Assessment 2: Assessing the Problem: Quality, Safety, and Cost Considerations Essay

Assessment 2: Assessing the Problem: Quality, Safety, and Cost Considerations Essay

Assessment 2: Assessing the Problem: Quality, Safety, and Cost Considerations Essay

In the previous assignment, Alzheimer’s disease (AD) was identified as a major health problem affecting seniors (adults from 65 years). Seniors are a vulnerable population due to deficits in cognitive function, poor health status, and social isolation. Their health status and declined cognitive function put them at risk of exploitation, particularly by people close to them. The purpose of this paper is to discuss how AD as well as state board nursing practice standards and organizational/governmental policies affect the quality of care, patient safety, and costs and recommend strategies to improve them. In addition, the paper will include a report on the practicum experiences.

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Part 1

How Alzheimer’s Disease Impacts the Quality of Care, Patient Safety, and Costs to the System and Individual

AD significantly affects the quality of patient care, compromises patient safety, and increases healthcare costs. The quality of care for AD patients is proportional to their quality of life (QoL). Due to deterioration in function, cognition, and behavior, persons with AD have complex health care needs and social services. Seniors with AD require more individualized care and more hours of care and supervision, which is associated with increased caregiver strain (Bökberg et al., 2018). The need for assistance with activities of daily living (ADLs) begins early in the course of AD and constantly progresses over time.

Older adults living with AD encounter a higher degree the types of accidents and injuries common among older adults. AD patients face safety issues such as falls, traffic safety, food safety, wandering, and adverse drug reactions due to polypharmacy. Cognitive impairment creates barriers to attaining high levels of safety in AD patients. Furthermore, patients with AD are especially prone to adverse reactions to drugs, particularly antipsychotics, which cause dysphagia, over-sedation, parkinsonism, stroke, and increase the risk of mortality (Bökberg et al., 2018). Therefore, it is crucial that caregivers take appropriate measures to prevent injuries and improve safety to help patients feel less overwhelmed, more relaxed, and maintain their independence longer.

AD is associated with high healthcare costs since patients require complex care. According to Grabher (2018), reimbursements by Medicare and Medicaid for health care, long-term care, and hospice for patients with AD were $150 billion in 2014, $236 billion in 2016, and $277 billion in 2018. Besides, some families spend more than $10,000 annually caring for a member with AD. In 2018, AD cost the country’s healthcare system approximately $277 billion (Grabher, 2018). The number of persons with AD will continue to increase, putting more strain on families and caregivers physically and emotionally and on the healthcare system economically.

How State Board Nursing Practice Standards and Organizational/Governmental Policies Can Affect AD Impact on The Quality of Care, Patient Safety, and Costs

The state boards of nursing practice and government have created standards and policies that impact the quality of care and patient safety in AD patients. The standards guide healthcare providers on the minimum quality of care they should provide to AD patients to promote safety and the best health outcomes possible. Federal and state legislators have a crucial role in ensuring that nursing home residents with AD are provided the appropriate, high-quality care that the residents and their families expect (Carder, 2018). Furthermore, organizational and governmental policies dictate the staffing ratios in nursing homes, particularly the ratio of nurses to residents. This is because adequate staffing, steady staff assignments, and the quality of provider-resident relationships greatly influence the QoL of nursing home residents with AD (Levy-Storms et al., 2018). Federal and state regulations demand regular formal evaluations of all residents in nursing homes using the Minimum Data Set of the CMS.

Pay-for-performance is an innovative approach developed to enhance the quality of nursing home care for residents with AD and other residents. Health facilities that participate in the program demonstrate significant improvements in their quality of patient care (Levy-Storms et al., 2018). Improved quality of care reduces comorbidities associated with AD and thus lowers healthcare costs. In addition, a number of residential care and assisted living (RC/AL) governmental policies influence the quality of care provided to AD patients (Carder, 2018). All states have policies requiring RC/AL facilities to assess residents to determine if their health needs can be met and thus arrange for activities to meet their health needs and preferences.

Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual

The quality of care and safety for AD patients can be improved through continuous staff training. Nurses caring for seniors with AD should be trained in pain assessment and management to promote physical and emotional well-being. Studies show that pain is under-diagnosed and poorly managed among seniors and comes as an even greater challenge for those with AD (Evripidou et al., 2019). They should also be trained on non-pharmacologic approaches (psychologic and social intervention) for managing behavior to promote physical and psychological well-being. In addition, nurses should be trained on pharmacologic interventions. They should use this knowledge to advocate for pharmacological options with fewer side effects to promote maximum functioning and coping (Mulyani et al., 2021). Therefore, healthcare organizations should incorporate professional development opportunities to support nurses in developing knowledge and skills to provide high-quality and safe care for seniors with AD.

Another recommendation is for nurses to create partnerships with family members and caregivers in the care of AD patients, especially for patients living in the community. Nurses should educate the family members and caregivers on how to care for AD patients at home and promote safety at home to promote patient safety. Thus, organizations should adopt a model of care that fosters a level of consistency in the nurse-client relationship (Chen et al., 2020). In addition, healthcare leaders and supervisors should make staffing decisions based on client acuity and complexity level to promote high-quality care and patient safety. Furthermore, proper coordination of care can improve the quality of care and lower healthcare costs. Organizations can promote effective care coordination by adopting effective processes to transfer information, including effective communication, appropriate referrals, and documentation (Chen et al., 2020). Organizations should also create policies that foster formal methods of patient information transfer and networking between providers.

