400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Course Code: 400837
University: Western Sydney University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:
Details 
In this assessment task you are required to write an essay on the following topic:
The growing aging population in Australia has led to an increased need for community aged services. To ensure that older people are getting the services they need, aged care community services have been reformed to use a consumer directed care model.
In this assessment task you are required to write an analytical paper that: 

Critiques consumer directed care
Critically discuss consumer directed care. Your discussion should include the positives and negatives of this model.

In this paper you should include:

Adiscussion of what consumer directed care is. Your discussion should include political and ethical positions.
Adiscussion and critique of the issues in providing consumer directed care for consumers and care providers.
Your paper must include references to the literature
You can use headings in an analytical paper

Answer:
Introduction 
The Australian government is concerned about the aged and their care, and they fund most of the aged care. The rest is paid out of pocket by the individuals or provided by sponsorships. There is an increased concern for the aged health care as the population of the elderly in the country is increasingly high. In 2050, the number of aged people is expected to have doubled. The government wants to ensure that apart from the funding, the elderly are getting the services that they need. This prompted them to come up with different strategies and approaches that ensure this.
Some of the initiatives that the Australian government funds to provide quality care for the aged are home care packages, commonwealth home and community care, residential care, and transitional care. All these initiatives are supposed to offer services regarding the Consumer Directed Care (CDC). Initially, the country was using the traditional provider-directed care which involved the care provider determining the services or helps that the aged individual needed. They, however, decided to switch to the CDC as they found it more useful.
Discussion
Consumer Directed Care
The CDC is a form of service delivery that focuses on giving the customers, more choice, and flexibility. Consumers that especially receive the home care package have a say in the services and the care that they will receive as well as the caregiver that will provide this.
CDC is based on the concept of choice and control. In this model, the Australian government aims at ensuring that the elderly have a say in the type of care and the services that they receive. Therefore the aged have a say in the type of care that they will receive to support them both at home and at the hospital. The primary aim of this model is for the care providers to work in partnership with the elderly to meet their needs as well as their goals. The model encourages the elderly to be as involved as they want in managing the package that they choose for the care (Buttigieg, Rathert, D’Aunno & Savage, 2015).
The model also allows the care providers to be transparent with their patients regarding the cost for services as well as the money spent for the services. The critical question that many of the aged population are concerned with is what the CDC model means to them. Overall, people never want to lose their sense of independence, and this applies to the elderly as well. As much as they are being taken care of, they want people to know that they are also capable of making their own choices (Castonguay, Beaulieu & Sévigny, 2017).
The model thus offers independence as the elderly have the authority to choose (choice) as well as the ability to control the care that they receive.  The basis of the model is that a person has been able to manage their life ever since they were born; therefore, they are well capable of continuing to do so even as they age (Garcia et al., 2016).
For instance, when an elderly have the home care package that is delivered in regards to the CDC, it means the following. They have the choice of:

Having more say in the care and services that they access as well as whom will provide these services.
Developing care that works for them with their care provider.
Being involved in the managing of the home care package or not.
Having a deeper understanding of how the home care package will be funded as well as the spending of the funds.
Monitoring the home care package to assess whether it meets one’s needs regarding care

In this model, the providers are required to do the following

Communicate with their consumers to identify their needs and their goals.
Produce care plans with the help of their consumers.
Provide transparency to their consumers regarding the funding that they have for their chosen package and the amount that is spent.
Reach an agreement with the consumer about how much they should be involved in the managing of the package.

Political View
As mentioned earlier the Australian government is responsible for funding most of the aged care in the country. By the Australian government, this means the taxpayers money. The government uses the taxes paid by the citizens to fund any health care systems that will lead to care for the aged. The Australian Government Department of Health is individually responsible for this and ensures that ultimate care is given to the older population as they are increasing day by day (Duckett & Willcox, 2015).
The Australian government needs to create a plan for the aged care system as researchers have predicted a possible increase in the elderly population over the next few years. To meet this challenge the government needs to increase its funding and decide what amount will be paid by the tax and what will be paid by the individual out of pocket. This might cause an increase in tax or allocation of more tax money to the aged care system to ensure that the country will be able to secure their future when the elderly population does increase (Gill & Cameron, 2015).
The government has taken an initiative to use the assets that the Australian residents possess to provide proper care for the elderly. Most residents own homes, and the government wants to use this to their advantage. This is seen through the funding of the home care package based on the CDC. This way the government will not have to spend more taxes on building homes for the aged instead, they will fund the care that they need in the comfort of their home.
The CDC model also means that the government will have to invest in aged care workers as they will need enough that can cater to their population especially in the home care package. They need to invest in more workers that can provide CDC to each older adult on the home package without being strained and stressed. The CDC model involves a deeper level of care that requires each practitioner to concentrate on their patient as they provide care solely. The last thing that the government wants is lawsuits from the family members claiming that the aged care worker mixed up medicine or caused an accident because of having too many patients (Macdonald & Charlesworth, 2016).
By 2020, research has predicted that the elderly population, will have doubled and for this reason, the Productivity Commission says that the country will need close to one million aged care providers so that it can sustain the aged care sector. This increase in demand for aged care providers will prompt the government to focus on the people that are supposed to provide this care. The Australian government, therefore, needs to consider the providers when wanting to provide CDC care to the elderly (Jin et al., 2015).
In this case, the Australian government will have to come up with strategies and plans that ensure that the aged care providers can meet the requirements for CDC. The providers have to be professional and trained in a manner that they can work in partnership with the elderly to cater to their needs.
The Minister of aged care in the country Mr. Ken Wyatt says that they will address the challenges that age care providers face especially those situated in the remote areas. This was as a result of a growing concern that the elderly in the remote areas are not able to receive CDC services (Kaambwa et al., 2015). This was mainly due to their location as they cannot be accessed quickly. The Minister assures the citizens that the country has sufficient well-trained age care providers and that they expect to increase their numbers to close to one million from the current number that is 366000.
Minister Ken Wyatt said that the location of the elderly would not matter in Australia as the ministry wants to ensure that they can be able to reach community care services based on the CDC. They want the elderly to have the independence that they once had by providing them with the choice to control their care. To enhance this, they aim at having more aged care workers that are trained and that are qualified (Laragy & Allen, 2015).
Ethical and Legal View
The Aged Care Act of 1997 contains the legal rules and laws that practitioners need to follow when providing care for the elderly in Australia. The act has principles that need to be followed such as the User rights principles 2014 and the Accountability Principles 2014. Other laws that govern the services for home care packages include the Anti-discrimination legislation and the Consumer Law. It is ethical for any aged care worker to abode to these laws and regulation and at times failed to do so may lead to lawsuits.
However, most of these legal issues refer to the home care package as opposed to the other packages such as the community aged care packages and the extended aged care at home. This is due to the decision of the Australian government to focus on flexibility and choice by using the CDC model (Laragy & Allen, 2015).
An ethical aged care worker is aware that they are supposed to provide elderly care as per the needs of the consumer based on the CDC model. When providing aged care, the providers are supposed to consider what the law requires them to do (legal) as well as what other people in the profession require them to do (ethics). An aged care worker needs to consider not only the safety of the consumer but the safety of other people and the rights of other people as well (Walsh et al., 2016).
The rights of other people are the right to privacy that is under the User Rights 2014. In this instance, the provider needs to ensure that will providing care to the consumer their right to privacy and those around them is maintained. Ethically it is the right thing to do as it means one can act professionally when performing their job (Low & Fletcher, 2015).
It is essential that a care provider balances hi/her duty of care with the legal responsibilities. The law requires that aged care workers take reasonable care of the elderly in ways that avoid injury and avoid harm to members of the public. The CDC, on the other hand, allows for the consumer to make their own choices on the services that they require. The care provider will have to trust the consumer that they can make decisions after weighing the risks and determining ones that require the least risks, while at the same time ensure that the care they will give will meet the legal requirements (Redfern et al., 2017).
To meet both needs, the care provider needs to create a respectful relationship with the consumer that is cooperative. This way the care provider can perform his or her duty of providing care, while at the same time meeting the legal requirements.
The act also contains the Quality of Care Principles 2014 where an aged care worker needs to follow the guidelines for the Home Care Common standards.   Some of the processes laid out in these are:

The procedures and policies for working with the elderly
The roles and the responsibilities of the providers
Policies for sharing information with partner agencies
Assessing the risks that are present when providing care

Advantages of CDC
The most important advantage of this model is that it allows for flexibility of the consumer when receiving care and services. The consumer can choose what care they want how they want it and whom they want to administer it.
Another advantage is that it creates transparency between the care provider and the elderly. This transparency is brought about when the provider shares with the consumer the funding for their package and how it was funded (Pease, Vreugdenhil & Stanford, 2017).
Also, it allows for the independence of the elderly by allowing them to manage their care plan. The elderly were independent for the better part of their life, and the model allows them to continue this even as they age.
The model also allows for the consumer to be in total control of their package. It is based on the concept of choice and control. Therefore, the consumer is in control by choosing a plan that works for their needs and their goals (Hussein & Ismail, 2017).
Disadvantages of CDC
One disadvantage is that the Australian government does not provide enough funding for the CDC care of the elderly. With the increasing number of the elderly in the country, the money that funds the home care package is not enough for all [forcing many to pay out of pocket for the services (McLeod et al., 2017).
The model allows for the elderly to be independent, but not all can be, therefore, it does not apply to all audiences. For instances, consumers with disability or dementia are unable to make choices or take control.
Also, the model does not consider the risks involved as it requires the provider to work according to the needs of the patient. The consumer may want services that have adverse risks, and that will not ensure quality care (Swaine, Parish, Igdalsky & Powell, 2016).
Issues Associated With the CDC Model
One major issue related to this model of care is that the number of aged care workers in Australia is not sufficient to adequately provide the care. As mentioned earlier the aged care providers are only 366000 which are not enough to provide quality care for the increasing population of the elderly. These results in negligence and carelessness as the workers are overloaded (Gill et al., 2017).
Another issue is that the CDC model only applies to the consumers with the home care packages and most of the times cannot be used on the elderly living in the remote areas in Australia. Research shows that older adults living in the remote areas cannot access services based on the CDC model due to their location.
Being able to balance between the duty of care of the patient and the dignity risks when using the CDC model is also an issue. This is because the consumer is given the choice and control and the care provider is supposed to trust that they have made the choices after evaluating the risks. Therefore it can be hard to provide care when the aged care worker is aware that the choices have adverse risks but at the same time provide the care to the patient. This issue can be a conflict of interest (Jackson, Dimitropoulos, Madden & Gillett, 2015).
Also, another issue of the model is that the care providers at times are not able to meet the choice of consumers which is continually increasing. They are more concerned about the risks that follow because the providers are the ones that are responsible for them. This is an issue as the model does not provide policies or guidelines for the choices that consumers can make as well as limits (McCaffrey et al., 2017).
In addition to this, the model does not protect or care for the providers but solely focuses on the consumers. This way the care providers have to care for the consumers as requested regardless of the choices that are made (Garnham & Bryant, 2017).
The model also does not take into consideration the various challenges that come with aging. For instance, not every older adult can be independent as they were or can make choices for themselves that cater to their needs. E.g., an elderly with a disability will not be able to manage their care plan or identify the services they need which are also the same case for consumers with dementia. Also providing choice and control to an elderly with Alzheimer’s will not be practical. This is because they can quickly forget their needs or the services they need (Serrat, Warburton, Petriwskyj & Villar, 2017).
Concerning this, another issue is that the model does not take into consideration family members to make the choices for the consumer.  For instance, in the case of a patient with Alzheimer’s the model needs to allow for family members or close friends to take the responsibility of the consumer. This is because they are the people that will most likely be able to identify the needs and the services that the elderly individual will need (Fisher, Baum, MacDougall, Newman & McDermott, 2016).
Another issue that is a concern with the CDC model is that it is quite challenging to come up with an arrangement that suits both the aged care worker and the consumer and that meets their educational and cultural backgrounds. To be able to come up with an agreement for providing efficient elderly care may be challenging (Connell & Walton-Roberts, 2016).
Another issue of the CDC model is that it will significantly affect the aged care workers. This will force them to be more flexible and more open-minded when providing care to the elderly.
Lastly, the guidelines for using the CDC model are useful, but they are very general. This means that the model has a lot of grey areas that need to be useful if they want it to achieve aged care sustainability. The guidelines only state what the provider and the consumer responsibilities are but do not give further information such as the factors to consider or the conditions for choice. This makes the model useful only to consumers that can apply to it. Any circumstances beyond that are trying to implement the model (Boadu et al., 2016).
CONCLUSION
The elderly population in Australia is increasing by year and by 2050 the population is predicted to be double what it is now. This has caused the Australian government to take measures in sustaining the aged care system well into the future. Australia has adopted the use of the CDC model to care for its elderly so that it can sustain the sector. The CDC model is based on choice and control. It allows for the independence of the consumer by making choices on the services that address their needs. The Australian government funds most of the home care packages so that the elderly can afford it. In conclusion, the country wants to ensure that there elderly are well taken care of well into the future. 
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Swaine, J. G., Parish, S. L., Igdalsky, L., & Powell, R. M. (2016). Consumers’ and workers’ perspectives about consumer-directed services in the United States. Disability and health journal, 9(3), 464-471.
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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Course Code: 400837
University: Western Sydney University

