Question

• What are the major ethical, societal, professional, and legal system-level issues confronting providers, insurers, public policymakers, and organizations regarding the care of the aging population?

Answer 1

1. What are the major ethical, societal, professional, and legal system-level issues confronting providers, insurers, public policymakers, and organizations regarding the care of the aging population?

Ans:-

Ageism can play a strong role in these decisions. Acknowledging and acting on the wishes of the older individual are a critical component of ethical care. While ethical dilemmas are central to the practice of medicine itself, the dependent nature of the older adult and the imminence of death raise special concerns.

What are ethical issues in aged care?

Some issues frequently encountered in this context are discussed:

Advance directives, competence and decision-making capacity, decisions about life-sustaining treatment, resident abuse, restraints, psychotropic medications, risk management, participation in research, and ethics committees.

Common Ethical Issues in the Workplace-

●Unethical Leadership.

●Toxic Workplace Culture.

●Discrimination and Harassment.

●Unrealistic and Conflicting Goals.

●Questionable Use of Company Technology.

Legal Issues in elder Care:-

Growing older will force people to make life care decisions that affect medical and end of life concerns. These decisions about health and medical care are highly sensitive, and they deserve the strongest protection under the law. Therefore, when it comes to a person’s health care, the law is very strict about who participates in the care related discussions.

These sensitive documents are meant to protect you from someone else making medical decisions on your behalf. The legal forms will give you peace of mind and the guidance to the friends and family members during a medical or financial emergency.Unfortunately, adults rarely think about their beliefs and preferences regarding end-of-life decisions until a crisis occurs, a time when decision-making is most problematic. By not planning in advance means that a family member might not have access to the information they need, or to act on your behalf.

Here is a list of legal documents to put your affairs in order:

Power of Attorney

Give someone you trust the durable power of attorney and if you don’t have someone you trust, consult a professional. This allows that friend, family member, or professional to manage your affairs if you become sick and unable to do so yourself. It remains valid even if you become incapacitated.

The document allows someone to:

Pay your bills Deposit your checks

Manage your financial affairs

Manage your business if you have one

Older people live with at least one chronic condition or disability and as it worsens it could lead to impairment.

The durable power of attorney allows you to maintain control and have a say about your finances.If you don't have a durable power of attorney for finances and you can’t manage them yourself, a judge will appoint someone to oversee your finances.

Write a will:

A will establishes a person's wishes regarding distribution of property and the care of minor children upon their death. By drafting a will, you ensure that the properties and possessions go to the desired beneficiaries. Some states may require probate (a review) for validity but having a will speeds it up.It’s not required to hire an attorney to draw up a will but there are drawbacks with one that’s written by you. For example, you won’t be around to explain your wishes, or correct an error in expression. In a will, there’s little room for error.In most states, a will and durable power of attorney will take care of most things, eliminating the need for a trust.

Advanced Care directive or living will the document gives a trusted friend, family member, or professional the medical power of attorney to carry out your health care treatment and wishes at the end of life. Name someone you have total trust in.

Without one, an individual can end up like Quinlan, Cruzan, or Schiavo generating battles between spouses, parents, and siblings.

What to know about advanced-care directives:

Everyone over 18 should have one. Must be completed while you are competent to know what you are signing, i.e. without dementia. Often used to decide on feeding tubes, ventilators and other treatments at the end of life or when someone is unconscious. Only needs to be witnessed; does not need to be notarized. Final wishes: the Funeral Ease the distress of the survivors by planning ahead for the funeral. You can write your own obituary, and leave instructions on how you want your body to be disposed of.Donate your body and organs. Carry an organ donation card in your wallet and keep another one with the documents so that it’s found quickly.

Social Problems and the Elderly

At the outset it is important to recognise that the relationship between the social state and health state is nowhere more important than amongst the elderly! To lead an independent life, the elderly need some basic requirements and skills for day to day living that include the ability to undertake social activities and perform personal and domestic tasks. Activities of daily living address these three aspects which are interlinked. In the elderly, according to Williams! with the passage of time, deterioration tends to occur first with sociability, followed by a breakdown in carrying out domestic tasks and finally in personal tasks. A medical practitioner must be aware that social problems can set in with the onset of an acute illness episode or injury which are often reversible with appropriate treatment.

However, with chronic disease problems, which develop gradually, the changes that occur are not so readily reversible requiring social and other support interventions to complement the treatment of the disease.

This is because the pure older and the extremely young are more vulnerable than any other age groups in society. Problems related to the elderly include financial instability, poverty, victimization, isolation, and dependency, lack of access to appropriate health care and inadequate housing.

What problems do the elderly face in society?

According to the National Institute on Aging, other chronic health conditions and diseases increase the risk of developing dementia, such as substance abuse, diabetes, hypertension, depression, HIV and smoking

Is aging a social problem?

Aging in the modern society is a social problem on its own. Aging has become a social problem because institutions in the modern society do not meet the needs of the elderly people who are weak. The elderly face stigmatization because they are not in a position to adapt to the society full of youth-oriented norms.

