Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition PDF

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett  Chapter 24 Economic and Legal Issues  Learning Objectives (1 of 2) Upon completion of this c...

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett  Chapter 24 Economic and Legal Issues  Learning Objectives (1 of 2) Upon completion of this chapter, the reader will be able to: Explain the reasons for the differences among Canadian provinces and territories in health insurance for out-of-hospital health care services. Describe the financing of the Canadian health care system. Compare the Old Age Security program, the Canada Pension Plan, and the Quebec Pension Plan. 1-3  Learning Objectives (2 of 2) Upon completion of this chapter, the reader will be able to: Compare and discuss the roles of a power of attorney and a guardian. Explain the process of assessing mental capacity. Detect and assess elder abuse. Describe strategies for preventing and detecting the abuse of older adults. 1-4  The Canada Health Act (1 of 2) The Canada Health Act of 1984 is an amalgamation of previous federal legislation. It sets out the national health insurance plan as well as federal, provincial, and territorial roles in the health care system. Health care is administered and delivered by the provinces and territories. 24-2  The Canada Health Act (2 of 2) Under the Canada Health Act, medically necessary services are publicly insured, including primary health care, care in hospitals, and surgical–dental services. The responsibilities of the federal government include the following: Setting and administering national principles for the health care system through the Canada Health Act Collaborating with provinces and territories on national health policies Contributing to funding of health care services through transfer payments to the provinces and territories There is provincial and territorial variability in provision of some services, such as home care, long-term care (LTC), medications outside of hospital, physiotherapy, optometry services, and others. 24-3  Health Care Financing Total health care spending in Canada in 2019 was about $265.5 billion. Government spending consistently accounts for about 70% of total health care spending, while private-sector spending (private insurance and out-of-pocket expenses) accounts for 30% of spending. Health care spending for older adults aged 65 years or older was $11,599 per capita, the second highest age group after infants younger than one years old ($12,678) Historically, increased use of services by older adults in poor health accounted for small portions of the increased health care expenditures for the entire population of older adults. 24-4  Social Security Retirement Income Programs (1 of 4) Old Age Security (OAS) Program The OAS program is an income support program for older Canadians. It includes the OAS pension, the Guaranteed Income Supplement (GIS), the Allowance, and the Allowance for the Survivor. It is federally financed through general tax revenues. A monthly payment available to Canadian citizens and legal residents, aged 65 years and older, who have lived in Canada for at least 10 years after the age of 18. In 201721 the maximum monthly OAS pension benefit was $615.37. OAS is indexed and is considered taxable income. 24-5  Social Security Retirement Income Programs (2 of 4) Guaranteed Income Supplement (GIS) A monthly benefit for OAS recipients who have little or no other; sometimes referred to as “the supplement” The amount of the benefit depends on amount of other income, marital status, and whether or not the spouse is receiving the OAS or GIS. In 2021, the maximum monthly benefit for a single person was $919.12, and $553.28 for a spouse of someone who receives the OAS or GIS. GIS is also indexed to the cost of living. 24-6  Social Security Retirement Income Programs (3 of 4) Allowance and Allowance for the Survivor The Allowance for the Survivor is paid to the survivor (widow or widower) of an OAS pensioner. It is an income-tested benefit based on the combined yearly income of a couple or the survivor. Persons between ages 60 and 64 years who meet Canadian citizenship and residency requirements are eligible to apply and must reapply annually. Maximum monthly benefit in 2021 was $1168.65 (Allowance) and $1393.05 (Allowance for the Survivor); not taxable income and are indexed to the cost of living. 24-7  Social Security Retirement Income Programs (4 of 4) Canada Pension Plan (CPP) and Quebec Pension Plan (QPP) Provide retirement pensions and disability benefits for persons who made contributions to these plans Older adults are eligible to receive the CPP or QPP retirement pension if they contributed to one of the plans, and are at least 65 years old or are between 60 and 64 years old and meet additional requirements. Maximum monthly income in 2021 was $1203.75 and is indexed to the cost of living. Survivor benefits include the CPP death benefit, the CPP survivor’s pension, and the CPP children’s benefit. 24-8  Implications for Gerontological Nursing and Healthy Aging OAS programs and the CPP/QPP are designed to ensure that older Canadians do not live in poverty. The health care services that older adults need are not always equally available across the country. Access may depend on older adults’ income or where they live. One of the most common measures of poverty in Canada is the low- income cut-off (LICO). Nurses’ assessments should include information about total income, all sources of income, and the person’s knowledge about the process of applying for OAS and CPP/QPP benefits. Gerontological nurses can promote age-friendly attitudes and combat ageism by being knowledgeable about the financing of both the health care system and the pension system. 