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Question
Details In this assessment task you are required to write an essay on the following topic: 
Discuss the concept of a ‘palliative approach’ to end of life care in residential aged care and critique how this approach may be implemented in practice for older people living in residential aged care. In your discussion you should consider policies around advanced care directives and funding models for residential aged care. 
Points to consider: In this paper you should include: 

A discussion of what a palliative approach is and what systems exist to promote a palliative approach in residential aged care at a national and international level.
A discussion and critique of the issues in providing palliative care in residential aged care. This should also include discussion of the way aged services are funded and how this impacts palliative care in aged care. 

This assessment requires you to:

Write an essay incorporating an introduction, body and conclusion (subheadings may assist with the structure of this longer essay). • Define the term ‘palliative approach’ and ‘end of life care using contemporary literature
Discuss advanced care directives particularly from an ethical perspective
consider how a palliative approach to end of life care may affect funding of residential care facilities
Critique these approaches and concepts with reference to the literature. 

Answer     

Introduction
Palliative Approach and End of Life Care
Diagnosis of malignant illnesses like cancer usually results in a short period of decline that begins and ends in acute care (Vans, Law, Turner, Rodgers, Cohen, 2011). For those individuals living with the life-limiting diseases like dementia, the progression of the disease is gradual and not easily reversible. The patients with these illnesses may just need occasional access to the specialist Palliative Care instead of relying on the primary care providers like the general practitioner to offer ongoing support for psychological, physical and social problems that are unique to the nature of the illnesses they have (Spellman, Griffith, Huefner, 2010). Most of the patients, aged and young with these life-limiting illnesses usually reside in the Residential Aged Care Facilities (RACF). The medical care offered in Australia prioritizes in treating diseases as well as preserving life as well as providing care at one’s end of life. This analytical paper aims to give an insight and critically analyze the various models of health care service delivery for older people that involve the palliative approach and the end of life care (Mitchell, 2009).
Discussion
Definition of Palliative Approach and End of Life Care
The Palliative Method usually targets improving the health standards of life for persons having diseases which threatening life and their families by aiming at  decreasing the distress via quick identification, evaluation as well as the pain treatment, psychological, physical, social, cultural and spiritual needs (Australian Medical Association, 2016). In health, End of Life Care is used to refer to the care that is given to patients not only in their final hours or days but also the broad care for all the persons with a terminal illness as well as other terminal conditions that develop, advance, progress and become incurable (Australian Commission of Healthcare, 2017). The end of life care ranges from the decisions, including the issue of palliative care, patient’s right to determine their treatment, medical research procedures, the ethics and the efficacy of the dangerous medical advancements, and the ethics involved in the continued standard medical interventions. The end of life includes issues on rationing and allocation of various resources in the hospitals as well as the national health systems. These decisions are informed by the technical, economic factors, medical considerations, and bioethics. The end of life care is usually subject to factors to the patient autonomy. It is up to the patient and family members to determine when aggressive treatment needs to be pursued or withdraw the life support mechanisms.
National and International Palliative Approach and End of life Projects
The Commonwealth of Australia via the World Health Organization (WHO), the state as well as other territory governments across Australia have improved and increasing their efforts that are focused on improving the palliative approach and the safety as well as the quality of the end of life care (Sharda, 2005). These institutions promote the care for the aged population through funding, promotion of health education, formulation of policies and setting the standards for the palliative care approach and end of life care (Australian Commission for Health, 2017).
The Australian Governments offers to fund for many projects aimed at enhancing knowledge in palliative care while providing the skills necessary for the health of the aged care workers, and promotes awareness of the end of life choices (Australian Government Department of Health, n.d). The Australian government in conjunction with the WHO have come up with various programs that are aimed at improving the palliative approach. WHO defines palliative approach as the method that is used to promote the quality of life of the sufferers as well as their families who are encountering various problems that are associated with the life-threatening illnesses by preventing and relieving their suffering by early detection, impeccable evaluation and the diagnosis of the pain and solving of the spiritual, psychological and physical problems (Barp, 2005). These mechanisms involve models of wellness, case management, and user-pays to promote active aging.
The National Palliative Care Strategy of 2010 is aimed at supporting all patients to live healthy at during End of Life. This strategy strongly represents the joint efforts of the Australian government, the state and the territory governments, community-based organizations and the palliative care service providers towards the development and the implementation of the palliative care programs plans and the services that are always consistent across Australia (URBIS, n.d).  The approach has four primary goals; the first one is Awareness and Understanding. The strategy aims at the improvement of the appreciation of death and dying by accepting that this is a normal process and that it is part of life continuum (URBIS, n.d).  The approach enhances the community and the professional awareness of the benefits and scope as well as to access the palliative care services. The second goal is effectiveness and appropriateness which ensures that proper and active palliative care is available to all the Australians based on the various needs (Moore, Petterson, Nair, Oliver, Brown, Keating & Riva, 2015). The third goal is governance and leadership to support proactive, collaborative and efficient management of the national palliative care approaches, resources, and different strategies. The fourth goal is the capability and capacity aimed at enhancing and building the capacity of all the relevant sectors in the health as well as the human service to offer quality palliative care. The government of Australia has a health policy based on the leadership role in the palliative care and also provide financial support to territory and state governments to enable them to operate the palliative care services as part of the health as well as the community service responsibility provision. The government also is involved in the funding of various National Palliative Care Projects that focuses on the training, education advance care planning and quality improvement (Draper, Melding & Brodaty, 2005).
Application of Palliative Care Policy and Practice
The different policies on the palliative care outline the application and practice guidelines and requirements involved in the application of this approach to models of case management, wellness, active aging, and user-pays. Palliative care offers the liberation from various forms of discomfort and other upsetting indications (Hindle & Coates, 2011). The approach upholds life and regards death as a normal process that is inevitable hence there should be no efforts to hasten or postpone death but emphasizes on the integration of the psychosomatic and the psychic part of the patient care. The approach gives a provision mechanism which assists the patients to live active lives until death (In Farmer, 2012). The family is also assisted in coping with the patient’s disease and the bereavement. The Palliative care encourages the use an approach promoting team work and that addresses the various requirements of the patients as well as their families which include bereavement counseling. The strategy enhances the excellence of life and influences the course of illness in a positive way. The palliative approach enables active aging as it is applicable early in the process of the disease (Finch, 2004). In conjunction with various other therapies, the method prolongs life such as radiation therapy or chemotherapy. This approach calls for the investigations that are needed to enable better understanding and management of the distressing clinical complications.
Strategies for Reforms in the Delivery of Aged Care Service
The current size and increase of elderly patients mean that they will create a challenge for the healthcare delivery system. Patient Survivorship for the care of the growing population has to entail late and long-term effects of the disease and the expected changes in the status of the old person that occurs with aging. Specific age chronological vary in regards to the ability to handle stress, cognition, and functionality. Although the assessment process starts with chronological age in the process of evaluation, additional tools are necessary to understand the proper care and attention for the needs of an individual (Australian Institute of Health and Walfare, 2012). For reforms in the delivery of aged care services, there needs to be a reformed system at the healthcare level as opposed to individual care setting. A more systematic and central approach is necessary so as to ensure management of flows in demand, and also ensure that the care setting is mixed with health catchment areas. Combining the different settings of the healthcare systems (optimizing healthcare) ensures that patients get the right care at the right time. Some context may require an increase of capacity and investment (Guah, 2011).
Consumer responsibility and empowerment can also be used a strategy for reform in the delivery of aged care. Customer segmentation methods can be applied to ensure that there is an understanding of consumer behavior, thus correctly implementing suitable user-friendly strategies. Such efforts can be more focused on driving positive behavioral change, thus used as a preventive method (Tavana, 2017). The health status of a person can be utilized as a means of segmenting the population. Consequently, thus ensures that the burden of disease is reduced, while the demand on the health system is slowed down. The objective would be designed to lessen the demand on the healthcare while consumers achieve healthier pathways compared to before (Information Resources Managemnt Association, 2016).
Wellness Module in Palliative Care
Wellness and prevention need to be carefully considered in the application of the palliative care approach and end of life processes. The multifaceted, complex and the interrelated factors that are usually driving the health care demand in some situations are way outside the ability of the government or other players in the healthcare system control (Care Search palliative care knowledge network, n.d). The demand of the healthcare system is usually influenced by the region demographics and the disease burden (Hovenga, 2013). The healthcare affordability is the most crucial driver of demand hence the government policy makers and the health funders influences directly. Affordability narrows the gap that exists between the actual demand and the latent demand. This ensures that the significant demand is not deferred which would result into later, costly and complex demand due to the worsening of the conditions if they remain untreated. This deterioration of the situation has adverse effects on all the stakeholders as more funds are required hence the burden on the individual, the family, community, the government and the international organizations.
Case Management module in Palliative Care
