week 5

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Chapter 9

Assisted Living and Ethics

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Concerns with Older Population Demographics

• Increased older population. • Concerns with chronic conditions. • Amount of family caregivers. • Community support resources. • Continuum of independent living, assisted

living, & nursing home. • Ethical value of resident’s autonomy.

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Description of Assisted Living

• Uses a ‘social model’ vs. a ‘medical model’. • Regulated by states, not federal law. • State licensure definitions & regulations vary.

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Description of Assisted Living

• Developed in the U.S. in early 1980’s. • Provides housing & ADL’s. • Has varied demographics of participants. • Emphasis on social engagement.

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Trend Changes with ALs

• Increased numbers of aged combined with concern with costs resulted in: – Increased numbers of ALs. – Ongoing state regulatory changes (18 states

in 2010-2011). – Desire to decrease state Medicaid

expenditures for nursing homes.

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Access Issues related to AL: Justice

• Concerns with variables affecting access other than need: – Income – Gender – Race – Language – Culture – Physical, behavioral, & mental behaviors

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Payment Systems in ALs

• Private pay – by individuals or insurance policy • Medicaid • Medicaid waiver (must meet nursing home

care level criteria)

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Payment Systems in ALs

• Statistics on AL acceptance of residents by Medicaid payment include: – Clinical concerns. – Ethical concerns.

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Health Care & ALs

• Amount of health care provided in ALs varies by states’ laws &regulations.

• Examples include nursing, pharmacy, & hospice care.

• Nebraska is an outlier state—RN unable to implement RN scope of practice.

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Nebraska AL as a Case Study

• Ethical Concerns Include: – Veracity. – Beneficence. – Nonmaleficence. – ANA Code of Ethics

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In Summary…

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