In the last couples of years, it has come out that there are no enough policy guidelines to evaluate the admission of patients who are 65 years and above in the U.S.The debate has been fueled by recent findings that have revealed that the overall health outcomes of majority of patients aged 65 years and above are depressing. Recent statistics show that about one-third of patients over 70 years old and more than half of patients over 85 years leave the hospital more disabled than when they arrived (Gorman, 2016). Hospital staff has come under the spotlight for their alleged ignorance of older patients which leaves them at the risk of potential occurrence of falls, skin breakdown, functional decline and adverse medical interaction (Gorman, 2016). Based on these findings, there have been rallying cries from various quarters that there is a need for policies to regulate the admission of such patients into hospital given the poor health outcomes witnessed. In this paper, I will create a policy that can help evacuate admission of such patients based on evidence-based practices.
Policy Background
Recent research has revealed that older patients, 65 years and above are the most regular visitors to hospitals accident and emergency departments in the U.S.A.They find themselves in these departments due to severe injury and illness. Frequently, the majority of these patients are functionally impaired by the time they leave the hospital. Despite this, there are still no policy guidelines in place to evaluate the admission of such patients or improve their ability to self-care after they are discharged from the hospital.
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Constructive Reviews
There have been numerous policies in the recent past that have been designed with an aim of improving the healthcare outcome among the elderly population in the U.S.One such policy has been the approval of the use of EBP (Evidence Based Practice) in healthcare (Titler, 2008).EBP is the prudent use of current best evidence in combination with clinical proficiency in order by the physicians to make better healthcare decisions. The policy has seen an overall improvement in the health outcomes of patients across the U.S as physicians nowadays use data from case studies and expert opinions in their practice.
Another healthcare policy that has significantly impacted the U.S healthcare system is the policy that has resulted into the use of Technology Informatics Guiding Education Reform (TIGER).The policy was developed in order to address the limitation in technology familiarity among the 21 s century nurses. Besides, it was developed in order to impact nurses with a wide for clinicians to eldrange of skills ranging from computer proficiencies to advanced level IT and literacy expertise (Hebda &Calderone, 2010).
Aimee Lee and a group of researchers also examined the importance of policies that focus on the improved evaluation of patients who are aged. In their research article, they concluded that there should be strict policy guidelines in place that make it mandatory for clinicians involved in the treatment of the elderly patients to screen them about their history of falls before admission to the hospital. Patients who report fall and balance difficulties should undergo in-office assessment before admission to the hospital (Lee et al., 2013).
The above two types of research prove that indeed there is a need for policy guidelines to evaluate admission of patients aged 65 years and above in all hospital settings in the U.S.Healthcare policies in the U.S are developed by the three branches of government and poses serious legal, ethical and social questions. Besides, several other interest groups also have an influence on the policies.
Healthcare Proposal
The policy recommendation which am proposing to address the gap in the evaluation of patients is training and retraining of all caregivers dealing with older patients with an emphasis on enhancing their skill base and also motivating the geriatric professionals so they can perform their work wholeheartedly. The target population for this policy change will be the thousands of geriatric healthcare professionals in the U.S who care for older patients. It has come out that most hospital-based clinicians are not adequately trained to treat older patients. Despite the increasing number of older patients hospitalized in emergency and accident departments. Besides, most hospital programs in the U.S do not emphasize the need for geriatric skills. It has come out that there are insufficient and also poor trained healthcare providers attending to thousands of elderly patients across the U.S today.
The USA today faces an alarmingly shocking low population of geriatrician professionals including nurses, social workers, and public health professionals. Recent statistics have revealed that the total number of board-certified geriatricians is 7500, which is less than half the estimated need (Rowe et al., 2016). Moreover, the pipeline for geriatricians in training is alarmingly inadequate. The underlying reason for this low numbers is the fact that the care the genetricians provide is more time intensive and all their patients are either on Medicare and Medicaid significantly limiting their finances. Profeg .
The nursing field is also deficient in geriatrics with less than 1% of registered nurses and 3% of advanced practice registered nurses certified in geriatrics. The major impediment that has been identified for nurses is the lack of sufficiently trained faculty in geriatric nursing (Rowe et al., 2016). Gaps in training and competency have also been identified among physicians and nurses who treat older patients with regards to the diagnosis and management of common geriatric problems. Also, gaps have been identified in the coordination of specialists such as geriatricians and primary care providers (Rowe et al., 2016). All the deficiencies mentioned above work together to contribute to ineffectiveness in admissions for older patients among healthcare providers thus exposing these patients to everyday occurrences such as skin breakdown, falls, adverse medical interactions and functional decline.
Determinants of the Policy
The determinants of the policy change stated above include interest groups and stakeholders such as the Congress, the federal and state government and the geriatric professionals. The Congress will play a critical role in ensuring that the policy finally becomes a law. The state and federal government, on the other hand, will play a crucial role in providing the successful implementation of the policy on the ground once it becomes a law. Finally, the geriatric healthcare professionals who are directly involved in the care of the older patients.
Legislations Supportive of the Policy Intentions
There are numerous legislations which have been passed in the past that are supportive of the policy intentions of the policy above that aims at improving the assessment of older patients before admission to hospitals. Such legislation includes the California Osteoporosis Prevention and Education Act, a session law in California which requires the department of health service in the state to develop an effective protocol to prevent falls and fractures among elderly patients (Alvaro et al., 2015). Besides, it requires the development of “aging in place” concept to retain elderly patients in their homes with less risk of injury. Another legislation is the Connecticut statute 17b-33 which establishes a falls prevention program in the department of social services that support the development and evaluation of risk identification and intervention strategies in fall prevention.