The models of health service delivery among the aged are aimed at offering the required medical interventions. Case management in the palliative care is intended for the development of modules that are needed in the case management for nurses and involves the palliative care assessment, the identification, implementation and the various approaches to physician feedback. The case management module provides formal palliative care assessment which contains structured feedback as well as the different recommendations for the health care professionals whose patients have been enrolled in the multifaceted palliative care management program. The module compares the different outcomes of the interventions patient getting palliative care evaluation and case management. This is compared against control patients who are receiving management on a standard level. The model evaluates the feasibility and the acceptability of the case management module to the patients, caregivers, family members, the health professionals as well as the industry.
Active aging module (WHO) and User-Pays
Population advancement in age raises numerous fundamental questions and issues for the policy makers. These questions are directed to help people remain self-sufficient sas they age. This model contributes to strengthening the prevention and health promotion policies among the older generation. The module ensures that the quality of life in the old age is improved. The model outlines guidelines on how the government should handle the various sources of elderly care funding so that a high population of older individuals does not bankrupt the health care as well as the social security systems. The model calls for balancing of the role of the state and the family in caring for older persons to enable active aging. The government’s decision-making process actively affects the wellbeing and graceful as well as improved old age quality of life. There are various rationales and concepts for the active aging a goal in the policy and also program formulation.  The individuals who can pay for the services for the aged are required to pay. However, the government helps the other older poor persons to cater for the financial duties in aged care services.
Contemporary Aged Care issues from a Political and Philosophical Position
The public focus on the Australia’s health care structure is majorly around the issues of how to provide high-quality, affordable and accessible aged care. The Australian government has formulated a health system which serves the older generation well as compared to the various key indicators to the overseas health systems. However, the government and other policy makers have room for improvement of the service delivery in aged care. There are various Commonwealth government interventions in aged care that include funding, regulatory mechanisms, research and other development approaches. There is a broad range of national machinery aimed at promoting and enhancing the quality of health care among the aged population. From a philosophical position, the objectives, and vision statement of various stakeholders have put in place various mechanisms of delivering aged care services needed in the palliative approach and end of life settings (Hovenga & In Grain, 2013). There is promotion of different policy, for instance, the Hardi Aged Care policy that promotes goodwill among the residents, relatives, health workers as well as the wider community.
Contemporary Aged Care issues from Ethical and Legal Positions
For the elderly individuals, ethics is all about how they want to be treated and handled by allowing them to make their decisions. For the caregivers and the family members, ethics revolves around doing what right all the time even when there is no one looking is. For the various professionals providing the aged care ethics is all about the adherence to the set canons of ethics propagated by various ethical organizations. The ethical issues range from conflict of interests, confidentiality, and the decision-making capacity. From a legal position, there are various mechanisms aimed at preventing elder abuse (Aras, 2017). The Elder abuse and the law safeguard the elderly from unfair treatment. The duty of care is based on a reasonable bystander’s perspective founded in the law of negligence. Conduct that is considered reasonable is the one that is acceptable, fair, honest, fit, proper, right, equitable, tolerable, average and within reason (Aras, 2017). All the staff in the residential facility are required to show the skills and the ability of a competent health worker in every solution. The duty of care embraces the rights of the aged concerning independence, dignity, and self-determination (Aras, 2017).
Palliative Approach to End of Life affects Funding of Residential Care Facilities
All the citizens of Australia are supposed to age gracefully and die with dignity as they are empowered to have much control over the various circumstances of their death which include the place of their choice. The Australian government and other national and international stakeholders fund various activities in palliative care aimed at improving the end of life care. The palliative care is usually marked differently from the ordinary medicinal method that concentrates on eliminating the illness and protecting life. As discussed above, the health sector have developed and implemented the National Palliative Care Strategy (Guah, 2011). Various pointers have been put in place for an effective palliative approach that is funded by the government and other stakeholders in the different aged care systems. However, shortcomings and key issues should be immediately addressed in the provision of the services of palliative care and end of life care to the older Australians. The government sources for financial support through the formation of various national and international alliances to fund residential care facilities to improve the palliative care and the end of life care (Sharda, 2005). These associations support the definitions and the different elements that the palliative care describes. The alliances claim that the delivery of quality palliative care can only be realized if an active network is present between the palliative care professionals, primary specialists, primary generalists, the support care providers as well as the community as a whole working as a unit to meet all the needs of all the people.
Barriers Facing the Provision Quality Palliative Care.
The nature of aged care services ensures that they are provided towards the end of life, dying and death are not uncommon to aged care. However, the provision of excellent palliative care in the community care and the residential settings is the exception instead of a norm. The conversations involving death and dying is an ad-hoc, it remains a taboo. The systems such as dysphasia and pain are usually poorly managed (Mitchell, 2009). The end of life processes like anorexia, dehydration and respiratory failure are also sometimes treated as medical emergencies thy may prompt hospitalization instead of normal constituents of an incurable illness that can be managed properly by the palliative care teams or by other staff with education and the clinical confidence in offering end of life care. The various financial arrangements in Australia for aged care leads to different outcomes for persons depending on place of residence. Poor, elderly people living in rural areas require more funding from the government. In WA, the government offers significant funds for the home palliative care via the Silver Chain. Because of the application of this service, WA has a low rate of persons that die in the hospital (Barp, 2014).
Conclusion
The aged persons in the population usually have terminal conditions that decrease the quality of life or may even lead to death. Most of these circumstances are not curable and result in loss of life. Therefore, death is inevitable hence preparations for the end of life should be put in place. The palliative approach is aimed at improving the quality of life of the aged persons and better the end of life processes. The government of Australia, national and international stakeholders including WHO have put many efforts in upholding the palliative care and end of life through funding and policy formulation. There are various strategies, policies and models that are aimed at improving the palliative care. There is many contemporary from legal, ethical, political and philosophical positions that needs to be understood and given much attention (Draper, Melding & Brodaty, 2005).
References
Aras, (2017). Duty of Care. Available Online At: https://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/elder_abuse_and_the_law/duty_of_care/  Accessed 19 May 2017
Australian Commission for Health, (2017). End of Life Care projects Across Australia. Available Online At: https://www.safetyandquality.gov.au/our-work/end-of-life-care-in-acute-hospitals/end-of-life-care-projects-across-australia/  Accessed 19 May 2017
Australian Commission of Healthcare, (2017). End of Life Care. Available Online At: https://www.safetyandquality.gov.au/our-work/end-of-life-care-in-acute-hospitals/ Accessed 19 May 2017.
Australian Government Department of Health, (n.d). Palliative Care. Available Online At: https://www.health.gov.au/palliativecare/ Accessed 19 May 2017
Australian Institute of Health and Welfare. (2012). Residential aged care in Australia 2010-11: A statistical overview. Canberra: Australian Institute of Health and Welfare.pg. 4-6
Australian Institute of Health and Welfare. (2012). Residential aged care in Australia 2010-11: A statistical overview. Canberra: Australian Institute of Health and Welfare. Pg.9
Australian Medical Association, (2016). Palliative Approach in Residential Aged Care-2015. Available Online At: https://ama.com.au/position-statement/palliative-approach-residential-aged-care-2015/ Accessed 19 May 2017.
BARR, P. (2014). A Chronic Problem. H&HN: Hospitals & Health Networks, 88(2), 51-56.
Care Search palliative care knowledge network, (n.d). Models of service Delivery. Available Online At: https://www.caresearch.com.au/caresearch/tabid/63/Default.aspx/  Accessed 19 May 2017
Draper, B., Melding, P. S., & Brodaty, H. (2005). Psychogeriatric service delivery. Oxford: Oxford University Press. Pg. 77
Finch, J. (2004). Evaluating mental health services for older people. Abingdon: Radcliffe Medical. Pg.53-56
Guah, M. W. (2011). Healthcare delivery reform and new technologies: Organizational initiatives. Hershey PA: Medical Information Science Reference. Pg.41
Hindle, A., & Coates, A. (2011). Nursing care of older people. Oxford: Oxford University Press. Pg.113
Hovenga, E. J. S., & In Grain, H. (2013). Health information governance in a digital environment. Pg.13
In Farmer, J. (2012). Community Co-Production: Social Enterprise in Remote and Rural Communities.
Information Resources Management Association. (2016). Big data: Concepts, methodologies, tools, and applications. Hershey, PA: Information Science Reference. pg.1670
Mitchell, P. R. (2009). Communication Supports in Congregate Residential Care Settings in Ohio. Journal Of Applied Research In Intellectual Disabilities, 22(4), 400-402.
Moore, A., Patterson, C., Nair, K., Oliver, D., Brown, A., Keating, P., & Riva, J. J. (2015). Minding the gap: Prioritization of care issues among nurse practitioners, family physicians and geriatricians when caring for the elderly. Journal Of Interprofessional Care, 29(4), 401-403. doi:10.3109/13561820.2014.966352
Sharda, A. (2005). Transcultural Geriatrics: Caring for Elderly People of Indo-Asian Origin Partha Gosh Transcultural Geriatrics: Caring for Elderly People of Indo-Asian Origin and Shahid Anis Khan Radcliffe 184 pp £23.50 1 85775 745 9 1857757459 [Formula: see text]. Nursing Older People, 17(7), 37.
Spellman, D. F., Griffith, A. K., Huefner, J. C., Wise, N. I., McElderry, E., & Leslie, L. K. (2010). Psychotropic Medication Management in a Residential Group Care Program. Child Welfare, 89(2), 151-167.
Tavana, M. (2017). Enterprise information systems and the digitalization of business functions. Pg.3
URBIS, (n.d). Evaluating the National Palliative Care Strategy. Available Online At: https://urbis.com.au/projects/evaluating-the-national-palliative-care-strategy/  Accessed 19 May 2017
vans, K., Law, H., Turner, R. E., Rogers, A., & Cohen, K. (2011). A Pilot Study Evaluating Care Staffs’ Perceptions of Their Experience of Psychological Consultation within a Mental Health Setting. Child Care In Practice, 17(2), 205-219.

