Access to Care for Older Developmentally Delayed Patients

Case Studies Content

Students will work in groups as assigned and complete the attached Epidemiology case study answering all of the questions. The students will upload the document in a Word document following the rubric assigned.

Case study GROUP WORK – is to be submitted by ONLY ONE STUDENT in the group- ensure all team members are noted on the cover page.

 

Please refer to your book CHAPTER 8 for this week’s case study. Answer the following questions as a group and submit them by the due date.

CASE STUDY 8.1

Access to Care: Older, Developmentally Delayed Patient With Several Chronic Illnesses and New Onset of Perceived Hearing Loss

Ms. Renee Sharrod is 65 years old and developmentally delayed. Ms. Sharrod has always been considered high functioning although she is unable to read or write. In the past, Ms. Sharrod was able to respond to straightforward questions and follow direct instructions. However, as she has gotten older, she has developed hearing and speech difficulties as well as some mild cognitive decline. When Ms. Sharrod’s mother passed away, Ms. Sharrod no longer had a direct caregiver to assist her with activities of daily living (ADLs) or with healthcare concerns. Shortly following the death of Ms. Sharrod’s mother, Ms. Sharrod was moved into an apartment in an assisted-living facility.

The assisted-living facility does a marginal job of supporting Ms. Sharrod’s ADLs, such as providing meals, assisting with bathing, and administering medications. However, when it comes to managing and facilitating treatment for Ms. Sharrod’s many chronic health conditions, the facility falls short. The assisted living facility does not have well-trained or adequate caregiving staff to stay on top of healthcare visits, procedures, or equipment orders. Although Ms. Sharrod has adequate health insurance, she has no one to assist her with navigating the “red tape” involved, such as prior authorizations, and with understanding when and where she can seek services and how often. Additionally, Ms. Sharrod needs assistance with scheduling appointments, arranging transportation, and communicating with healthcare providers.

As mentioned previously, Ms. Sharrod has developed what is perceived as hearing loss. Ms. Sharrod’s caseworker schedules an appointment for Ms. Sharrod to have her hearing checked. The assisted-living facility arranges the visit and sends an aide with Ms. Sharrod to the visit. Ms. Sharrod’s hearing is evaluated at this visit, and it is determined that she has moderate hearing loss and needs hearing aids. Although this same healthcare facility also provides hearing aids, Ms. Sharrod’s insurance will not cover the hearing aids from this healthcare facility; she can only receive hearing aids from a select few places. Ms. Sharrod goes home with an order for hearing aids but needs another appointment at a separate facility to be fitted for them. A few months go by, with the overworked caseworker attempting to find out from the insurance company where Ms. Sharrod can go to be fitted for hearing aids. Prior authorization is submitted and is finally obtained from Ms. Sharrod’s insurance company. At this point, Ms. Sharrod is assigned a new caseworker, who is unaware of the prior authorization and the need to schedule an appointment to have Ms. Sharrod fitted for hearing aids, so several more weeks go by. Once Ms. Sharrod is finally scheduled and goes to be fitted for the hearing aids, she is informed that the hearing evaluation and order for hearing aids have expired. She now needs a new hearing evaluation and an order for hearing aids. Although this current facility can perform hearing evaluations, Ms. Sharrod’s insurance will not cover testing at this facility, only the hearing aids. Ms. Sharrod now needs another hearing test at yet another facility, essentially starting all over again.

This entire process has taken more than 9 months, and Ms. Sharrod still does not have hearing aids or any one person available to her to facilitate and connect the various steps it takes to use her health insurance and access appropriate care. COVID-19 emerges about 2 months later and all efforts cease; there are not enough staff to address Ms. Sharrod’s hearing loss issues. It has now been almost 2 years and Ms. Sharrod still does not have hearing aids; by all accounts, her hearing has gotten significantly worse. Her speech is now being impacted by the hearing deficit. Of note, hearing loss is only one of Ms. Sharrod’s health issues, which include diabetes, hypertension, and pulmonary hypertension. Although Ms. Sharrod has what would be considered adequate health insurance, her being older, developmentally delayed, and lacking a caregiver or advocate to coordinate her care means that she ultimately does not have adequate access to healthcare.

Case Study Questions

1. What other barriers might older persons or persons with disabilities face when trying to access healthcare?
2. What are steps you could take both as an individual nurse and at the systems level, to improve access to care for older or developmentally delayed patients?
3. What could be done in situations where a lack of advocacy resources and “red tape” restrict needed healthcare access?
4. Develop a policy that health professionals could create and implement to address the needs of individuals in assisted living facilities. Provide a rationale for your proposed policy.

