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400837 Health and Socio Political Issues in Aged Care- Healthcare Prof

Critique the World Heath Organisations' active ageing model of care. Your critique should include a description of the way that older people are represented in policy, legislation and society. 
Points to consider:
• Your essay can be focused on a specific country or cover these principles globally.
• Critiquing a model of care is essentially evaluating the model. The critique should include discussion of the positives and negatives of the model
. • You should also include a discussion of the way that older people are represented in policy legislation and society. The way older people are represented has an impact on health policyand models of care The active ageing model of care is an example of this. In your modules there is more information on this topic. 

This assessment requires you to:
• Write an essay incorporating an introduction, body and conclusion (NB no headings). If you have just returned to study or have difficulty constructing essays please refer to the 'Academic Literacy' document on how to develop an essay under 'Assessment' on the vUWS site.
• Define the term 'social capital' and provide examples of how this concept has been applied in health and social policy and programs
• Critique these examples with reference to the literature. 

Answer:

Palliative care is provided my healthcare professionals in the aged care facility with the aim to achieve the best possible ways which will ensure quality of life care for an elderly person who is suffering from life limiting illness or has developed poor physiological health to conduct his activities of daily lives (van der Steen et al., 2014). Palliative care helps in affirming the lives and treats the concept of dying as a normal procedure of lifespan. However, palliative care never interferes with any activities of the behalf of the healthcare staffs that will hasten or delay death.

Therefore, it acts as a constant support that provides relief from pain and many other distressing symptoms that are experienced by aging people towards the end of their lives (da Silvi Soares, Nunes & Gomes, 2016).  The essay will mainly portray different approaches that are followed by different nations all over the world. It will also portray the different political, ethical, legal and other complications that act as barriers and the recommendations that if followed will assure best palliative care in every parts of the world.

The palliative care was previously argued by many researchers to be less effective in providing a proper support to dying patients. However, recent evidences confirm that palliative care is successful in integrating different domains of care. These domains constitute the physical, social, psychological, spiritual as well as emotional aspects of care of the aged patients. Not only that, it also consists of the coordinated assessment as well as the management of the each person’s needs (Zimmerman et al., 2014).

The best positive aspect of the treatment is that it helps in the offering support to the old patients so that they live actively as much s possible till they reach the ending day of their lives. Not only that, palliative care is also found to be helpful in offering support to the family members and develop a comfort zone in their distress time die to their closed ones illness and during their own bereavement (Wright et al., 2014).

World Health organization has taken active step in making different nations aware about the benefits that such services can assure for old aged patients who are counting the end days of their lives. They have clearly stated that with the advancement of the medical science, the population of old people is also increasing. However although the systems are being able to keep them alive for a slightly longer period of time by treatment, support services to meet their needs are not properly planned and developed. Meeting the needs of such patients has thereby become a public challenge according to the World Health Organizations (Gomes, Calanzzani & Higginson, 2014).

Therefore they have tried to help the national as well as the international healthcare systems with guidelines and approaches for healthcare staffs to plan and care with different health oriented care services providing the best service to the aged patients. They have included the examples not only to describe the processes that would be initiated by the whole health system and also provide smaller examples which would consider improvement of palliative care education (Quill & Abernethy, 2013).

These small examples also included providing support services in communities, hospitals and different groups of people, people suffering from dementia and many others. They have taken both an individualistic as well as health system approach that addressed planners, decision makers, policy makers as well as multidisciplinary professionals concerned with care and quality of life of different aged-patients (Gomez et al., 2014).

Different approaches for effective palliative care that has been recognized by WHO is the joint working of different sectors which include both the palliative care, primary care as well as the social care. As palliative care and care for older people have been neglected for many days, it has become an urgency to grow and is thereby linked with other services to provide an overall development of the patients. This joint approach mainly includes the properly trained palliative as well as primary care clinicians containing proper knowledge about the syndromes noticed in such patients, terminal diseases, falls and many others (van Lancker et al., 2014). A holistic approach should also be provided by them which would help in exploration of the different kinds of problems which reduces patient’s quality of lives besides the problem of life limiting diseases. Joint working and new models of integrated care with specialists from both palliative care and care for old people properly trained in geriatrics and palliative care procedures are helpful in meeting goals of care.