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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Course Code: 400837
University: Western Sydney University

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Question:
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:
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-1025.
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.
Gómez-Batiste, X., Martínez-Muñoz, M., Blay, C., Amblàs, J., Vila, L., Costa, X., … & Mitchell, G. K. (2014). Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliative medicine, 28(4), 302-311.
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.
Jang, R. W., Krzyzanowska, M. K., Zimmermann, C., Taback, N., & Alibhai, S. M. (2015). Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer. Journal of the National Cancer Institute, 107(3), dju424.
Lovell, A., & Yates, P. (2014). Advance care planning in palliative care: a systematic literature review of the contextual factors influencing its uptake 2008–2012. Palliative medicine, 28(8), 1026-1035.
Mercadante, S., Porzio, G., Valle, A., Aielli, F., Casuccio, A., & Group, H. C. I. (2014). Palliative sedation in patients with advanced cancer followed at home: a prospective study. Journal of pain and symptom management, 47(5), 860-866.
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.
Robinson, J., Gott, M., & Ingleton, C. (2014). Patient and family experiences of palliative care in hospital: what do we know? An integrative review. Palliative medicine, 28(1), 18-33.
Siouta, N., van Beek, K., Preston, N., Hasselaar, J., Hughes, S., Payne, S., … & Hodiamont, F. (2016). Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways. BMC palliative care, 15(1), 18.
Smith, S., Brick, A., O’Hara, S., & Normand, C. (2014). Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliative medicine, 28(2), 130-150.
van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., … & Koopmans, R. T. (2014). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 28(3), 197-209.
Van Lancker, A., Velghe, A., Van Hecke, A., Verbrugghe, M., Van Den Noortgate, N., Grypdonck, M., … & Beeckman, D. (2014). Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. Journal of pain and symptom management, 47(1), 90-104.
Ventura, A. D., Burney, S., Brooker, J., Fletcher, J., & Ricciardelli, L. (2014). Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers. Palliative medicine, 28(5), 391-402.
Wilson, K. G., Dalgleish, T. L., Chochinov, H. M., Chary, S., Gagnon, P. R., Macmillan, K., … & Fainsinger, R. L. (2016). Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ supportive & palliative care, 6(2), 170-177.
Wright, A. A., Keating, N. L., Ayanian, J. Z., Chrischilles, E. A., Kahn, K. L., Ritchie, C. S., … & Landrum, M. B. (2016). Family perspectives on aggressive cancer care near the end of life. Jama, 315(3), 284-292.
Wright, A. A., Zhang, B., Keating, N. L., Weeks, J. C., & Prigerson, H. G. (2014). Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ, 348, g1219.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., … & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.

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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Task you are required to write an essay on the following topic:
Discuss Me concept of a ‘palliative approach’ to end of life care in residential aged care and critique how this approach may be implemented in practice for older people living in residential aged care. In your discussion you should consider policies around advanced care directives end fundng model for residential aged care.

A discussion of what a oaliatrve approach is and what systems east to promote a palliative approach in residential aged care at a national and international level
A discussion and unique of the issues in providng palliative care in residential aged care. This should also include discussion of the way aged services are funded and how this impacts palliative cam in aged care
Write an essay incorporating an introduction body and conclusion (subheadngs may assist with the structure of this longer essay)
Defne the term ‘panelme approach and ‘end of life care’ using contemporary literature
Discuss advanced care directives parecularly from an ethcal perspective
consider how a palliative approach tO end of life care may ante d funding Of reSidental Care faCilities
Critique these approaches and concepts with reference to the literature

Answers:

Introduction
Palliative care services are designed to improve the life of patient with progressive disease. People receiving palliative care have illness that has no prospect of cure.  As per the World Health Organisation, palliative care is a care given to patient suffering from life threatening illness to improve their quality of life by preventing and providing relief from sufferings by early recognition , assessment and treatment of pain and psychological, physical and spiritual problem (Zimmermann et al., 2014). Palliative care is delivered in various settings including paediatric services, neonatal units, acute hospitals, residential aged care services, and community settings such as home care. Specialist services operate from community based services, inpatient and hospice care (Parker et al., 2013). The paper deals with Palliative approach in end of life care in residential aged care at a national and international level. The purpose of the analytical paper is to demonstrate the concept of palliative care and demonstrate the synthesis of this approach with evidence about its application in policy and practice. The paper is the critique on how palliative approach is implemented in practice for older people. The paper considers the policies around advance care directives and the models of funding for residential aged care. It includes the discussion of issues in palliative care and its impact.
Palliative care
The term palliative comes from the Latin “palliatus” which means hidden or covered with cloak and it refers to “relieving without curing” (Zimmermann et al., 2014). Palliative care is provided to patient suffering from active and progressive disease that has no prospect of care. It includes the later stages of cancer, non –malignant conditions such as heart failure, dementia, motor neurone disease, respiratory failure, renal failure,  Parkinson’s disease, and muscular dystrophy among others. This approach affirms life; it provides pain relief and relief from other distressing symptoms. In this approach, dying is regarded as normal process and efforts are made to neither hasten nor prolong death (Parker et al., 2013). In some countries, a distinction is made between palliative care and hospice care.  The two approaches have similar philosophy.  In US, the distinction is operative and the two aspects differ in respect to the payment system and the location of the services. However, in UK both the hospice and the non-hospice team of palliative care deliver care to those with any stage of illness and is not curable. However, many professionals are non-specialist in heath care and yet apply the principles of palliative care in their routine work (Free, 2018). In Australia, palliative approach is recognised to be important and considered it a core competency for all the health professionals (Broad et al., 2013). 
In an individual’s journey through life, culture constitutes fundamental part. Culture along with spirituality plays a significant role in a person’s life. It has been found in many cases that health beliefs are strongly tied to spiritual and religious affiliations of an individual as well as to his or  her cultural background (Mazanec & Panke, 2015).  Therefore, palliative care incorporates the cultural, spiritual and psychological aspects to help a patient live actively until death. Palliative care also addresses the family’s needs and wants such as coping up with bereavement (Free, 2018).
End of life care
The end of life care is provided to the patients in last months or years of their life. It includes people whose death is imminent such as those with advanced stage of cancer, stroke, dementia and patients who have experienced a catastrophic event in life. The goal of the care is to help a person die with dignity and to assist a dying person to live as well as possible until death. While providing care the patient’s wishes, preferences, and perspectives of the family members are taken into account. Such patients are entitled to high quality of care and are allowed to express their wishes to receive care at home, hospice, care homes, or hospitals and depending on need and preferences (Rosenwax et al. 2016). The hospital doctors, nurses, community staff, general practioners, counsellors, social care staff, physiotherapists, occupational therapists and hospice staff provides the end of life care. General Practioners are responsible for overall care if the patient with the end of life receives care at home. Palliative care is included in the end of life care in case where pain and distressing symptoms of the illness are curable. This approach is included to provide comfortability to the patients (Virdun et al., 2015).
Palliative approach to end of life care in residential aged care
The residential aged care facilities at national and international level are designed in a manner that supports the medical professionals to access the files of the patients and allow the palliative approach to be incorporated at the earliest opportunity. The residential aged care facilities best supports the palliative approach, which facilitates open communication system between the patients and health care professionals of the aged care team (Tuckett et al., 2015). These facilities ensure that skilled staff is recruited that can provide quality care at all hours. Staff with right skill mix is needed to decrease the transfer of patients to acute care setting and potential distress to both the aged person and the family. The role of the aged care staff is to engage in continual professional development and education about the palliative approach. 
The palliative approach in the aged care facility,  includes various elements. It includes incorporating the principle of autonomy, dignity, respect and comfort. It involves the principles of having honest and open communication with the aged adults in regards to the current conditions and the treatment options. It is mandatory for the palliative care team to provide choice to the older adults in available evidence based treatment methods. Palliative approach to the end of life care involves effective management of the distressing symptoms and pain relief. It includes provision of people with the type of access they wish to have and involves fulfilment of needs considering the cultural and spiritual wishes (Mazanec & Panke, 2015). The palliative care team works hard to improve the quality of life of patient with life limiting illness by providing care in conjunction with other therapies that may prolong the life of the patient. However, the goal is not to hasten or postpone the death (Free, 2018). Spiritual considerations involve providing people with resources such as pastoral care workers, meditative music, aromatherapy resources, objects of personal significance, and photos of family members that can provide relief and comfort (López-Sierra & Rodríguez-Sánchez, 2015).
According to Parker et al. (2013) the care for aged people with life limiting illness in residential aged care facility is directed by the medical practioners. The role of the practioners is to prescribe medications or treatments and make effective decision related to treatment. These practioners play a central role in this process. The practioner must be clear about the difference between the goals of palliative and acute care. Therefore, the medical practioner must ensure that the aged person at the end of life and those with chronic illnesses receives palliative care and appropriate services. It is essential to provide care based on the need and comfort rather than being cure focused. However, appropriate care does not indicate sending the older patient to hospital. Further, Tuckett et al. (2014) argued that the palliative approach should limit interventions that are distressing to the patient wherever possible even if the symptoms can be cured such as in-situ. However, some hospital visits may be necessary to provide active comfort. A greater emphasis is laid on providing relief to distressing symptoms using positive approach and by taking into account cultural and spiritual needs.
