Determining Eligibility for Hospice Patients
In the field of medicine, it is possible to determine the duration of one’s life, especially if they are suffering from terminal illnesses such as cancer. The patients are referred to a hospice facility where they get the best care in their last days of their lives. Due to the limited resources, it is not possible to accommodate all the terminally ill patients in a hospice facility. The medical regulations on the hospice care requires that only the patients who have not more than six months can be admitted into the facilities (Schonwetter et.al, 2003). Although the patients in the hospice cannot have their diseases cured, the aim of the physicians is to provide the best medical care for them. It is the physician’s duty to ensure that the patients get not only medical care but also that their social, psychological, and spiritual needs catered. In providing this care to the patients, the physician must be sensitive to their religious, personal, and cultural values. There are various parties that provide care for the patients in hospice including the nurses, family members, volunteers, social workers, and doctors. For one to be qualified for an admission in the facility, a medical doctor must certify that they are terminally ill. The patients can only be admitted in the hospice after the factors such as the Medicare have been considered to avoid a situation where the patients lack adequate funds to cater for their hospital bills (Pyenson, Connor & Kinzbrunner, 2004). The patients do not have to be hospitalized to access the hospice services but they can receive the care from their homes.
Prior to being assigned their professional duties, the physicians are taught about the ethical standards that they should uphold in their duties. It is unprofessional for medical personnel such as nurses to act in ways that contradict the ethical standards in the field of medicine. One of the major goals of the ethical code in the medical field is the definition of the relationship between the patients and the physicians. The ethical standards present a framework that allows the physicians to carry out their work professionally for the satisfaction of the patient needs (Lynn, 2001). The ethical standards also require the physicians to observe the policies of the medical facilities where they work. At times, the physicians may find themselves in ethical dilemmas as they try to meet the ethical standards. The pressure that the physicians may face from the senior personnel in the facilities may force them to do activities that may be against the ethical code. The need to obey the authorities and maintaining high ethical standards lead to ethical dilemma in medicine. This paper examines the ethical dilemma likely to be faced by nurses with regard to eligibility of the patients to hospice facilities.
Some patients prefer receiving the hospice care from their homes where they can be with their family all the time. The families may also prefer the patients being at home so that they provide them with the best care in their last days of their lives. The cost of receiving the hospice care at home may also be cheaper than in the hospitals thus making it economical to have the patients at home. However, there are other situations where the patients prefer dying away from their homes for the feeling that they would be a bother to their families due to the high dependency resulting from the illnesses (Lynn, 2001). The families may also prefer to have the patients in the hospice facilities for fear that they would not be able to accord them the attention they deserve. Further, it is easier for the nurses and other medical professionals to help the patients in managing their pain when they are hospitalized than when they are at home. One of the reasons the patients seek services of the hospice is to be helped in managing their challenges emotionally, physically and psychologically.
Beneficence is one of the principles that guide the ethical practices in medicine. It requires that the persons providing health care to the patients must put the interests of the patients first. In the case of eligibility of the patients to a hospice facility, one may argue that the nurse is supposed to admit the patient first regardless of the implications of their actions on Medicare. The patient may be experiencing a lot of pain that can only be solved by their admission to the facility. In addition, the patient may be in need of the other care services provided by the facilities such as counseling. Guided by the beneficence principle, the nurse ought to admit the patient. The other guiding principle used is non-malfeasance that dictates that the physicians should not do any action that can harm the patients. By admitting the patient into the hospice, the nurses would have done, no action to harm the patient rather their actions would have been purely to enhance their welfare. However, the admission of the patient in the hospice facility should only be done if they have met the necessary conditions. One of these conditions is that the patients must be terminally ill. The patients can only be admitted if their life expectancy is below six months. The hospice staff must ensure that there is a medical report by the doctor indicating the expected life expectancy and the illnesses they are suffering from.
Admitting a patient who is not eligible to be in the hospice facility is a violation of the ethical principles in medicine and it is also a criminal offence. The ethical principle of justice requires the medical staff to use the scarce resources of a medical facility efficiently so that they are able to serve a maximum number of patients. Admitting the patient who is not qualified implies that they will spend more time in the facility than the normal six months. Although the welfare of the patients is considered in a situation like this, it undermines the welfare of the other patients who are qualified ad may be in more need of the facility. The patient would have to use more financial resources in the form of Medicare in the facility as they are likely to spend more time there. This is inefficient usage of the limited resources and it is against the principle of justice. In a similar case involving the federal government and AseraCare Inc., the company was accused of defrauding the government of the Medicare fund through admission of patients who stayed longer in the facilities (Stevenson et. al, 2015). In its defense, the hospice claimed that the patents took longer in the facility due to inaccuracy of their prognosis but it was identified that the staff was not strict on the eligibility criteria. The actions by the hospice were against the False Claims Act that forbids individuals and institutions to defraud the government in any way (Krause, 2002).
Applying the ethical-legal reasoning model, it is important to consider the legal implications of admitting the patient to the facility (Rizzo, 2005). It is illegal to have the unqualified patient in the facility thus the hospice staff ought to desist from the action. One of the recommendations that the hospice staff should take in solving the case is sticking to the ethical principles so as to avoid committing a crime. The other way the nurse can help the situation is to link the patient’s family with hospice care facilities that can offer the services to the patient from home. It is also highly recommendable for the nurses to explain to the patient and the family that they cannot be admitted to the facility due to eligibility reasons.