Part 2

The two practicum hours were spent in a meeting with retired Fathers/ priests living in priesthood missionary home in Connecticut. The retired Fathers and priests do not have social services such as counseling on health insurance, protection from elder abuse, legal assistance, and assistance with long-term care needs. After conducting reviews from different websites on social services for seniors, it was established learned that the best alternative for seniors depending on their social security as a sole and only source of income is to apply to a different social security service named ‘Supplement Security Income’ SSI program. Besides, it was discovered that some social services are only available to seniors depending on their specific conditions: health, military service, income, assets, and education level.

The Retired Fathers/ priests encounter various social and economic barriers in accessing healthcare, which may worsen their health outcomes. The Retired Fathers and priests do not have families, and the brotherhood is all they have. Nursing care is paid for out of pocket using their social security or the Pope or Catholic Church. However, nursing care is not provided 24 hours a day and is only available from 6 am to 10 pm. In addition, the priests are allowed to eat without monitored dietary restrictions to promote free will. Their food is placed in trays for self-service with no portion control and includes desserts, use of salt, and unsupervised access to all drinks. Nevertheless, nurses encourage and educate them to follow dietary restrictions.

Connecticut does not regulate the priesthood, and the residence is their home, which is similar to a group home setting. There are different floors based on the level of care. Furthermore, there is no on-call physician, although a physician is their primary provider, and in case of an emergency, they call 911). The priests are allowed to refuse medication; however, there is a need to find creative approaches to increase their willingness to adhere to physicians’ orders. The priests agreed with me that AD was a problem affecting them, and it had a significant impact on their health and QoL. Collaboration with the primary care provider involved documenting and listing potential concerns or active issues with the physician. The residents’ day-to-day activities were also monitored. A discussion ensued with the CAN about the priests’ concerns, what nurses find most difficult when providing care, and gave suggestions to improve their care.

After the discussion with the retired priests and the CAN, recommendations were given to improve care for seniors, including those with AD. The recommendations include medication reconciliation, assistance with serving meals, and redirecting and encouraging resident from taking snacks with high sugar and fat content, caffeinated and sugared beverages, and sweets. In addition, patient-specific snacks were recommended and making them readily available in their rooms to limit the need to search the house for snacks. Other suggestions included having sugar-free sweets and drinks and a mini-fridge in the residents’ rooms for easy access and to limit the temptation of other beverages within the common fridge. The meeting was a success since the objectives of identifying health problems faced by the priests and barriers to accessing quality healthcare were achieved. However, there should have been more discussions with the CAN in identifying the challenges nurses face in providing quality and safe care to residents with AD.

Conclusion

AD impacts the quality of care since it requires complex and constant care, which strains caregivers and increases healthcare costs. Cognitive deficits in AD compromise patient safety, putting patients at risk of falls and injuries. The state boards of nursing practice standards and government policies dictate the quality of care provided to AD patients and the minimum standards for nursing homes to promote safety. The quality of care, patient safety, and healthcare costs in AD can be improved by training healthcare providers, creating partnerships with family members, and appropriate care coordination.

References

Bökberg, C., Ahlström, G., & Karlsson, S. (2018). Significance of quality of care for quality of life in persons with dementia at risk of nursing home admission: a cross-sectional study. BMC nursing, 16, 39. https://doi.org/10.1186/s12912-017-0230-6

Carder, P. C. (2018). State regulatory approaches for dementia care in residential care and assisted living. The Gerontologist, 57(4), 776-786. https://doi.org/10.1093/geront/gnw197

Chen, B., Cheng, X., Streetman-Loy, B., Hudson, M. F., Jindal, D., & Hair, N. (2020). Effect of care coordination on patients with Alzheimer’s disease and their caregivers. The American journal of managed care, 26(11), e369–e375. https://doi.org/10.37765/ajmc.2020.88532

Evripidou, M., Merkouris, A., Charalambous, A., & Papastavrou, E. (2019). Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol. BMJ Open, 9(7), e030459. http://dx.doi.org/10.1136/bmjopen-2019-030459

Grabher, B. J. (2018). Alzheimer’s Disease and the Effects it has on the Patient and their Family. Journal of Nuclear Medicine Technology. https://doi.org/10.2967/jnmt.118.218057

Levy-Storms, L., Cherry, D. L., Lee, L. J., & Wolf, S. M. (2018). Reducing safety risk among underserved caregivers with an Alzheimer’s home safety program. Aging & mental health, 21(9), 902–909. https://doi.org/10.1080/13607863.2016.1181710

Mulyani, S., Probosuseno, P., & Nurjannah, I. (2021). The effect of training on dementia care among nurses: A systematic review. Open Access Macedonian Journal of Medical Sciences, 9(F), 145-152. https://doi.org/10.3889/oamjms.2021.5969

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Practicum Focus Sheet
Assessment 2
Note: Expect to spend at least 2 hours with the patient, family, or group you’ll be working with
during this portion of your practicum, exploring issues of patient safety, quality, and costs
associated with the health problem you’ve defined. This includes time spent in consultation with
subject matter or industry experts. You’ll report on the results of this work as part of your next
assessment.
For this portion of your practicum, discuss, in depth, how the problem will affect patient safety,
quality of care, and costs. Consider the following questions to help guide your exploration of
quality, safety, and costs and to make the most of your time:
• Has the patient, family or group experienced any serious safety events because of the
problem? Diabetes II
• How many times have they gone to the emergency department (ED)?

• How many times have they been hospitalized?

• What is the frequency of ED visits or hospitalizations?

• How many medications are needed to manage the problem?

• Does insurance pay for these medications?

• Have the medications caused any side effects?

• How often are doctors’ visits or other therapies needed?

• Does insurance pay for these visits or treatments