Health system: an approach:

The health system approach mainly comprises of three important goals. The first goal is the improvement of the health status of the population covering both the average level of health as well as the equal distribution of health. The next goal is the improvement in the fairness of fund allocation as well as financing. This mainly ensures the financial protection as well as the equitable distribution of the burden of funding system. The last goal is the improvements of the responses to the non medical requirements of the patient population as well as their family members. The last goal in turn consists of two important dimensions that they try to achieve.

These are providing respect to the patient in maintaining the dignity, autonomy, confidentiality as well as communication of the patients (Hussain & Mooney & Russon, 2013). The other dimension mainly constitutes of the client orientation which are based on the prompt attention, social support, choice as well as basic amenities. This approach also takes into account the psychosocial aspects of palliative care that involves dignity as well as the quality of lives for both the individuals as well as their families. They mainly have four important functions which are the financing that includes the revenue collection followed by fund pooling as well as the purchasing steps.

The next is the resource generation in the terms of the human resources, facilities as well as the technologies. The third function is the delivery of a personal as well as the population based different types of health services. The last function is the stewardship which includes not only health policy formulation but also includes regulation as well as intelligence. This healthcare approach always provide service as well as interventions which are tailored according to the national demographic, economic, cultural, social as well as different political factors taking into consideration of healthcare system (Heyland et al., 2013).

Whole system: an approach

There is an urgent need of incorporation of a whole system approach to palliative care so that it can cover all the important aspects of care required by a dying old age patients. Catalonia is an European state which is very much in similar to the principles of palliative acre like Australian states and wants to be a model for palliative care for other countries. Healthcare services here provide a mix of public and not for profit organization. Just like the Catalonian principles of healthcare, every nation should adopt the principles which include palliative care to be the important part of the mainstream healthcare provision with its focus mainly on the community as well as the home care for aged patients (Ventura et al., 2014). Depending upon the needs of patients and family members, a new type of palliative care service has been developed which consists of the not only the palliative care workers but also the physicians, nurses and different allied healthcare professionals in units if various settings.

Palliative care at homes: an approach

Another approach called the home based approach of the palliative care is the most common form of palliative care that is provided to the old age patents by specialist palliative acre teams as well as nurse led schemes. Providing intensive home support teams, support for family as well as addressing and assessing the risk factors associated with the patients and family members are the main principles of home based approaches (Siouta et al., 2016). The team usually comprises of a multidisciplinary team approach who could meet the needs of the people at the end of life. This mainly involves the family physician and another community support nurse who helps by providing service to the patients in the form of coordination, supervision, advice as well as visits at home form a palliative medicine center. They also carry educational schemes for different community staffs, treatment plans and also joint discharges.

Care at nursing homes and residential cares: an approach

Different guidelines have been proposed by the United Kingdom health services called the Gold Standards Framework for end-of-life care. It has been included in the different states of their country yielding positive results. Australia has also published many guidelines for proper palliative care in residential and nursing homes. Another wonderful initiative is developed by the United States Veterans Health Administration nursing homes which are funded by both government as well as non-governmental contributions. They have prepared questionnaires which they provide to the representatives of the already deceased old patients (Robinson, Gott & Ingleton, 2014).

Their valuable answers and recommendations help the healthcare sectors to modify the different negative aspects about their care and hence provide a more fruitful care to the patients the next time. The main focus of the nursing homes and residential homes also is to work in collaboration with the primary care as well as the specialist palliative care teams in order to provide physical, mental, emotional, psychosocial, social as well as spiritual and holistic support to the patients so that the chances of shifting them to the hospital in the last week of the patient is reduced. This has resulted in reduction of hospital costs, reduction in crisis admission in hospitals, decreased hospital deaths (Jang et al., 2015). A report suggests that in United Kingdom, such systematic services have resulted in the saving of about £40000–80000 per care home per year to the National Health Service ultimately saving resources for attending other critical ailments in the nation

Issues:

Like the population of astral, there are many nations where the population is ageing. The fastest growing population of Australia is the centenarians and therefore it has become extremely important for the considerations of palliative care for these growing populations. Therefore palliative care is to be looked at with braider economic as well as social factors which are responsible for driving healthcare as well as different physiological factors. However, a large number of issues are being faced by the government is allocating resources for palliative care for such a huge population (Wilson et al., 2016).

