage gap for low-income individuals who do not qualify for Medicaid and cannot afford private insurance (Roberts et al., 2021). This disparity disproportionately affects homeless individuals, raising questions about equity in access to healthcare services and resources.

At the state level, differing approaches to mental health care funding and services can create ethical dilemmas for care coordination. For instance, states with limited funding for mental health care services may struggle to provide adequate support for homeless individuals with mental health needs (Wirth et al., 2019). This disparity can lead to increased reliance on emergency services and inadequate long-term care, perpetuating cycles of homelessness and poor health outcomes.

At the local level, ordinances that criminalize homelessness, such as those penalizing activities like sleeping in public spaces, loitering, or panhandling, raise ethical concerns. These policies can create barriers for homeless individuals to access healthcare services and housing, as they may face fines or even incarceration (Giamarino & Loukaitou-Sideris, 2023). The ethical implications of these local policies include potential human rights violations and the exacerbation of health disparities among the homeless population (Roberts et al., 2021).

Capella 4050 Assessment 2

These examples provide concrete illustrations of the ethical implications and consequences of specific policy provisions at the national, state, and local levels in care coordination. The variation in Medicaid expansion under the Affordable Care Act (ACA) at the national level results in a coverage gap for low-income individuals who do not qualify for Medicaid and cannot afford private insurance, disproportionately affecting homeless individuals and raising questions about equity in access to healthcare services and resources (Roberts et al., 2021). At the state level, limited funding for mental health care services creates ethical dilemmas for care coordination, potentially leading to inadequate support for homeless individuals with mental health needs and perpetuating cycles of poor health outcomes (Wirth et al., 2019). At the local level, ordinances that criminalize homelessness can lead to human rights violations and exacerbate health disparities among the homeless population, creating barriers to accessing healthcare services and housing (Roberts et al., 2021).

Impact of the Code of Ethics for Nurses on Care Coordination

The Code of Ethics for Nurses has a profound impact on the coordination and continuum of care, guiding nursing professionals in providing services to vulnerable populations, such as those in homeless shelters. By adhering to the Code of Ethics, nurses ensure the delivery of equitable, high-quality care to all individuals, regardless of their social or economic status (Antón-Solanas et al., 2022).

An essential element of the Code of Ethics lies in its focus on social determinants of health, as highlighted in Healthy People 2020. These determinants encompass aspects like socioeconomic standing, education, physical surroundings, employment, social support systems, and healthcare accessibility (Hill-Briggs et al., 2020). By taking these factors into account, nursing professionals can pinpoint and tackle the underlying reasons for health inequalities, ultimately enhancing care coordination and overall health results for at-risk populations. For example, research indicates that homeless individuals often face barriers to accessing healthcare services, such as lack of transportation, insurance, or identification (Barile et al., 2019). By recognizing these challenges and advocating for policy changes that address these barriers, nurses uphold the Code of Ethics and contribute to more effective care coordination.

Additionally, the Code of Ethics for Nurses emphasizes the importance of cultural competence in care coordination. This involves understanding and respecting the diverse cultural backgrounds of patients and tailoring care to meet their unique needs (Sin et al., 2019). A study found that patients receiving care from culturally competent providers reported better overall satisfaction and health outcomes. By fostering cultural competence, nurses can bridge gaps in communication and understanding, ultimately improving the coordination and continuum of care for vulnerable populations (Flynn et al., 2019). 

Conclusion

In conclusion, tackling the intricate ethical and policy challenges that influence the coordination and continuity of care for individuals experiencing homelessness is vital for enhancing their health results and overall quality of life. As representatives of homeless shelters and nursing professionals, it is our collective responsibility to consider the social determinants of health, advocate for equitable policies, and adhere to the Code of Ethics for Nurses. By working together, we can bridge the gaps in care and promote a healthier, more inclusive community for all. Thank you for your dedication to this important cause, and let us continue our collaborative efforts to make a positive impact on the lives of those we serve.