24-9  Health Care and Services for Veterans The federal government, through Veterans Affairs Canada, provides treatment and other health-related benefits and services to veterans, and to civilians who served in wartime. Disability pensions War veterans allowance Home care services LTC, treatment benefits Counselling Personalized care planning Medical needs assessment Advice Information and referral Legal help with pension or allowance matters, and help with the cost of funerals and burials 24-10  Implications for Gerontological Nursing and Healthy Aging Gerontological nurses need to be aware of the services and support available for veterans. Assessments of older adults should include questions about military service or civilian service during wartime. 24-11  Legal Issues in Gerontological Nursing (1 of 2) Legal Capacity: A person’s ability to make decisions It is a legal construct, not a clinical condition. In general, to be deemed capable of making a decision, the person must be able to understand information that is relevant to making a decision, evaluate data, and appreciate the consequences of the decision or of not making a decision. People are presumed to have capacity unless there is clear evidence to the contrary and the person has been legally deemed incapable. Applies to different kinds of decisions, including financial decisions, decisions about daily activities, housing, and personal care, as well as medical and health-related decisions, including consent to treatments and procedures. 24-12  Legal Issues in Gerontological Nursing (2 of 2) Legal Capacity (cont’d) Capacity exists on a continuum and is issue- or task-specific. Mental capacity is assessed by different people, depending on the kind of decision being made. Power of Attorney: a legal document and legal device in which one person designates another person (e.g., family member, friend, etc.) to act on their behalf It can be either continuing or enduring. Non-continuing (appointed for a limited time, such as when the person is out of the country) Guardians May have responsibility for finances and property, personal care, or both Appointment is made at a court hearing in which someone provides evidence of the incapacity of the person, who often is not present 24-13 Abuse, Mistreatment, and Neglect of Older Adults (1 of 2) Elder abuse is any action by someone in a relationship of trust that results in harm or distress to an older person. Elder Abuse is found in all socioeconomic, racial, and ethnic groups in Canada. Neglect is a lack of action by that person in a relationship of trust with the same result. Types of elder abuse Physical abuse Psychological or emotional abuse Sexual abuse and exploitation Economic or financial abuse Spiritual abuse 24-14 Abuse, Mistreatment, and Neglect of Older Adults (2 of 2) Most common types of abuse are emotional abuse and financial abuse. Estimates of abuse range from 5% to 10%, but this is probably low due to reluctance to report and people who are vulnerable are less likely to participate in surveys about elder abuse. See Table 24-2: Risk Factors for Abuse and Neglect 24-15  Institutional Abuse Involves inadequate care and nutrition; low standards of nursing care; inappropriate and aggressive staff– patient interactions; or substandard, overcrowded, or unsanitary living environments Risk factors include the environment and organizational culture; staff characteristics; resident characteristics Two types: Resident–Resident abuse and Resident–Resident Abuse/Aggression is estimated to occur in 1%–41%. Reported sexual abuse is more likely to be from another resident than a staff member. Residents with one or more of the following characteristics are at a higher risk of resident–resident abuse: female; cognitive impairment; wandering behaviour; and limited mobility. Staff–Resident Abuse 24-16  Signs of Elder Abuse Fear, anxiety, depression, or passiveness in relation to a family member, friend, or care provider Unexplained physical injuries Dehydration, poor nutrition, or poor hygiene Improper use of medication Confusion about new legal documents, such as a new will or a new mortgage Sudden drop in cash flow or financial holdings Reluctance to speak about the situation 24-17  Implications for Gerontological Nursing and Healthy Aging (1 of 2) Assessment Nurses must be vigilant in their sensitivity to the potential for abuse, observing for signs and symptoms in all their interactions with vulnerable elders. If abuse is suspected, a full assessment should be done, including a determination of the safety of the victim and the desires of the victim if competent. See Box 24-3: Questions to Ask When Assessing Suspected Abuse 24-18  Implications for Gerontological Nursing and Healthy Aging (2 of 2) Intervention Stop mistreatment and neglect of older adults. Provide care and treatment for the consequences of abuse. Protect the victim and society from inappropriate and illegal acts. Hold abusers accountable. Rehabilitate the offender. Order restitution of property and payment for expenses incurred as a result of the abuser’s conduct. 24-19  Prevention of Abuse Gerontological nurses should be alert to a situation of risk for mistreatment of vulnerable elders and take steps to prevent the occurrence of abuse or neglect. Make sure that the potential victims know how to get help if it is needed. Provide support and encouragement that it is possible to leave the situation, if this is necessary. 24-20  Criminal Code and Reporting Provincial and territorial laws may require reporting to police when there is evidence of abuse of a person who is incapable of seeking assistance. Most provinces and territories have mandatory reporting of suspected abuse or neglect of residents in LTC homes and assisted living facilities. 24-21