 

This assignment is to be submitted as an essay- with an introduction, questions developed at the graduate level, and a conclusion to summarize and synthesize key points. APA must be strictly followed. Minimum 5 references should be utilized to validate answers. Paper should be minimally 6-7 pages long not counting cover and reference pages.

Case Study 8.1: Access to Care for Older, Developmentally Delayed Patients

Introduction

Access to healthcare is a critical concern for older adults and individuals with disabilities, often exacerbated by systemic barriers, inadequate caregiving support, and bureaucratic challenges. This case study explores the challenges faced by Ms. Renee Sharrod, a 65-year-old developmentally delayed woman, who encounters significant obstacles in accessing healthcare due to her chronic illnesses and perceived hearing loss. This essay addresses the barriers to healthcare access, strategies to improve care, and policy recommendations to enhance the quality of care for individuals in similar circumstances.

Barriers to Healthcare Access

1. Barriers Faced by Older Persons or Persons with Disabilities
   • Physical Barriers: Mobility issues, lack of transportation, and inaccessible healthcare facilities can prevent individuals from attending medical appointments.
   • Communication Barriers: Hearing loss, speech difficulties, and cognitive impairments hinder effective communication with healthcare providers.
   • Financial Barriers: Despite having insurance, out-of-pocket costs, and limitations on covered services can restrict access to necessary care.
   • Systemic Barriers: Complex healthcare systems, lack of coordinated care, and extensive paperwork for prior authorizations create significant delays in treatment.
   • Social Barriers: Isolation, lack of social support, and absence of a caregiver or advocate can impede the ability to navigate the healthcare system and adhere to treatment plans.

Strategies to Improve Access to Care

2. Individual and System-Level Interventions
   • Individual Nurse Interventions:
     • Advocacy: Nurses can act as advocates for patients, ensuring they receive timely and appropriate care by coordinating with healthcare providers and insurance companies.
     • Education: Providing patients and their families with education on navigating the healthcare system and managing chronic conditions can empower them to seek appropriate care.
     • Support Services: Referring patients to community resources, social services, and support groups can enhance their access to necessary care and support.
   • System-Level Interventions:
     • Integrated Care Models: Implementing integrated care models that coordinate care across multiple providers and services can streamline the process for patients with complex needs.
     • Policy Changes: Advocating for policy changes that reduce bureaucratic barriers, such as simplifying prior authorization processes and expanding insurance coverage for essential services.
     • Training Programs: Establishing training programs for healthcare providers and staff to improve their understanding and management of the unique needs of older adults and individuals with disabilities.

Addressing Lack of Advocacy Resources and Red Tape

3. Overcoming Advocacy and Bureaucratic Challenges
   • Case Management Services: Establishing dedicated case management services within healthcare facilities to assist patients with navigating insurance requirements, scheduling appointments, and coordinating care.
   • Patient Navigators: Employing patient navigators who can provide personalized support and advocacy, ensuring that patients receive timely and appropriate care without being hindered by bureaucratic obstacles.
   • Streamlined Processes: Simplifying administrative processes, reducing paperwork, and utilizing electronic health records to improve communication and coordination among healthcare providers.

Policy Development for Assisted Living Facilities

4. Proposed Policy and Rationale

   Policy Proposal: “Enhanced Care Coordination and Support Services for Residents of Assisted Living Facilities”

   • Policy Components:
     • Comprehensive Care Plans: Develop individualized care plans for each resident, addressing their specific healthcare needs and ensuring regular follow-ups and evaluations.
     • Dedicated Case Managers: Assign dedicated case managers to each facility to oversee residents’ healthcare coordination, facilitate communication with healthcare providers, and manage insurance-related issues.
     • Regular Training for Staff: Implement ongoing training programs for facility staff on managing chronic conditions, recognizing early signs of health deterioration, and effectively communicating with residents with disabilities.
     • Collaboration with Healthcare Providers: Establish formal partnerships with local healthcare providers, ensuring seamless referrals, and access to specialized care when needed.
   • Rationale: This policy aims to address the gaps in care coordination and support services within assisted living facilities, ensuring that residents receive timely and appropriate care. By implementing comprehensive care plans, dedicated case managers, and ongoing staff training, the policy seeks to improve health outcomes and quality of life for residents, reducing the burden on both the residents and their families.

Conclusion

Access to healthcare for older adults and individuals with disabilities is a multifaceted issue requiring both individual and systemic interventions. By understanding the barriers these individuals face and implementing targeted strategies at both the individual nurse and systems levels, healthcare providers can significantly improve access to care. Developing and implementing comprehensive policies within assisted living facilities can further ensure that residents receive the support and coordination necessary for optimal health outcomes. Addressing these challenges is crucial in providing equitable and effective healthcare for all individuals, regardless of age or disability.