Within the last few years, the number of old aged ailing patients under palliative care has increased due to the successful awareness programs in many developed countries. However the funding system is yet not prepared to handle such a huge population at a time and therefore resource allocation is found to be a big issue in managing care for the patients. Moreover, there has been many political parties who believe that resource allocation for other chronic ailments like cancer management, cardiovascular diseases and other are far more important than treating patients who are on the verge of meeting their ends. Such insensitive debates have been a barrier for funding form reliable sources and more funding is been allocated to such treatments. Hence, it has resulted in decreased scope of proper palliative care delivery for the patients (Wright et al., 2016).

Nurses also face a large number of challenges that act as barrier in care giving for aged patients. Recently, as aged patients are living for a longer period of time, they are often burdened with more number of ailments as days pass. Therefore it becomes extremely difficult for every nurses and caregivers to alter their courses of treatment with every passing day according to the requirements of the patient. It becomes extremely difficult for the nurses to constantly adapt themselves with the changing demands of the situation and modify the care that they deliver to the patients (Heyland et al., 2015). Moreover with the scarcity of the resources and lack of opportunities to increase or promote the access and equity in healthcare, palliative care provided to the patients are never fully successful.

Many healthcare professionals have also suggested a number of different issues that they face. They have often complained that providing palliative care is very stressful as it not only involves proper maintenance of the physiological system of the patients but also has to give him mental, emotional as well as spiritual support which is very much energy draining and therefore they often suffers from burnouts (Lovell & Yates, 2014). Many researchers have suggested that healthcare providers who face both external as well as internal barriers that prevent effective palliative care.

External barriers may occur when the nurses’ values, suggestions as well as her opinions are not respected by the family members or even at workplace that makes them disappointed decreasing their values within them. This ultimately affects their working procedures and affects the quality of the care provided. Another type of issue is the internal barriers faced by the nurses. The internal barriers mainly arise when the healthcare professionals have poor communication skills, lack of knowledge in correct ways of providing care as well as different skills that help to provide spiritual and holistic care as well as emotional support to patients and their family members. All these lead to job dissatisfaction ultimately affecting the quality of care (Brinkman et al., 2014).

Nurses often feel emotionally weak when attending severe cases and develops a feeling of hopelessness. When she is unable to develop the condition of a patient who is terminally ill and request others to end his life, the nurses develop deep sense of sadness, helplessness and ambivalence (Higginson et al., 2014). They often fail to cope up with the dilemma of providing curative care or palliative care. Such situation harms the nurse emotionally and develops a strong sense of loss of control over the nurse’s own life both mentally and emotionally. Therefore often mixing up with the professional as well as personal life disrupts the ability of the staff to provide correct care.

Lack of proper funding system for the delivery of appropriate care along with the use of correct equipments often act as another issue that needs urgent attention. It has been stated in reports that the current funding which is conducted under the ACFI for the palliative care by the residential and nursing homes is found to be only one third of the specialist palliative care services received per individual in Australia. Hence it can be seen that health equity is not maintained with unequal resource distribution all over Australia making services poor in different residential and nursing homes due to inappropriate funding (Hui et al., 2014).

In many community care services, it has been seen that many patients who receive palliative care services are prevented from getting packaged care and those who get packaged care are not provided with palliative care. A large number of complaints are found to be lodged due to ambiguity of the HACC policy guidelines where such services were denied to people. Hence, inappropriate planning of different sectors for both private and public aspects often act as issue in receiving proper palliative care to the patients (Cooper et al., 2016).