What is social aging?

Social aging refers to the changes in a person's roles and relationships as the person ages.

Why is social age important?

Socialization may improve memory and longevity as it reduces stress and isolation. Many seniors socialize by spending time in group exercise classes which can provide a number of physical benefits, including the potential to increase lifespan.

What is the social impact of Ageing?

In general, longevity has increased while fertility has declined resulting in an increase in the proportion of the older people. Aging of the population affects all aspects of the society including health, social security, education, socio-cultural activities, family life and the labor market.

Health Conditions:

There are certain health conditions that are expected to be a challenge to our health care system with the increasing aging population. These conditions include cancer, dementia, increase in the number of falls, obesity, and diabetes.

Cancer

Due to the increasing aging population, the number of cancer cases is expected to increase to 17 million by 2020 and 27 million by 2030.1

Dementia

The burden of dementia is expected to increase with the increasing aging population, as well. Alzheimer’s Disease International projects there will be 115 million individuals living with Alzheimer’s disease/dementia in the world by 2050. The organization also projects a significant proportion of the 115 million will be in less developed countries.

Increase in Falls

With falls being one of the most common causes of injury in the older population, this is expected to be a challenge to our health care system. This is attributed to the fact that Baby Boomers are living longer, remaining active, and possibly on medications that could lead to falls.

According to a report released by the American Hospital Association (AHA), “More than one-third of adults 65 or older fall each year. Of those who fall, 20% to 30% suffer moderate to severe injuries (such as hip fractures) that decrease mobility and independence. Almost 350,000 hip fractures occurred in 2000, a figure that is expected to double by the year 2050.”

Obesity

The number of people who are considered obese will continue to increase and have a negative impact on our health care system. Not only is obesity a risk factor for many health conditions, but it is very costly: patients who are obese cost the Medicare program approximately 34% more compared with patients of normal weight.

Diabetes

According to another report released by the AHA, the number of “Americans with diabetes is expected to rise from 30 million today to 46 million by 2030, when 1 of every 4 Boomers, 14 million, will be living with this chronic disease.”3

Challenges

Expected challenges to the health care system include the following3-5:

• Resource needs will continue to increase across all health care settings
• The incidence of obesity will continue to increase
• A shortage of health care professionals is expected
• The diversity of caregivers lags behind the growing diversity of patients
• Care has been focused on a single disease versus addressing comorbidity
• The sustainability and structure of federal programs in relation to the increasing aging population are a concern
• Changes in family structure may lead to fewer family caregivers
• Adapting and adjusting to the Affordable Care Act pose challenges

To address the increasing aging population, the health care system must take on the challenges listed above. Our health care system also needs to prepare for new technology (especially because of the higher cost) by increasing training of health care workers and examining how technology will impact hospital infrastructure.

Legal Advocacy

Legal advocacy is a recognized strategy to address social factors that influence the health of populations with complex care needs. Such advocacy can improve housing stability, increase access to public benefits that support a host of social needs, assure that medical and financial proxy decision makers are in place, and reduce psychosocial distress.

Older adults are disproportionately likely to have complex medical needs. Legal advocacy has been recognized as integral to the health and health care of older adults in the medical literature since 1988, and in current Medicare quality metrics. Additionally, since 1965, the Older Americans Act has provided legal assistance as an “essential service” among other aging supports such as nutrition, transportation, and in-home care. Under the act, state area agencies on aging must provide legal services free to adults older than age 60 with the “greatest social or economic need.”

Yet, while emerging care models for older adults with complex needs are highly multidisciplinary, none incorporate legal advocacy in their design. This is in some ways not surprising as clinicians are not trained to recognize or address legal needs of older patients, and older patients are unable to self-diagnose their legal problems, thus making it unlikely that they will articulate legal needs as such to health care providers, social workers, or case managers.

Clinical Team Support And Education

Legal partners can provide training to clinicians, navigators, social workers, and other health care team members who are responsible for implementing workflows but who may not otherwise have opportunities to develop their own legal literacy. Lawyers can also collaborate with social workers to distribute advocacy work efficiently, keeping in mind a state’s scope of practice laws as well as practical limitations such as bandwidth.

Global Economic Issues of an Aging Population

The social and economic implications of an aging population are becoming increasingly apparent in many industrialized nations around the globe. With populations in places such as North America, Western Europe and Japan aging more rapidly than ever before, policymakers are confronted with several interrelated issues, including a decline in the working-age population, increased health care costs, unsustainable pension commitments and changing demand drivers within the economy. These issues could significantly undermine the high living standard enjoyed in many advanced economies.

Advanced Industrialized Societies Are Growing Older

As of December 2015, people 65 or older account for more than 20% of the total population in only three countries: Germany, Italy and Japan. This figure is expected to rise to 13 countries by 2020 and 34 countries by 2013.