It is unprofessional to admit patients into the hospice facilities if they are not qualified because this denies the qualified patients a chance to use the facilities. One of the key qualifications is that the patient must be in the facility for only six months or less before they die. However, this does not imply that the patients should be sent out of the facility if they live longer. The evaluation of their medical conditions should indicate the number of days that they are expected to live but this report is not always accurate. At times some patients take longer to fight for their lives due to the nature of their bodies. However, if there was an error in the prognosis, it is likely that the physicians at the hospice facilities will notice. This is because the medical status of the patients is checked in two phases, that is, after every 90 days. This is meant to ensure that the medical condition of the patients is accurate and that they are qualified to be in the facility. In some cases, the hospice may put their providers in dilemma by requiring that they admit unqualified persons. In such a case, the physicians may even go to jail for acting in an unprofessional manner.
The qualification of the patients is not only based on their life expectancy. For one to be rightfully admitted in the facility they must be suffering from a terminal illness. Admitting patients who do not meet this qualification is against the professional ethics that regulate the medical field. At times the nurses are pressured to admit these patients even if they know that it is not right. They may be threatened to do so by the senior officials at the hospice and the fear of losing their jobs may lead them to committing the crime. The senior official in the facility may even influence the results of the medical check-up done after the 90 days so that the results show that the patients are terminally ill. This is unethical and the nurses should not be part of the crimes no matter the pressure put on them.
For the patients to benefit from the Medicare fund, they must have the Part A of the cover. This allows the patients to receive the health care insurance cover for a period of more than six months, should they live longer than the expected period. The patients are covered for 90 days for two periods and the rest are 60 days terms until the day they die (Gardner et.al, 2013). Admitting a patient who does not met the qualifications therefore implies that they use more Medicare funds than the qualified ones. The patients who are not qualified are likely to stay in the hospice facility longer.
To ensure that the right guideline and legal requirements are followed, it is important for the health care providers to ensure that the employees understand the rules completely. It is also important for the management to make a regular survey to ensure that only the qualified patients access the facilities. Before the patients can be admitted, the hospice should require them to provide a letter of election so that they file a notice with the Medicare contractors. This ensures that the process of admitting the patients is transparent thus avoiding a situation where the nurses may be pressurized to admit an illegible patient. Prior to submitting a claim to the health insurer, the hospice must ensure that it obtains a written certification from the patient and this should be reserved in the patient’s file. The other clinical information relating to the patient’s condition must also be kept in the same file. This ensures that there are no loopholes in the admission procedure so s to enhance accountability. In cases where recertification is required, the nurses must have a face to face encounter with the patient to assess their condition. This is meant to ensure that the patient is qualified for the services they get from the hospice. In case the hospice services rendered to a patient are terminated, it is the duty of the hospice facility to notify the health insurer so that the financial aid is stopped. This enhances the medical ethics in the facility and it allows the other patients to benefit from the services.
At times the nurses may be able to get away with the offence of admitting an unqualified patient. However, the financial distress that they may suffer makes it insensible to admit unqualified persons. The nurses know the ethical standards that should be observed in their line of duty and the deviation from these standards causes emotional problems that have adverse impacts on their lives (Chambers & Neumann, 2011). The nurses experience a lot of psychological pain when they know the right thing to do but cannot do it at the prevailing circumstances. This is the situation that they face when they are asked to admit unqualified patients to hospice facilities. Research has proven that the nurses who observe high ethical standards are less likely to experience psychological distress associated with unethical behavior. At times the nurses try to advocate for the patients by filing complaints to the administration but this does not always have positive results. The frustration that the nurses get in trying to find solutions to the ethical dilemmas that face them is among the leading causes of moral distress.
Admitting a patient who is not qualified in a hospice may make the nurses feel unable to meet their main objective of making the patients comfortable. Due to the limited resources in the economy, admitting a patient who is not qualified implies that there are other needy patients who may not get accommodation in the facility. This makes the nurses feel depressed because their main goal is to enhance the patients’ quality of life. On the one hand, the failure to attend to a patient is unethical but on the other hand, admitting the admission of a patient must follow the appropriate guidelines (Stone & Hoffman, 2010). In situations where the nurses are pressurized to admit unqualified patients the families may not be ready to accept the truth in cases where the nurse is opposed to the action. The families may have been given hopes of having their patient admitted in the facility only for the nurses to refuse. Explaining to such a family that the patient cannot be admitted into the facility may distress the nurse. Moral distress may lead to the loss of key talent and skills as the nurses leave the profession for other jobs. It is therefore important that the medical professionals learn the need to have moral courage. To cope with the moral distress, it is crucial for the nurses to take a course in ethics so as to be in a position to handle the dilemmas that face them professionally.
Conclusively, while it is important to consider the welfare of the patient in line with the beneficence principle, it is also crucial to respect the law that guides the actions in the hospice facilities. It is not possible to admit all the terminally ill patients into the facilities due to the scarcity of resources. It is therefore important for the hospice staff to ensure that only the qualified patients benefit from their services. The government needs to be stricter in implementing the False Claims Act so as to ensure that only the qualified persons access the facilities so that the Medicare funds can serve the right purpose.
It is important for the medical learning institutions to emphasize on teaching the medical personnel about ethics at the workplace as a way of reducing moral distress. The nurses should avoid violating the ethical standards so that they are not subjected to moral distress that may cause serious psychological problems to them. There is a need for the hospice institutions to ensure that the eligibility criterion is strictly followed prior to admitting the patients into the facilities. There should be fairness in accessibility of the medical insurance and the hospice facilities. The facilities should ensure that only the qualified patients access the funds by following the guidelines and legal framework put in place to govern the hospice care. Admitting the patients who do not meet the qualifications is similar to defrauding the government since they spend the medical fund that would otherwise be used for other needy patients who are qualified. Defrauding the government is a criminal offence as it is a violation of the law and the offenders ought to face the law. The government should thus be keen on ensuring that all the needy patients access the fund. Carrying out impromptu check-ups on the eligibility of the patients admitted in the facilities is a sure way of enhancing transparency and professionalism in the medical field.
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