References

Antón-Solanas, I., Rodríguez-Roca, B., Vanceulebroeck, V., Kömürcü, N., Kalkan, I., Tambo-Lizalde, E., Huércanos-Esparza, I., Casa Nova, A., Hamam-Alcober, N., Coelho, M., Coelho, T., Van Gils, Y., Öz, S. D., Kavala, A., & Subirón-Valera, A. B. (2022). Qualified nurses’ perceptions of cultural competence and experiences of caring for culturally diverse patients: A qualitative study in four european countries. Nursing Reports, 12(2), 348–364. https://doi.org/10.3390/nursrep12020034 

Barile, J. P., Pruitt, A. S., & Parker, J. L. (2019). Identifying and understanding gaps in services for adults experiencing homelessness. Journal of Community & Applied Social Psychology, 30(3), 262–277. https://doi.org/10.1002/casp.2440 

Betts, A., Easton-Calabria, E., & Pincock, K. (2021). Localising public health: Refugee-led organisations as first and last responders in COVID-19. World Development, 139, 105311. https://doi.org/10.1016/j.worlddev.2020.105311 

Bhatia-Lin, A., Boon-Dooley, A., Roberts, M. K., Pronai, C., Fisher, D., Parker, L., Engstrom, A., Ingraham, L., & Darnell, D. (2019). Ethical and regulatory considerations for using social media platforms to locate and track research participants. The American Journal of Bioethics, 19(6), 47–61. https://doi.org/10.1080/15265161.2019.1602176 

Chen, A. H., & Ghaly, M. A. (2022). Medicaid as a driver of health equity. JAMA, 328(11), 1051. https://doi.org/10.1001/jama.2022.14911 

Crews, D. C., & Novick, T. K. (2020). Achieving equity in dialysis care and outcomes: The role of policies. Seminars in Dialysis, 33(1), 43–51. https://doi.org/10.1111/sdi.12847 

Flynn, P. M., Betancourt, H., Emerson, N. D., Nunez, E. I., & Nance, C. M. (2019). Health professional cultural competence reduces the psychological and behavioral impact of negative healthcare encounters. Cultural Diversity and Ethnic Minority Psychology, 26(3). https://doi.org/10.1037/cdp0000295 

Giamarino, C., & Loukaitou-Sideris, A. (2023). “The Echoes of Echo Park”: Anti-homeless ordinances in neo-revanchist cities. Urban Affairs Review, 107808742311629. https://doi.org/10.1177/10780874231162936 

Herring, C. (2019). Complaint-oriented policing: Regulating homelessness in public space. Semantic Scholar, 84(5). https://doi.org/10.1177/0003122419872671 

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2020). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053 

Mosley, J. E. (2021). Cross-sector collaboration to improve homeless services: Addressing capacity, innovation, and equity challenges. The ANNALS of the American Academy of Political and Social Science, 693(1), 246–263. https://doi.org/10.1177/0002716221994464 

Roberts, E. T., Glynn, A., Cornelio, N., Donohue, J. M., Gellad, W. F., McWilliams, J. M., & Sabik, L. M. (2021). Medicaid coverage “Cliff” increases expenses and decreases care for near-poor medicare beneficiaries. Health Affairs, 40(4), 552–561. https://doi.org/10.1377/hlthaff.2020.02272 

Sin, D., Chew, T., Chia, T. K., Ser, J. S., Sayampanathan, A., & Koh, G. (2019). Evaluation of constructing care collaboration – nurturing empathy and peer-to-peer learning in medical students who participate in voluntary structured service learning programmes for migrant workers. BMC Medical Education, 19(1). https://doi.org/10.1186/s12909-019-1740-6 

Sullivan, A. A. (2022). What does it mean to be homeless? How definitions affect homelessness policy. Urban Affairs Review, 107808742210951. https://doi.org/10.1177/10780874221095185 

Wirth, T., Mette, J., Prill, J., Harth, V., & Nienhaus, A. (2019). Working conditions, mental health and coping of staff in social work with refugees and homeless individuals: A scoping review. Health & Social Care in the Community, 27(4), e257–e269. https://doi.org/10.1111/hsc.12730