Planning and communication  that is oriented to cultural and spiritual background  of the care  user  is the vital part of  palliative approach in end of life care and in aged care facilities  The practioners must make decisions by having open dialogue with the older adults in the aged care and by taking consent from the patient’s family members.  It is essential that the patients and their loved ones understand the various service options, treatment modalities and it realistic outcomes. It is the only effective methods that will allow them make informed choices (Keeley, 2016).  In some cases where an older adult having illness with unpredictable courses may create a situation where is it is difficult to make effective communication. In such cases collaboration is needed between residential aged care services, primary care providers, disease specific organisations, and specialist palliative care services for discussion and communication (Petriwskyj et al., 2014).
Processes of palliative approach to residential aged care
In Australia, the Palliative approach in the residential aged care incorporates the advance care planning or ACP. ACP gives opportunity to the patient’s relatives to make choices or decisions on behalf of the patients such as how they want to live until they die. It may be applicable in case patient has dementia where one is not in the state to make decisions related to their life. ACP guides the doctors to respect the wishes of relatives related to care, health insurance. ACP onsets if the estimated prognosis is of greater than six months and patients are reviewed every six months. However, it is not a single event of communicating and documenting wishes, rather an ongoing process of discussion and is commenced soon after resident’s admission (Street et al., 2015).
Even though people are, clear about the concept of the end of life care there is difference in their preferences.  Advance care directives or ACD is the process of allowing people to plan ahead in case of decision making considering cultural parameters. ACD is the systematic approach of making decision while respecting the previously expressed wishes of the person. In both national and international level, the residential aged care services are making ACD as a part of routine care for appropriate transfer of information between the health care professionals, clinicians and the residential aged care facilities. In this system, the future decision-making is based on the person’s values, beliefs and preferences (Crispin, Bestic, & Leditshke, 2015). ACD is the formal advance care plan expressed in writing that is agreed by both the individual and the recognised by the common legislation. The ACDs inform the plans related to the clinical care treatment and resuscitation (Petriwskyj et al., 2014).
According to Tuckett et al. (2014) palliative care case conferences and use of an end of life care pathway are the key processes will be successful only if there exist an ongoing and open communication between all the members of the residential care team. Palliative care case conferences are initiated if the estimated prognosis is of less than six months and patients are reviewed monthly. End of life care pathway is initiated when estimated prognosis is of less than 1 week and patients are reviewed daily. The care facilitators should be aware of different prognosis of each member. In palliative care conferences, a meeting is held between the care team and the residents including their families. The meeting comprises of the issues and the current condition of the residents and identify the clear goals of care (Reymond, 2014). In end of life care pathway a clinical document guides the delivery of high quality care in terminal phase of illness. In case of improvement he/she is taken out off the end of life care. The normal care routine is resumed (Reymond et al., 2016).
Key issues
The primary challenge in palliative approach to residential aged care facilities is the ethical decision-making and legal obligations. The main ethical issues are related to the advance care planning and documentation, burdensome treatment, poor quality of life and pain management at the end of life, issues related to treatment adherence, hydration and nutrition. Family members frequently report difficulty in making decisions related to patient’s request to die and resuscitation. The care providers have to make decisions based on the principles of autonomy, beneficence, non-maleficence and justice (McLennan et al., 2015).
In countries like Australia, which contain diverse population it, is often difficult to maintain autonomy in respect to diverse religious, spiritual beliefs. For instance, Torres Strait Islanders and Aboriginals have different beliefs than the Non Aboriginal Australians. The perceptions about what constitutes “quality of life” are different for different communities. Consequently, the substitute decision maker of the patient may accept or refuse the intervention in a valid ACD (Stokoe et al., 2015). In most cases it is difficult for the care providers to remember different customs that show respect and different reactions to death and dying. In several incidents, Language is key barrier. It is assumed that everyone understands and speaks English. Therefore, interpreter and translator services are an important part of palliative approach. Lack of these services also leads to failure to meet the spiritual aspects of palliative care and legal issues which in turn delays the discussions until death is imminent. Lack of skilled staff and knowledge on importance of considering the person’s values, goals, delays informed choices and advance care planning documentation (Connolly et al., 2014).
There are various legislations enacted in Australia covering ACD with the name and the nature of the legislated instruments for each ACD component (Crispin et al., 2015). However, the key issues are change of people’s preferences over time, which may not be updated in ACD. Sometimes the medical directions, which are uinformed, are too specific to be changed during medical treatment or are too non-specific to guide decision-making. In different countries the advance care policy and best practice principles are not consistent. There is inappropriate documentation and transfer of information triggers lawsuits (Broad et al., 2015). Several legislations are introduced in UK to provide framework for administration of medicines without individual prescription.
Residential aged care face difficulties in administrating palliative care due to residents having dementia and or communication difficulties. The permanent residents are appraised as requiring palliative care under Australian aged care funding instrument. The proportion of funding increases with the increase in age of the resident. These systems have undergone several reforms. The government of Australia has developed guidelines for a palliative approach, which addresses the inequities of service in residential aged care centres. There is a difference in funding between these centres and the multi-purpose services which influences the delivery of palliative and end of life care in residential care facilities. In these facilities the funding is based on individual needs whereas in the multi-purpose service units the funding is based on the agreed number of beds to provide care which gives these services a consolidated revenue. Thus, the residential classification scale is the major issue in the delivering palliative care. In most cases palliative care inpatients referred to residential aged care die before discharge and hence there is a need of careful placement. In certain circumstances, the some amount is deducted in relation to the repayment of capital grants. Inspite of capital grants in regional and rural areas residential care is not accessed due to geographic location, lack of non grant funding to undertake the capital work and low means residents such as defined in Aged care Act. The rising demand for aged care services is an added burden (Sung et al., 2014).
Conclusion
Palliative approach is truly a holistic care delivered to patients with life threatening illness with no prospects to cure. It incorporates psychological, spiritual and cultural needs while addressing the patient’s problems. It is evident from the literature review that in near future the needs of the palliative care is likely to increase. The services should align with the WHO recommendations. There is a need of making further assessments of unsatisfied requirements and other diagnoses in the need of palliative care. The ethical and legal obligation are inevitable if the palliative approach  in residential aged care facilities do not incorporate cultural, spiritual and religious values and beliefs of the people. There is a need of clear preferences and it must be followed in practice to prevent loss of decision making capacity. There is a need of systematic approach to ACD. Planning and communication is essential in any ACD to ensure that the care  services are congruent with the patients’ preferences and demands.
References
Broad, J. B., Ashton, T., Gott, M., McLeod, H., Davis, P. B., & Connolly, M. J. (2015). Likelihood of residential aged care use in later life: A simple approach to estimation with international comparison. Australian and New Zealand journal of public health, 39(4), 374-379.
Broad, J. B., Gott, M., Kim, H., Boyd, M., Chen, H., & Connolly, M. J. (2013). Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. International Journal of Public Health, 58(2), 257-267.
Connolly, M. J., Broad, J. B., Boyd, M., Kerse, N., & Gott, M. (2014). Residential aged care: The de facto hospice for New Zealand’s older people. Australasian journal on ageing, 33(2), 114-120.
Crispin, T., Bestic, J., & Leditshke, A. (2015). Advance care directives in residential aged care. Australian family physician, 44(4), 186.
Free, L. (2018). Palliative and end?of?life care. Acute Medicine?A Practical Guide to the Management of Medical Emergencies, 5th Edition, 625-631.
Keeley, M. P. (2016). End?of?Life Communication. The International Encyclopedia of Interpersonal Communication.
López-Sierra, H. E., & Rodríguez-Sánchez, J. (2015). The supportive roles of religion and spirituality in end-of-life and palliative care of patients with cancer in a culturally diverse context: a literature review. Current opinion in supportive and palliative care, 9(1), 87-95.
Mazanec, P., & Panke, J. T. (2015). Cultural considerations in palliative care. Spiritual, Religious, and Cultural Aspects of Care, 4.
McLennan, V. E., Boddy, J. H., Daly, M. G., & Chenoweth, L. M. (2015). Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning. Australian Health Review, 39(5), 528-532.
Parker, D., Tuckett, A., Clifton, K., Reymond, L., Israel, F., McAnelly, K., … & Walker, H. (2013). Palliative care case conference (PCCC) in residential aged care (RAC): views of general practitioners. In APCC2013: 12th Australian Palliative Care Conference. Palliative Care: everyone’s business. Centre for Palliative Care Research and Education.
Petriwskyj, A., Gibson, A., Parker, D., Banks, S., Andrews, S., & Robinson, A. (2014). Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature. International journal of evidence-based healthcare, 12(2), 64-86.
Reymond, L. (2014). A model of care. Australian Ageing Agenda, (Jul/Aug 2014), 50.
Reymond, L., Cooper, K., Parker, D., & Chapman, M. (2016). End of Life Care: Proactive Clinical Management of Older Australians in the Community. The Royal Australian College of General Practitioners, 45(1-2).
Rosenwax, L., Spilsbury, K., McNamara, B. A., & Semmens, J. B. (2016). A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?. BMC palliative care, 15(1), 46.
Stokoe, A., Hullick, C., Higgins, I., Hewitt, J., Armitage, D., & O’Dea, I. (2015). The challenges associated with caring for acutely unwell aged care facility residents: the perspectives of staff in residential aged care facilities and their primary care physicians. Australas J Ageing.
Street, M., Ottmann, G., Johnstone, M. J., Considine, J., & Livingston, P. M. (2015). Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. Health & social care in the community, 23(5), 513-522.
Sung, C. B., Johnson, C. E., Lim, W. K., & Fullerton, S. L. (2014). Assessing palliative care unit inpatients for residential aged care placement: is it worth it?. Journal of palliative medicine, 17(2), 204-208.
Tuckett, A., Parker, D., Clifton, K., Glaetzer, K., Greeve, K., Israel, F., … & Walker, H. (2014). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 1. Progress in Palliative Care, 22(2), 61-68.
Tuckett, A., Parker, D., Clifton, K., Walker, H., Reymond, E., Prior, T., … & Glaetzer, K. (2015). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 2. Progress in Palliative Care, 23(1), 9-17.
Virdun, C., Luckett, T., Davidson, P. M., & Phillips, J. (2015). Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliative medicine, 29(9), 774-796.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., … & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.