In line with the healthcare policy above, the following is the healthcare proposal which is recommending to address the limitations in training and motivation of geriatric professionals. E
The proposal focuses on workforce policies that will improve the competence of the geriatric practitioners and also increase their recruitment and retention.
Enhancing geriatric competence
To improve geriatric capability, the following are the priority considerations to be made
Physician and nurse training should be undertaken in all settings where older adults receive medical care including hospitals, nursing homes, and patient’s homes.
The demonstration of knowledge in the care of older adults should be included as a prerequisite requirement for the licensure and certification of healthcare professionals.
The Centers for Medicare &Medicaid Services (CMS) should incorporate direct care workers into team-based approaches for caring for chronically disabled older adults.
The federal government should include mandatory training of at least 120 hours for CNAs and also include a demonstration of competence in the care of older adults as a criterion for certification.
Increasing Recruitment and Retention
About increasing recruitment and retention, the following should be the priority considerations:
Both the public and private prayers should provide financial incentives to increase the number of geriatric professionals in the healthcare profession.
States and federal governments should consider putting in place programs which will guarantee scholarships and financial incentives for professionals aspiring to be geriatric specialists.
The CMS should extend graduate medical education payments to cover the cost of residency training to public health physicians and nurses.
The direct care workforce should be adequately compensated with a living N equivalent to the skills and knowledge required to perform high-quality work.
Expressed ideas/concepts for the future
The use of health information technology (HIT) to improve care and outcomes for the older patients. There are growing calls for the adoption of electronic health records which will improve the efficiency of healthcare.
Nurses and other healthcare professionals who provide healthcare services to the aged people should in the future adopt geriatric care improvement programs such as NICHE (Nurses Improving Care for Health System Elders). The program, together with an integrated EHR, provides clinical decision support ensuring that older adults receive evidence-based, personalized care.
Financial and Political feasibility
The policy change I have described above is both financially and politically feasible. About financial feasibility, the policy change is financially viable. Although the cost of training and retraining of geriatric healthcare professionals and motivating them is high, I believe that a model that incorporates both the federal and the state governments is the best way to address the issue. Every year, the U.S federal government provides millions of dollars to help in the training of healthcare professionals through various grants (Severs, 2018). The funds can be used to train the geriatric healthcare professionals.
Concerning political feasibility, the healthcare policy I have suggested is politically viable since it is in line with the U.S government Department of Health goal to improve the health and quality of life for the old people. The policy will have first to be communicated to a policy maker (Shehan, 2016). After that, the bill will have to be introduced to the Congress by the policymaker. Upon introduction to the Congress, the bill will be referred to critical committees which will hold hearings. Such committees include the Senate Finance committee, the Senate Committee on Health, Education and Labor and the house committee on energy and commerce. After passing through this committees, the bill will be debated by the full house of representatives. Then, it will be voted on by the full Senate or house. After the House and Senate both approve it, it will be sent to the president for his signature.
Foreseeable Derived Outcomes
With the successful adoption and implementation of the policy above, I foresee the following outcomes in the evaluation of older patients:
Geriatric physicians who handle older patients will be able to be able to determine if such patients are better at home being taken care at home or in the hospitals.
The physicians will be able to act in time to prevent potential occurrences such as falls among these patients.
There will be better coordination between the home-based care professionals and geriatric physicians to determine the best health outcome for patients with advanced age.
The geriatric professionals will be more committed to perform their work and offer the most significant help possible to these group of patients.
Conclusion
From the above, it is evident that indeed there are significant limitations in the evaluation of old patients before admission to hospitals in the U.S.The result of this has been deteriorating health outcomes for these patients with the majority of them leaving the hospital in a far worse condition that at the time of admission. This is a worrying picture and is unacceptable for
highly developed nation such as the U.S.A.The policy which I have come up with to remedy the situation is training and retraining of geriatric healthcare professionals who attend to the elderly as well as motivating them. I believe that the policy which I have just highlighted below will be of great help in ensuring that there is a better evaluation of patients before admission. I hope that the policy made it to the Congress and passed into law soon.
References
Alvaro, R., Pennini, A., Zannetti, E. B., Cittadini, N., Feola, M., Rao, C., & Tarantino, U. (2015). Bone care nurses and the evolution of the nurse’s educational function: the Guardian Angel® research project. Clinical Cases in Mineral and Bone Metabolism , 12 (1), 43.
Gorman, A. (2016).The Older you are, the Worse the Hospital is for you. Retrieved fromhttps://edition.cnn.com/2016/08/15/health/elderly-hospital-patients/index.html
Hebda, T &Calderone, L. (2010). What Nurse Educators Need to Know about the Tiger Iniaitive .Nurse Educ; 35 (2):56-60.doi:0.1097/NNE.0b13e3181ced83d.
Lee et al. (2013).Preventing falls in the Geriatric Population. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854807/
Rowe et al. (2016).Preparing for Better Health and Healthcare for an Ageing Population. Retrieved from https://nam.edu/wp-content/uploads/2016/09/Preparing-for-Better-Health-and-Health-Care-for-an-Aging-Population.pdf
Severs, E. (2018).Government Retraining Grants.Retrived fromhttps://bizfluent.com/government-retraining-grants-5922.html
Sheehan, J. (2016).How does a Health Care Idea Become a Law? Retrieved
Titler, M. (2008).The Evidence for Evidence-Based Practice Implentation.In: Hughes RG, editor. Patient safety and Quality: An Evidence-Based Handbook for Nurse. Rockville (MD0: Agency for Healthcare Research and Quality (US0; Chapter 7.Retrieved from https//www.ncbi.nlm.nij.gov/books/NBK2659/
