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.
Bottom of Form
Ms. Renee Sharrod is 65 years old and developmentally delayed
**Access to Healthcare for Older Persons and Individuals with Disabilities: A Case Study Analysis**
**Introduction**
Access to healthcare is a fundamental right, yet many older persons and individuals with disabilities face significant barriers in obtaining necessary medical services. This case study highlights the challenges faced by Ms. Renee Sharrod, a 65-year-old developmentally delayed woman with multiple chronic illnesses and new onset hearing loss. Through analyzing this case, we can identify barriers to healthcare access and propose strategies to address these issues at both the individual and systems level.
**Case Study Questions**
**1. What other barriers might older persons or persons with disabilities face when trying to access healthcare?**
– Financial barriers: Limited income, lack of insurance coverage, and high out-of-pocket costs can hinder access to healthcare services.
– Physical barriers: Mobility limitations, lack of transportation, and inaccessible healthcare facilities can prevent individuals from seeking care.
– Communication barriers: Language barriers, cognitive impairments, and sensory deficits may impede effective communication with healthcare providers.
– Discrimination and stigma: Older persons and individuals with disabilities may face discrimination or stigma from healthcare providers, leading to suboptimal care or avoidance of seeking medical attention.
– Lack of caregiver support: Like Ms. Sharrod, individuals without caregivers may struggle to navigate healthcare systems and advocate for their needs effectively.
**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?**
– Individual nurse:
– Provide patient education in a manner tailored to the individual’s cognitive abilities and communication preferences.
– Advocate for accommodations such as sign language interpreters or written materials in accessible formats.
– Collaborate with interdisciplinary teams to develop comprehensive care plans that address the unique needs of older or developmentally delayed patients.
– Systems level:
– Implement policies to ensure healthcare facilities are accessible and accommodate individuals with disabilities.
– Train healthcare staff on disability awareness and communication techniques to better serve diverse patient populations.
– Establish care coordination programs to assist patients in navigating complex healthcare systems and accessing necessary services.
– Advocate for policy changes to improve insurance coverage and reduce financial barriers to care for vulnerable populations.
**3. What could be done in situations where a lack of advocacy resources and “red tape” restrict needed healthcare access?**
– Develop community-based advocacy programs to provide support and guidance for individuals navigating healthcare systems.
– Streamline administrative processes and reduce bureaucratic barriers to accessing care, such as simplifying prior authorization requirements and improving communication between healthcare providers and insurance companies.
– Collaborate with social service agencies and non-profit organizations to address social determinants of health and provide holistic support for individuals with complex needs.
**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.**
**Policy Title: Enhanced Care Coordination for Residents of Assisted Living Facilities**
**Policy Rationale:**
Assisted living facilities play a crucial role in supporting older adults and individuals with disabilities in maintaining their independence while receiving necessary assistance with daily activities. However, as demonstrated in Ms. Sharrod’s case, these facilities may not always adequately address residents’ healthcare needs. Therefore, it is imperative to implement a policy focused on enhancing care coordination to ensure residents receive timely and appropriate medical care.
**Policy Components:**
- **Designated Care Coordinator:** Each assisted living facility must designate a qualified care coordinator responsible for overseeing residents’ healthcare needs, including scheduling appointments, coordinating transportation, and communicating with healthcare providers.
- **Comprehensive Assessments:** Upon admission and periodically thereafter, residents will undergo comprehensive assessments to identify their healthcare needs and preferences.
- **Individualized Care Plans:** Based on assessment findings, care coordinators will develop individualized care plans in collaboration with residents, their families, and interdisciplinary healthcare teams.
- **Regular Monitoring and Follow-up:** Care coordinators will regularly monitor residents’ health status, follow up on recommended treatments and appointments, and facilitate continuity of care during transitions between healthcare settings.
- **Education and Empowerment:** Residents and their families will receive education on navigating healthcare systems, understanding insurance coverage, and advocating for their rights and preferences.
- **Quality Improvement Measures:** Assisted living facilities will implement quality improvement initiatives to assess and improve the effectiveness of care coordination processes, ensuring residents’ healthcare needs are met efficiently and effectively.
**Conclusion**
The case of Ms. Renee Sharrod highlights the critical importance of addressing barriers to healthcare access for older persons and individuals with disabilities. By implementing policies focused on enhancing care coordination and advocacy, both at the individual and systems level, we can work towards ensuring equitable access to quality healthcare for all individuals, regardless of age or disability status.
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