Recommendations can be provided that will help the development of the palliative care services in different nations. The policy makers should first recognize the needs of the palliative care by the aged people by identifying the public healthcare implications and the development of the care required to provide the best care in their end of life stages. After thoroughly researching over the issues, they should develop, invest in and implement strategies of palliative care. They should ensure a system wide approach and monitor the success of the strategies, learning models from other countries and so on (Cooper et al., 2016).

Developing knowledge and guidelines for the health care professionals to overcome their barriers, develop skills to overcome various issues, programs for them to attend to constantly modify their practices to meet the needs of the patients should all be included in policies and guidelines. Investing in training programs for healthcare professionals in geriatric nursing, palliative medicine, mental health services, handling adverse and crisis situations are also very necessary.

Each and every nation should take an active step in making palliative care as one of the mainstream care in different healthcare sectors making the government realize the urgency of the needs in order to develop the quality of life for the increasing population of the old aged patients. The governmental healthcare systems as well as the private health care systems, community settings, the centers providing home supports all should incorporate some basic strategies into their programs to provide uninterrupted best service to their patients (Smith et al., 2014). These mainly include the revision of the legislations of the public as well as the private healthcare centers if each and every nation that governs the delivery of the opioid analgesics. Another important initiative that is not only needs to be included in Australia but also in many developed and developing countries is the training of the healthcare professionals in the basic palliative care. Another important step that they need to include in their program is a planned model of funding so that there is no disruption of service due to lack of resources in providing palliative care.

Another important initiative that needs to be incorporated is the integration of the basic palliative care in the conventional healthcare services (Mercadan te et al., 2014). Moreover each and every nation should also try to implement specialist palliative services throughout the healthcare systems. Other two most initiatives that need to be taken is the development of professional standards and development in the monitoring as well as the evaluation strategy.

Conclusion:

Palliative care is an important healthcare treatment that needs to be conducted in every nation to meet the growing demand of the maintenance of quality lives of aging population that is growing at a rapid rate. Palliative treatment is provided by specialized teams not only in homes but also in different residential homes and nursing homes. However, a large number of issues like political debates, resource allocation, funding issues, healthcare skills, emotional and mental stresses in healthcare professionals, lack proper knowledge, constant development of skill all act as barriers.

However, proper initiatives like modification of legislations, proper policy development, proper funding strategies, training of healthcare professionals to handle crises, knowledge and skill development and many others would help them to fight different barriers. This would provide nation with a future where quality lives are not only be enjoyed by the children and the adults but also for the senior citizens.

References:

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Cooper, Z., Koritsanszky, L. A., Cauley, C. E., Frydman, J. L., Bernacki, R. E., Mosenthal, A. C., ... & Block, S. D. (2016). Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions. Annals of surgery, 263(1), 1-6.

da Silva Soares, D., Nunes, C. M., & Gomes, B. (2016). Effectiveness of Emergency Department Based Palliative Care for Adults with Advanced Disease: A Systematic Review. Journal of palliative medicine, 19(6), 601-609.

Gomes, B., Calanzani, N., & Higginson, I. J. (2014). Benefits and costs of home palliative care compared with usual care for patients with advanced illness and their family caregivers. Jama, 311(10), 1060-1061.

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Heyland, D. K., Barwich, D., Pichora, D., Dodek, P., Lamontagne, F., You, J. J., ... & ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team. (2013). Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA internal medicine, 173(9), 778-787.

Heyland, D. K., Dodek, P., Mehta, S., Cook, D., Garland, A., Stelfox, H. T., ... & Turgeon, A. F. (2015). Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study. Palliative medicine, 29(4), 324-335.

Higginson, I. J., Bausewein, C., Reilly, C. C., Gao, W., Gysels, M., Dzingina, M., ... & Moxham, J. (2014). An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. The Lancet Respiratory Medicine, 2(12), 979-987.

Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), 1743-1749.

Hussain, J. A., Mooney, A., & Russon, L. (2013). Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease. Palliative medicine, 27(9), 829-839.

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