Decline in Working-Age Population

A rapidly aging population means there are fewer working-age people in the economy. This leads to a supply shortage of qualified workers, making it more difficult for businesses to fill in-demand roles. An economy that cannot fill in-demand occupations faces adverse consequences, including declining productivity, higher labor costs, delayed business expansion and reduced international competitiveness. In some instances, a supply shortage may push up wages, thereby causing wage inflation and creating a vicious cycle of price/wage spiral.

To compensate, many countries look to immigration to keep their labor forces well supplied. While countries such as Australia, Canada and the United Kingdom are attracting more highly skilled immigrants, integrating them into the workforce can be a challenge because domestic employers may not recognize immigrant credentials and work experience, especially if they were obtained in countries outside of North America, Western Europe and Australia.

Increase in Health Care Costs

Given that demand for health care rises with age, countries with rapidly aging populations must allocate more money and resources to their health care systems. With health care spending as a share of gross domestic product (GDP) already high in most advanced economies, it is difficult to increase spending while ensuring care improves and other social needs do not deteriorate in the case of publicly funded or government-administered health care systems.

Additionally, the health care sector in many advanced economies faces similar issues, including labor and skills shortages, increased demand for home care and the need to invest in new technologies. All of these cost escalators make it more difficult for existing systems to handle the increased prevalence of chronic diseases, let alone sufficiently address the needs of large and growing senior populations.

Increase in Dependency Ratio

Countries with large elderly populations depend on smaller pools of workers in which to collect taxes to pay for higher health costs, pension benefits and other publicly funded programs. This is becoming more common in advanced economies where retirees live on fixed incomes with much smaller tax brackets than workers. The combination of lower tax revenue and higher spending commitments on health care, pension and other benefits is a major concern for advanced industrialized nations.

Changes to the Economy

An economy with a significant share of seniors and retirees has different demand drivers than an economy with a higher birth rate and a larger working-age population. For example, rapidly aging populations tend to have greater demands for health care services and retirement homes. Although this is not necessarily negative, economies may face challenges transitioning to markets that are increasingly driven by goods and services linked to older people. As advanced economies become older over the next 15 years, it remains to be seen whether immigration will fill the voids in sectors left by aging populations or whether the broader economies will have to adjust to changing demographics.

Health of the Elderly: Policy Issues and Challenges

Congress is consumed in its health policy deliberations with an overriding concern: reducing the federal government's massive budget deficit. Within this policy framework, Medicare is a tempting target for the budget-cutters; the emphasis is on freezing provider payments and increasing beneficiary cost-sharing. In this essay, Dorothy Rice and Carroll Estes suggest that given the changing composition of the elderly population —it is growing older and, in its totality, larger—the time has come when Congress should consider not simply spending reductions but the very structure of Medicare itself The authors argue that such exploration is necessary because the medical care needs of the elderly are changing along with the complexion of this age group. As more people live longer, chronic diseases afflict more of them.

Medicare is essentially a health insurance plan for acute illness. Very few of its resources finance chronic care. Rice and Estes are well equipped to discuss this policy problem. For seven years before her retirement from government in 1981, Rice directed the National Center for Health Statistics. During her stewardship at the center, Rice was internationally recognized as the key architect of the National Health Expenditure Survey. She also developed the methodology for the governments Cost of Illness Survey. At present, Rice is a professor at the University of California-San Francisco's School of Nursing. Estes is professor of sociology and director, Aging Health Policy Center, at the University of California-San Franciso and author of the 1979 book, The Aging Enterprise . She has been involved in aging policy and program issues for almost two decades as a scholar conducting research and teaching, a state commissioner on aging, a Gerontological Society officer, and a consultant to the U.S. Senate Special Committee on Aging.

TOPICS

• ELDERLY CARE
• LONG-TERM SERVICES AND SUPPORTS
• NURSING HOMES
• CHRONIC DISEASE
• DISEASES
• CLINICAL CARE
• MORTALITY
• ACCESS AND USE
• POPULATIONS
• DISABLED

The aging of our population represents a most significant demographic change affecting American society. It has important challenges and consequences for the nation's economic, social, and health institutions and for the health and well-being of older persons and their families. Improved standards of living and medical advances in the prevention and control of formerly fatal infectious diseases have made it possible for an increasing number of persons to reach an age at which they become more vulnerable to heart diseases, stroke, cancer, arthritis, mental disorders, and other chronic illnesses causing limited or total disability.

As more people live longer, chronic diseases, most commonly conditions of middle and old age, have emerged as major causes of disability and functional dependency requiring services that affect many sectors of the economy: income security, health, housing, transportation, and recreation. The burden of chronic diseases poses a great challenge for policymakers, for providers of long-term care services, including families and friends, and for the individual suffering from the disease.

The changing structure of the population resulting from declines in mortality are first described in this paper as a basis for understanding the magnitude of the aging problem. The health of the elderly will be examined in terms of their health status, use of medical services, costs of health care, and future morbidity patterns. We will then address the policy issues and challenges for long-term care emerging from these demographic changes. The final section briefly looks at the future of aging policy.