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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Task you are required to write an essay on the following topic:
Discuss Me concept of a ‘palliative approach’ to end of life care in residential aged care and critique how this approach may be implemented in practice for older people living in residential aged care. In your discussion you should consider policies around advanced care directives end fundng model for residential aged care.

A discussion of what a oaliatrve approach is and what systems east to promote a palliative approach in residential aged care at a national and international level
A discussion and unique of the issues in providng palliative care in residential aged care. This should also include discussion of the way aged services are funded and how this impacts palliative cam in aged care
Write an essay incorporating an introduction body and conclusion (subheadngs may assist with the structure of this longer essay)
Defne the term ‘panelme approach and ‘end of life care’ using contemporary literature
Discuss advanced care directives parecularly from an ethcal perspective
consider how a palliative approach tO end of life care may ante d funding Of reSidental Care faCilities
Critique these approaches and concepts with reference to the literature

Answers:

Introduction
Palliative care services are designed to improve the life of patient with progressive disease. People receiving palliative care have illness that has no prospect of cure.  As per the World Health Organisation, palliative care is a care given to patient suffering from life threatening illness to improve their quality of life by preventing and providing relief from sufferings by early recognition , assessment and treatment of pain and psychological, physical and spiritual problem (Zimmermann et al., 2014). Palliative care is delivered in various settings including paediatric services, neonatal units, acute hospitals, residential aged care services, and community settings such as home care. Specialist services operate from community based services, inpatient and hospice care (Parker et al., 2013). The paper deals with Palliative approach in end of life care in residential aged care at a national and international level. The purpose of the analytical paper is to demonstrate the concept of palliative care and demonstrate the synthesis of this approach with evidence about its application in policy and practice. The paper is the critique on how palliative approach is implemented in practice for older people. The paper considers the policies around advance care directives and the models of funding for residential aged care. It includes the discussion of issues in palliative care and its impact.
Palliative care
The term palliative comes from the Latin “palliatus” which means hidden or covered with cloak and it refers to “relieving without curing” (Zimmermann et al., 2014). Palliative care is provided to patient suffering from active and progressive disease that has no prospect of care. It includes the later stages of cancer, non –malignant conditions such as heart failure, dementia, motor neurone disease, respiratory failure, renal failure,  Parkinson’s disease, and muscular dystrophy among others. This approach affirms life; it provides pain relief and relief from other distressing symptoms. In this approach, dying is regarded as normal process and efforts are made to neither hasten nor prolong death (Parker et al., 2013). In some countries, a distinction is made between palliative care and hospice care.  The two approaches have similar philosophy.  In US, the distinction is operative and the two aspects differ in respect to the payment system and the location of the services. However, in UK both the hospice and the non-hospice team of palliative care deliver care to those with any stage of illness and is not curable. However, many professionals are non-specialist in heath care and yet apply the principles of palliative care in their routine work (Free, 2018). In Australia, palliative approach is recognised to be important and considered it a core competency for all the health professionals (Broad et al., 2013). 
In an individual’s journey through life, culture constitutes fundamental part. Culture along with spirituality plays a significant role in a person’s life. It has been found in many cases that health beliefs are strongly tied to spiritual and religious affiliations of an individual as well as to his or  her cultural background (Mazanec & Panke, 2015).  Therefore, palliative care incorporates the cultural, spiritual and psychological aspects to help a patient live actively until death. Palliative care also addresses the family’s needs and wants such as coping up with bereavement (Free, 2018).
End of life care
The end of life care is provided to the patients in last months or years of their life. It includes people whose death is imminent such as those with advanced stage of cancer, stroke, dementia and patients who have experienced a catastrophic event in life. The goal of the care is to help a person die with dignity and to assist a dying person to live as well as possible until death. While providing care the patient’s wishes, preferences, and perspectives of the family members are taken into account. Such patients are entitled to high quality of care and are allowed to express their wishes to receive care at home, hospice, care homes, or hospitals and depending on need and preferences (Rosenwax et al. 2016). The hospital doctors, nurses, community staff, general practioners, counsellors, social care staff, physiotherapists, occupational therapists and hospice staff provides the end of life care. General Practioners are responsible for overall care if the patient with the end of life receives care at home. Palliative care is included in the end of life care in case where pain and distressing symptoms of the illness are curable. This approach is included to provide comfortability to the patients (Virdun et al., 2015).
Palliative approach to end of life care in residential aged care
The residential aged care facilities at national and international level are designed in a manner that supports the medical professionals to access the files of the patients and allow the palliative approach to be incorporated at the earliest opportunity. The residential aged care facilities best supports the palliative approach, which facilitates open communication system between the patients and health care professionals of the aged care team (Tuckett et al., 2015). These facilities ensure that skilled staff is recruited that can provide quality care at all hours. Staff with right skill mix is needed to decrease the transfer of patients to acute care setting and potential distress to both the aged person and the family. The role of the aged care staff is to engage in continual professional development and education about the palliative approach. 
The palliative approach in the aged care facility,  includes various elements. It includes incorporating the principle of autonomy, dignity, respect and comfort. It involves the principles of having honest and open communication with the aged adults in regards to the current conditions and the treatment options. It is mandatory for the palliative care team to provide choice to the older adults in available evidence based treatment methods. Palliative approach to the end of life care involves effective management of the distressing symptoms and pain relief. It includes provision of people with the type of access they wish to have and involves fulfilment of needs considering the cultural and spiritual wishes (Mazanec & Panke, 2015). The palliative care team works hard to improve the quality of life of patient with life limiting illness by providing care in conjunction with other therapies that may prolong the life of the patient. However, the goal is not to hasten or postpone the death (Free, 2018). Spiritual considerations involve providing people with resources such as pastoral care workers, meditative music, aromatherapy resources, objects of personal significance, and photos of family members that can provide relief and comfort (López-Sierra & Rodríguez-Sánchez, 2015).
According to Parker et al. (2013) the care for aged people with life limiting illness in residential aged care facility is directed by the medical practioners. The role of the practioners is to prescribe medications or treatments and make effective decision related to treatment. These practioners play a central role in this process. The practioner must be clear about the difference between the goals of palliative and acute care. Therefore, the medical practioner must ensure that the aged person at the end of life and those with chronic illnesses receives palliative care and appropriate services. It is essential to provide care based on the need and comfort rather than being cure focused. However, appropriate care does not indicate sending the older patient to hospital. Further, Tuckett et al. (2014) argued that the palliative approach should limit interventions that are distressing to the patient wherever possible even if the symptoms can be cured such as in-situ. However, some hospital visits may be necessary to provide active comfort. A greater emphasis is laid on providing relief to distressing symptoms using positive approach and by taking into account cultural and spiritual needs.
Planning and communication  that is oriented to cultural and spiritual background  of the care  user  is the vital part of  palliative approach in end of life care and in aged care facilities  The practioners must make decisions by having open dialogue with the older adults in the aged care and by taking consent from the patient’s family members.  It is essential that the patients and their loved ones understand the various service options, treatment modalities and it realistic outcomes. It is the only effective methods that will allow them make informed choices (Keeley, 2016).  In some cases where an older adult having illness with unpredictable courses may create a situation where is it is difficult to make effective communication. In such cases collaboration is needed between residential aged care services, primary care providers, disease specific organisations, and specialist palliative care services for discussion and communication (Petriwskyj et al., 2014).
Processes of palliative approach to residential aged care
In Australia, the Palliative approach in the residential aged care incorporates the advance care planning or ACP. ACP gives opportunity to the patient’s relatives to make choices or decisions on behalf of the patients such as how they want to live until they die. It may be applicable in case patient has dementia where one is not in the state to make decisions related to their life. ACP guides the doctors to respect the wishes of relatives related to care, health insurance. ACP onsets if the estimated prognosis is of greater than six months and patients are reviewed every six months. However, it is not a single event of communicating and documenting wishes, rather an ongoing process of discussion and is commenced soon after resident’s admission (Street et al., 2015).
Even though people are, clear about the concept of the end of life care there is difference in their preferences.  Advance care directives or ACD is the process of allowing people to plan ahead in case of decision making considering cultural parameters. ACD is the systematic approach of making decision while respecting the previously expressed wishes of the person. In both national and international level, the residential aged care services are making ACD as a part of routine care for appropriate transfer of information between the health care professionals, clinicians and the residential aged care facilities. In this system, the future decision-making is based on the person’s values, beliefs and preferences (Crispin, Bestic, & Leditshke, 2015). ACD is the formal advance care plan expressed in writing that is agreed by both the individual and the recognised by the common legislation. The ACDs inform the plans related to the clinical care treatment and resuscitation (Petriwskyj et al., 2014).
According to Tuckett et al. (2014) palliative care case conferences and use of an end of life care pathway are the key processes will be successful only if there exist an ongoing and open communication between all the members of the residential care team. Palliative care case conferences are initiated if the estimated prognosis is of less than six months and patients are reviewed monthly. End of life care pathway is initiated when estimated prognosis is of less than 1 week and patients are reviewed daily. The care facilitators should be aware of different prognosis of each member. In palliative care conferences, a meeting is held between the care team and the residents including their families. The meeting comprises of the issues and the current condition of the residents and identify the clear goals of care (Reymond, 2014). In end of life care pathway a clinical document guides the delivery of high quality care in terminal phase of illness. In case of improvement he/she is taken out off the end of life care. The normal care routine is resumed (Reymond et al., 2016).
Key issues
The primary challenge in palliative approach to residential aged care facilities is the ethical decision-making and legal obligations. The main ethical issues are related to the advance care planning and documentation, burdensome treatment, poor quality of life and pain management at the end of life, issues related to treatment adherence, hydration and nutrition. Family members frequently report difficulty in making decisions related to patient’s request to die and resuscitation. The care providers have to make decisions based on the principles of autonomy, beneficence, non-maleficence and justice (McLennan et al., 2015).
In countries like Australia, which contain diverse population it, is often difficult to maintain autonomy in respect to diverse religious, spiritual beliefs. For instance, Torres Strait Islanders and Aboriginals have different beliefs than the Non Aboriginal Australians. The perceptions about what constitutes “quality of life” are different for different communities. Consequently, the substitute decision maker of the patient may accept or refuse the intervention in a valid ACD (Stokoe et al., 2015). In most cases it is difficult for the care providers to remember different customs that show respect and different reactions to death and dying. In several incidents, Language is key barrier. It is assumed that everyone understands and speaks English. Therefore, interpreter and translator services are an important part of palliative approach. Lack of these services also leads to failure to meet the spiritual aspects of palliative care and legal issues which in turn delays the discussions until death is imminent. Lack of skilled staff and knowledge on importance of considering the person’s values, goals, delays informed choices and advance care planning documentation (Connolly et al., 2014).
There are various legislations enacted in Australia covering ACD with the name and the nature of the legislated instruments for each ACD component (Crispin et al., 2015). However, the key issues are change of people’s preferences over time, which may not be updated in ACD. Sometimes the medical directions, which are uinformed, are too specific to be changed during medical treatment or are too non-specific to guide decision-making. In different countries the advance care policy and best practice principles are not consistent. There is inappropriate documentation and transfer of information triggers lawsuits (Broad et al., 2015). Several legislations are introduced in UK to provide framework for administration of medicines without individual prescription.
Residential aged care face difficulties in administrating palliative care due to residents having dementia and or communication difficulties. The permanent residents are appraised as requiring palliative care under Australian aged care funding instrument. The proportion of funding increases with the increase in age of the resident. These systems have undergone several reforms. The government of Australia has developed guidelines for a palliative approach, which addresses the inequities of service in residential aged care centres. There is a difference in funding between these centres and the multi-purpose services which influences the delivery of palliative and end of life care in residential care facilities. In these facilities the funding is based on individual needs whereas in the multi-purpose service units the funding is based on the agreed number of beds to provide care which gives these services a consolidated revenue. Thus, the residential classification scale is the major issue in the delivering palliative care. In most cases palliative care inpatients referred to residential aged care die before discharge and hence there is a need of careful placement. In certain circumstances, the some amount is deducted in relation to the repayment of capital grants. Inspite of capital grants in regional and rural areas residential care is not accessed due to geographic location, lack of non grant funding to undertake the capital work and low means residents such as defined in Aged care Act. The rising demand for aged care services is an added burden (Sung et al., 2014).
Conclusion
Palliative approach is truly a holistic care delivered to patients with life threatening illness with no prospects to cure. It incorporates psychological, spiritual and cultural needs while addressing the patient’s problems. It is evident from the literature review that in near future the needs of the palliative care is likely to increase. The services should align with the WHO recommendations. There is a need of making further assessments of unsatisfied requirements and other diagnoses in the need of palliative care. The ethical and legal obligation are inevitable if the palliative approach  in residential aged care facilities do not incorporate cultural, spiritual and religious values and beliefs of the people. There is a need of clear preferences and it must be followed in practice to prevent loss of decision making capacity. There is a need of systematic approach to ACD. Planning and communication is essential in any ACD to ensure that the care  services are congruent with the patients’ preferences and demands.
References
Broad, J. B., Ashton, T., Gott, M., McLeod, H., Davis, P. B., & Connolly, M. J. (2015). Likelihood of residential aged care use in later life: A simple approach to estimation with international comparison. Australian and New Zealand journal of public health, 39(4), 374-379.
Broad, J. B., Gott, M., Kim, H., Boyd, M., Chen, H., & Connolly, M. J. (2013). Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. International Journal of Public Health, 58(2), 257-267.
Connolly, M. J., Broad, J. B., Boyd, M., Kerse, N., & Gott, M. (2014). Residential aged care: The de facto hospice for New Zealand’s older people. Australasian journal on ageing, 33(2), 114-120.
Crispin, T., Bestic, J., & Leditshke, A. (2015). Advance care directives in residential aged care. Australian family physician, 44(4), 186.
Free, L. (2018). Palliative and end?of?life care. Acute Medicine?A Practical Guide to the Management of Medical Emergencies, 5th Edition, 625-631.
Keeley, M. P. (2016). End?of?Life Communication. The International Encyclopedia of Interpersonal Communication.
López-Sierra, H. E., & Rodríguez-Sánchez, J. (2015). The supportive roles of religion and spirituality in end-of-life and palliative care of patients with cancer in a culturally diverse context: a literature review. Current opinion in supportive and palliative care, 9(1), 87-95.
Mazanec, P., & Panke, J. T. (2015). Cultural considerations in palliative care. Spiritual, Religious, and Cultural Aspects of Care, 4.
McLennan, V. E., Boddy, J. H., Daly, M. G., & Chenoweth, L. M. (2015). Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning. Australian Health Review, 39(5), 528-532.
Parker, D., Tuckett, A., Clifton, K., Reymond, L., Israel, F., McAnelly, K., … & Walker, H. (2013). Palliative care case conference (PCCC) in residential aged care (RAC): views of general practitioners. In APCC2013: 12th Australian Palliative Care Conference. Palliative Care: everyone’s business. Centre for Palliative Care Research and Education.
Petriwskyj, A., Gibson, A., Parker, D., Banks, S., Andrews, S., & Robinson, A. (2014). Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature. International journal of evidence-based healthcare, 12(2), 64-86.
Reymond, L. (2014). A model of care. Australian Ageing Agenda, (Jul/Aug 2014), 50.
Reymond, L., Cooper, K., Parker, D., & Chapman, M. (2016). End of Life Care: Proactive Clinical Management of Older Australians in the Community. The Royal Australian College of General Practitioners, 45(1-2).
Rosenwax, L., Spilsbury, K., McNamara, B. A., & Semmens, J. B. (2016). A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?. BMC palliative care, 15(1), 46.
Stokoe, A., Hullick, C., Higgins, I., Hewitt, J., Armitage, D., & O’Dea, I. (2015). The challenges associated with caring for acutely unwell aged care facility residents: the perspectives of staff in residential aged care facilities and their primary care physicians. Australas J Ageing.
Street, M., Ottmann, G., Johnstone, M. J., Considine, J., & Livingston, P. M. (2015). Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. Health & social care in the community, 23(5), 513-522.
Sung, C. B., Johnson, C. E., Lim, W. K., & Fullerton, S. L. (2014). Assessing palliative care unit inpatients for residential aged care placement: is it worth it?. Journal of palliative medicine, 17(2), 204-208.
Tuckett, A., Parker, D., Clifton, K., Glaetzer, K., Greeve, K., Israel, F., … & Walker, H. (2014). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 1. Progress in Palliative Care, 22(2), 61-68.
Tuckett, A., Parker, D., Clifton, K., Walker, H., Reymond, E., Prior, T., … & Glaetzer, K. (2015). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 2. Progress in Palliative Care, 23(1), 9-17.
Virdun, C., Luckett, T., Davidson, P. M., & Phillips, J. (2015). Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliative medicine, 29(9), 774-796.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., … & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.

