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Assignment: Read the following case study and submit a 1300 – 1500 word paper that addresses the case study and the questions at the end of the case 5 study. Include 4 citations NOT OLDER THAN YEARS OLD. Include the text below of Clark (2015) in the citations. APA formatting required. Mr. B. is an 83 year old male referred to home health services following a hospital admission for congestive heart failure. His payor source is Medicare (traditional). He lives alone and indicates he does not have sufficient financial resources to afford private-pay in home supportive care. His daughter, who lives in the neighboring county about 30 miles away, has offered her father to move in with her – he has refused and she is not “forcing the issue”. Mr. B. is also not open to discussing moving to an assisted living environment. This is his third hospital admission for the same problem over the last 12 months and his second admission to a home health agency. He was discharged from the previous home health agency 6 weeks ago. Physician orders are for the home health agency to provide skilled nursing for assessment of his cardiac condition and to teach him about his care and medication regime. Physical therapy has been ordered to establish a home exercise program. Home health aide services have been ordered 3 times a week to assist Mr. B. with his personal care needs. By the end of the third week of service, it is clear to the RN Case Manager that Mr. B. is not making progress to the established goals. She reports during case conference that he is not a good candidate for teaching because of intermittent confusion and forgetfulness. According to the nurse, no matter what she has tried to teach him and regardless of the aids she has used, Mr. B. continues to take is medication incorrectly. She states, “I know he needs services, but I am not sure that he is in the right environment. I am concerned about Mr. B. – I am not sure why his daughter won’t just step up and put her foot down.” The physical therapist reports at case conference that the “client lacks motivation”. The home exercise program has been established with Mr. B.; however, he does not complete the exercises between therapy visits. An improvement in his personal hygiene has been noted with the Home Health Aide (HHA) services. The HHA has also been successful in decluttering his living space. The HHA reports that she is concerned that he is not eating regular meals. This situation offers an ethical challenge to the professional caregivers and to the agency for which they work. Discuss how you would handle this ethical dilemma. Address the following questions as a part of your response: 1. What are your concerns about this case? 2. How does the RN Case Manager meet her ethical responsibilities to the patient and to the organization? 3. What is the best plan of action to ensure the client’s safety and well-being? 4. What are realistic outcomes and goals for this client? 5. Who will provide the ongoing care needs required by this client? Goals After completing this module, you will be able to do the following: Identify trends, issues, and opportunities influencing the provision of home health care services. Explain how pay for quality performance initiatives are influencing home health care delivery. Explore the ethical challenges faced by professional caregivers in community-based care. Overview We plan to examine the present state of the home health care industry and examine future trends and opportunities. Just as other segments of the health care industry have been impacted by health care reform, the home health industry is no different – provider organizations have been challenged by the changing reimbursement landscape and more often than not, are having to “do more with less”. As a result, it is imperative to examine productivity and efficiency while simultaneously looking to enhance patient outcomes. The prudent home health care administrator is constantly surveying the horizon and must be vigilant to ensure that his/her agency remains viable in the face of industry challenges. However, one cannot focus only on the challenges; he/she must look to the future and position the agency to be a leader in the provision of quality services that patients and their families expect. Future trends and opportunities for the home health care industry include, but are not limited to : Partnerships with other providers in the provision of quality care that enhances patient outcomes. Pay for quality performance initiatives. Demographics of an aging population. Use of technology in the provision of home health care services. Research opportunities in home health care. Home health nurses cannot be passive participants in their practice environment, but instead should seize the opportunity to lead the organization to new levels. Ethical dilemmas present themselves in the home care setting just as they do in any other health care setting. The home health care nurse must be comfortable with navigating these situations so that patient’s desires can be respected and care can be provided within professional boundaries. Learning Materials Chapter 13 – Clark, M. (2015). Population and community health nursing (6th ed.). Upper Saddle River, NJ: Pearson. Case Management Society of America’s Standards of Practice for Case Management (2016). Pay for Performance Demonstration Home Health Star Ratings HHC Star Ratings (46 minutes)