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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Discuss about the Active Ageing Policy Framework.
 
 
Answer:

Aging Health Policies
In its Active Ageing policy framework, the World Health Organization defines active aging as the optimization process of participation, security, and health in an attempt to enhance the quality of life as individuals grows old. Healthy aging is essential in that it enables the elderly to play an active role in society and enjoy independence and the high quality of life. The essay will critique the active aging model of the World Health Organization and the application of social capital in various social policies and programs.
According to the WHO, Active Ageing Policy Framework, involvement in moderate and frequent physical activity helps in delaying functional deterioration at old age. For instance, it reduces the onset of chronic diseases such as hypertension and diabetes. The policy suggests that regular activity could also greatly reduce the extent of the severity of disabilities among the aged which are associated with heart and chronic illnesses. The active aging policy reveals how living an active early life promotes independence at old age and the reduction of the risk of frequent falls among the elderly. Consequently, economic benefits will be realized because the medical costs for the active older people will be significantly lower (World Health Organization, 2002).
 
However, this policy framework only makes the considerable suggestions and does not provide the opportunities that could possibly encourage inactive people to become more active. The benefits of these physical activities heavily rely on affordability and accessibility. Funding systems that promote physical activities in a community can bring about several benefits such as improved health, cost saving and heightened social connection all which contributes to active aging (Abdullah, & Wolbring, 2013). In addition, the active aging model established the major determinants of active aging as health and social services, personal factors, behavioral factors, social factors, economic factors and the physical environment of an individual. The framework suggests that all these principal determinants and the interaction of the factors reflect upon the aging process of individuals and communities. The framework fails to attribute a cause of active aging to each of the determinants. The proposal brings out the need to evaluate how each of the active aging determinants influences old age in a multidimensional investigation. Therefore, in order to help the aging population, adequate funding on programs that benefit the aging population should be established (Farrell et al. 2015).
The World Health Organization has explored policies and factors that make the urban physical environment age-friendly. In its worldwide age-friendly cities project, the organization came up with strategies to make urban communities more age-friendly via community development, policy reforms, and through advocacy. Consequently, these strategies have improved the quality of life among the aging population living in urban centers (Bauman, Merom, Bull, Buchner, & Singh, 2016).
Representation of the aged in policy, laws, legislations, health, and social service delivery has been guided by international policy and legal frameworks particularly the WHO’s Active Ageing policy framework and the Political Declaration and Madrid International Plan of Action on Ageing. Each of the documents highlights the significance of health in old age and emphasizes on the potential for the contribution of the aged in society using their skills, wisdom, and experience. They outline a wide range of areas where maximization on active aging policies can enhance the contribution, autonomy, prolonged life expectancy, and independence of the aged. Therefore, adequate presentation of the old in health, legislation, and healthcare delivery is beneficial as it will enable the aging population receive the attention and care they deserve (World Health Organization, 2002).
 
In the last two decades, major attempts have been made in advancing the human rights of the old people in the International Human Rights Law. A couple of international treaties and instruments have been implemented referring to aging and the older people, preserving non-discrimination of older immigrants, older disabled persons, and older women. The human rights advocates for freedom from discrimination of the aged in matters pertaining to social security, health, sufficient living standards and their right to be free from abuse, violence or exploitation (Renteln, 2013).
The Madrid International Plan of Action on Ageing put forward some priorities for action, which were development of older individuals, advancing wellness and health into old age and making sure that the old benefit from a supportive and enabling environment. The plan emphasized on some key issues, which included availing universal and non-discriminatory access to health-care services for the old. This ensured appropriate services for seniors with HIV/AIDS, effective training of caregivers and health practitioners, provision of proper health services to the elderly with disabilities. In addition, it protected this group of people from abuse, neglect, and violence against the aged and providing moral support and care to the care providers (Sidorenko & Mikhailova, 2014).
Several benefits have been realized as a result of this representation of old people in the health policies and models of care. For instance, advocating for active aging and healthier life choices in early stages of life has severely reduced the incidences of disability among the elderly thus, alleviating the health and economic burden of long-term care and boosts the quality of life for the seniors. In addition, there has been a continuous decline in the mortality rates among the older people and the population of those aged 80 and above is on the rise. The life expectancy and lifespan has been expanded due to these programs and policies that have proved that people can be healthy and independent in old age and can contribute to their families and communities (Day, 2014). However, the longer life-expectancies are kicking in with negative consequences in that the prevalence of dementia among the old is on the rise, especially the Alzheimer’s disease. The dementia patients need constant help and care in basic daily activities and this creates a health and economic burden. Hence, the government should come up with programs that benefit the welfare of the aging population Waverijn, Heijmans & Groenewegen, 2016.
Social capital refers to the social connections or networks that promote coordination and cooperation, an important aspect in the achievement of positive social and economic outcomes. It is a collective resource and a feature of social groupings instead of individuals and it is as a result of shared experiences which cultivate trust and reciprocity. It has been linked and applied to the healthcare domain, social policy, and programs of the older people. Therefore, in order to improve the welfare of the aged population, proper programs should be formulated that favor the well-being of this population (Kawachi& Berkman, 2014).
 
For instance, in Minnesota, Vital Aging Network (VAN) is assisting the seniors in becoming agents of social change in their societies. The organization trains them in community organization and instills in them skills to evaluate what their communities require, gather resources and develop new programs. Some of the projects that have been initiated as a result of VAN include construction of walking paths for the aged, a moderate physical activity program to decrease the risk of falls among the older population and a program to befriend the isolated seniors in the neighborhoods. Such an initiative reduces the need for a nursing home for the seniors in such a community because physical activity together with high social capital and the commitment to caring for each other keeps the aged population healthier (Swift, Abrams, Lamont & Drury, 2017). However, there are limitations to such a neighborhood design of social connections whereby not all communities have a cohesive neighborhood that can allow for such an initiative. Many societies lack a public platform for meetings or opportunities for engagement in meaningful activities. High rates of crime are the other obstacle whereby social networking cannot prosper in an environment that does not have a welcoming place for such an initiative (Gilbert, Quinn, Goodman, Butler & Wallace, 2013).
 
Gated communities being privately managed residential organizations hold a wide appeal on social capital among older people when it comes to their health and social life. They are marked as centers of security, social connection, neighborliness, group participation, common values and a sense of belonging that aim at recreating social capital and cohesion. They offer health enhancement opportunities due to the common gathering spaces, sports such as clubhouses, golf courses and swimming pools, the low-traffic streets and opportunities for participating in community programs. Despite these advantages, gated communities draw away the younger and wealthier retirees, leaving behind the seniors and the poorer elderly population. The residents left behind are less likely to have resources to organize for basic amenities and services such as transportation, police or emergency responses, street lighting and cleaning of public parks(Portes, 2014).
In conclusion, aging should neither be considered a burden nor be seen as a factor that reduces the seniors’ ability to contribute to their communities. Appropriate policies and programs should not only create awareness of the requirements and determinants of active, successful and healthy aging but also implement their recommendations by providing the key resources and showcasing practical initiatives of health promotion of the aged.
 
References
Abdullah, B., &Wolbring, G. (2013). Analysis of Newspaper Coverage of active aging through the lens of the 2002 World Health Organization active ageing report: a policy framework and the 2010 Toronto charter for physical activity: a global call for action. International journal of environmental research and public health, 10(12), 6799-6819.
Bauman, A., Merom, D., Bull, F. C., Buchner, D. M., & Singh, M. A. F. (2016). Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence and interventions to promote “Active Aging”. The Gerontologist, 56(Supplementary 2), S268-S280.
Bousquet, J., Kuh, D., Bewick, M., Standberg, T., Farrell, J., Pengelly, R.,&Camuzat, T. (2015). Operational definition of Active and Healthy Ageing (AHA): A conceptual framework. The journal of nutrition, health & aging, 19(9), 955.
Day, C. L. (2014). What older Americans think: Interest groups and aging policy? Princeton University Press.
Gilbert, K. L., Quinn, S. C., Goodman, R. M., Butler, J., & Wallace, J. (2013). A meta-analysis of social capital and health: A case for needed research. Journal of health psychology, 18(11), 1385-1399.
Kawachi, I., & Berkman, L. F. (2014). Social capital, social cohesion, and health. Social epidemiology, 2, 290-319.
Renteln, A. D. (2013). International human rights: universalism versus relativism. Quid Pro Books.
Portes, A. (2014). Downsides of social capital. Proceedings of the National Academy of Sciences, 111(52), 18407-18408.
Renteln, A. D. (2013). International human rights: universalism versus relativism. Quid Pro Books.
Sidorenko, A. V., &Mikhailova, O. N. (2014). Implementation of the Madrid International Plan of Action on ageing in the CIS countries: The first 10 years. Advances in Gerontology, 4(3), 155-162.
Swift, H. J., Abrams, D., Lamont, R. A., & Drury, L. (2017). The Risks of Ageism Model: How Ageism and Negative Attitudes toward Age Can Be a Barrier to Active Aging. Social Issues and Policy Review, 11(1), 195-231.
Waverijn, G., Heijmans, M., &Groenewegen, P. P. (2016). Chronic illness self-management: a mechanism behind the relationship between neighborhood social capital and health? The European Journal of Public Health, ckw185.
World Health Organization. (2002). Active Ageing-A Policy Framework. A contribution of the World Health Organization to the Second United Nations World Assembly on Ageing. Madrid (ES): WHO.

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400837 Health And Socio Political Issues In Aged Care

400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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400837 Health And Socio Political Issues In Aged Care

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Question:
Discuss about the Active Ageing Policy Framework.
 
 
Answer:

Aging Health Policies
In its Active Ageing policy framework, the World Health Organization defines active aging as the optimization process of participation, security, and health in an attempt to enhance the quality of life as individuals grows old. Healthy aging is essential in that it enables the elderly to play an active role in society and enjoy independence and the high quality of life. The essay will critique the active aging model of the World Health Organization and the application of social capital in various social policies and programs.
According to the WHO, Active Ageing Policy Framework, involvement in moderate and frequent physical activity helps in delaying functional deterioration at old age. For instance, it reduces the onset of chronic diseases such as hypertension and diabetes. The policy suggests that regular activity could also greatly reduce the extent of the severity of disabilities among the aged which are associated with heart and chronic illnesses. The active aging policy reveals how living an active early life promotes independence at old age and the reduction of the risk of frequent falls among the elderly. Consequently, economic benefits will be realized because the medical costs for the active older people will be significantly lower (World Health Organization, 2002).
 
However, this policy framework only makes the considerable suggestions and does not provide the opportunities that could possibly encourage inactive people to become more active. The benefits of these physical activities heavily rely on affordability and accessibility. Funding systems that promote physical activities in a community can bring about several benefits such as improved health, cost saving and heightened social connection all which contributes to active aging (Abdullah, & Wolbring, 2013). In addition, the active aging model established the major determinants of active aging as health and social services, personal factors, behavioral factors, social factors, economic factors and the physical environment of an individual. The framework suggests that all these principal determinants and the interaction of the factors reflect upon the aging process of individuals and communities. The framework fails to attribute a cause of active aging to each of the determinants. The proposal brings out the need to evaluate how each of the active aging determinants influences old age in a multidimensional investigation. Therefore, in order to help the aging population, adequate funding on programs that benefit the aging population should be established (Farrell et al. 2015).
The World Health Organization has explored policies and factors that make the urban physical environment age-friendly. In its worldwide age-friendly cities project, the organization came up with strategies to make urban communities more age-friendly via community development, policy reforms, and through advocacy. Consequently, these strategies have improved the quality of life among the aging population living in urban centers (Bauman, Merom, Bull, Buchner, & Singh, 2016).
Representation of the aged in policy, laws, legislations, health, and social service delivery has been guided by international policy and legal frameworks particularly the WHO’s Active Ageing policy framework and the Political Declaration and Madrid International Plan of Action on Ageing. Each of the documents highlights the significance of health in old age and emphasizes on the potential for the contribution of the aged in society using their skills, wisdom, and experience. They outline a wide range of areas where maximization on active aging policies can enhance the contribution, autonomy, prolonged life expectancy, and independence of the aged. Therefore, adequate presentation of the old in health, legislation, and healthcare delivery is beneficial as it will enable the aging population receive the attention and care they deserve (World Health Organization, 2002).
 
In the last two decades, major attempts have been made in advancing the human rights of the old people in the International Human Rights Law. A couple of international treaties and instruments have been implemented referring to aging and the older people, preserving non-discrimination of older immigrants, older disabled persons, and older women. The human rights advocates for freedom from discrimination of the aged in matters pertaining to social security, health, sufficient living standards and their right to be free from abuse, violence or exploitation (Renteln, 2013).
The Madrid International Plan of Action on Ageing put forward some priorities for action, which were development of older individuals, advancing wellness and health into old age and making sure that the old benefit from a supportive and enabling environment. The plan emphasized on some key issues, which included availing universal and non-discriminatory access to health-care services for the old. This ensured appropriate services for seniors with HIV/AIDS, effective training of caregivers and health practitioners, provision of proper health services to the elderly with disabilities. In addition, it protected this group of people from abuse, neglect, and violence against the aged and providing moral support and care to the care providers (Sidorenko & Mikhailova, 2014).
Several benefits have been realized as a result of this representation of old people in the health policies and models of care. For instance, advocating for active aging and healthier life choices in early stages of life has severely reduced the incidences of disability among the elderly thus, alleviating the health and economic burden of long-term care and boosts the quality of life for the seniors. In addition, there has been a continuous decline in the mortality rates among the older people and the population of those aged 80 and above is on the rise. The life expectancy and lifespan has been expanded due to these programs and policies that have proved that people can be healthy and independent in old age and can contribute to their families and communities (Day, 2014). However, the longer life-expectancies are kicking in with negative consequences in that the prevalence of dementia among the old is on the rise, especially the Alzheimer’s disease. The dementia patients need constant help and care in basic daily activities and this creates a health and economic burden. Hence, the government should come up with programs that benefit the welfare of the aging population Waverijn, Heijmans & Groenewegen, 2016.
Social capital refers to the social connections or networks that promote coordination and cooperation, an important aspect in the achievement of positive social and economic outcomes. It is a collective resource and a feature of social groupings instead of individuals and it is as a result of shared experiences which cultivate trust and reciprocity. It has been linked and applied to the healthcare domain, social policy, and programs of the older people. Therefore, in order to improve the welfare of the aged population, proper programs should be formulated that favor the well-being of this population (Kawachi& Berkman, 2014).
 
For instance, in Minnesota, Vital Aging Network (VAN) is assisting the seniors in becoming agents of social change in their societies. The organization trains them in community organization and instills in them skills to evaluate what their communities require, gather resources and develop new programs. Some of the projects that have been initiated as a result of VAN include construction of walking paths for the aged, a moderate physical activity program to decrease the risk of falls among the older population and a program to befriend the isolated seniors in the neighborhoods. Such an initiative reduces the need for a nursing home for the seniors in such a community because physical activity together with high social capital and the commitment to caring for each other keeps the aged population healthier (Swift, Abrams, Lamont & Drury, 2017). However, there are limitations to such a neighborhood design of social connections whereby not all communities have a cohesive neighborhood that can allow for such an initiative. Many societies lack a public platform for meetings or opportunities for engagement in meaningful activities. High rates of crime are the other obstacle whereby social networking cannot prosper in an environment that does not have a welcoming place for such an initiative (Gilbert, Quinn, Goodman, Butler & Wallace, 2013).
 
Gated communities being privately managed residential organizations hold a wide appeal on social capital among older people when it comes to their health and social life. They are marked as centers of security, social connection, neighborliness, group participation, common values and a sense of belonging that aim at recreating social capital and cohesion. They offer health enhancement opportunities due to the common gathering spaces, sports such as clubhouses, golf courses and swimming pools, the low-traffic streets and opportunities for participating in community programs. Despite these advantages, gated communities draw away the younger and wealthier retirees, leaving behind the seniors and the poorer elderly population. The residents left behind are less likely to have resources to organize for basic amenities and services such as transportation, police or emergency responses, street lighting and cleaning of public parks(Portes, 2014).
In conclusion, aging should neither be considered a burden nor be seen as a factor that reduces the seniors’ ability to contribute to their communities. Appropriate policies and programs should not only create awareness of the requirements and determinants of active, successful and healthy aging but also implement their recommendations by providing the key resources and showcasing practical initiatives of health promotion of the aged.
 
References
Abdullah, B., &Wolbring, G. (2013). Analysis of Newspaper Coverage of active aging through the lens of the 2002 World Health Organization active ageing report: a policy framework and the 2010 Toronto charter for physical activity: a global call for action. International journal of environmental research and public health, 10(12), 6799-6819.
Bauman, A., Merom, D., Bull, F. C., Buchner, D. M., & Singh, M. A. F. (2016). Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence and interventions to promote “Active Aging”. The Gerontologist, 56(Supplementary 2), S268-S280.
Bousquet, J., Kuh, D., Bewick, M., Standberg, T., Farrell, J., Pengelly, R.,&Camuzat, T. (2015). Operational definition of Active and Healthy Ageing (AHA): A conceptual framework. The journal of nutrition, health & aging, 19(9), 955.
Day, C. L. (2014). What older Americans think: Interest groups and aging policy? Princeton University Press.
Gilbert, K. L., Quinn, S. C., Goodman, R. M., Butler, J., & Wallace, J. (2013). A meta-analysis of social capital and health: A case for needed research. Journal of health psychology, 18(11), 1385-1399.
Kawachi, I., & Berkman, L. F. (2014). Social capital, social cohesion, and health. Social epidemiology, 2, 290-319.
Renteln, A. D. (2013). International human rights: universalism versus relativism. Quid Pro Books.
Portes, A. (2014). Downsides of social capital. Proceedings of the National Academy of Sciences, 111(52), 18407-18408.
Renteln, A. D. (2013). International human rights: universalism versus relativism. Quid Pro Books.
Sidorenko, A. V., &Mikhailova, O. N. (2014). Implementation of the Madrid International Plan of Action on ageing in the CIS countries: The first 10 years. Advances in Gerontology, 4(3), 155-162.
Swift, H. J., Abrams, D., Lamont, R. A., & Drury, L. (2017). The Risks of Ageism Model: How Ageism and Negative Attitudes toward Age Can Be a Barrier to Active Aging. Social Issues and Policy Review, 11(1), 195-231.
Waverijn, G., Heijmans, M., &Groenewegen, P. P. (2016). Chronic illness self-management: a mechanism behind the relationship between neighborhood social capital and health? The European Journal of Public Health, ckw185.
World Health Organization. (2002). Active Ageing-A Policy Framework. A contribution of the World Health Organization to the Second United Nations World Assembly on Ageing. Madrid (ES): WHO.

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Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) is the spectrum of medical conditions caused due to human immunodeficiency virus (HIV) following which the patient suffers from a series medical complications due to suppression of the immune system of the body. With the progression of the disease, the patient is likely to suffer from a wide range of infections like tuberculosis and other opportu…
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Introduction
Leadership in the hospital is the ability to influence the staff toward providing quality health care. Leadership involves influencing human behavior to create a positive working environment (Langlois, 2012). Good leadership enables healthy relationships among staffs in the hospital enhancing quality delivery of health care services. Leadership is responsible to building teams that have trust, respect, support and effecti…
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BL9412 Public Health
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Course Code: BL9412
University: University Of The West Of England

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Country: United Kingdom

Answer:
Introduction
According to the researchers, it can be said that the management of the health care organizations has become a difficult task nowadays and the reason behind this is the occurrence of various issues in this sector (Hall et al., 2014). Therefore, the administrative employees of the organization should incorporate various revolutionized strategies for enriching the worth of care provided by the hospital to its clients and re…
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Australia Ryde Management Information system strategy University of New South Wales (UNSW) Masters in Business Administration 

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