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McMaughan DJD, Halphen JM, Velky P, Burnett J, Drake SA. Victimization in Unethical Unlicensed Small Residential Care Homes in the United States: The Case for Whole System Disruption. J Aging Soc Policy 2024; 36:87-103. [PMID: 36975036 DOI: 10.1080/08959420.2023.2195788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/10/2022] [Indexed: 03/29/2023]
Abstract
In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams.
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Affiliation(s)
- Darcy Jones Dj McMaughan
- College of Education and Human Sciences, School of Community Health Science, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - John M Halphen
- (UTHealth), Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | | | - Jason Burnett
- (UTHealth), Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Stacy A Drake
- College of Nursing, Texas A&M University, Houston, Texas, USA
- Stacy Drake Consulting, LLC, USA
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Lively CLP. Medical-Legal Partnerships and Prevention: Caring for Unrepresented Patients Through Early Identification and Intervention. HEC Forum 2023:10.1007/s10730-023-09518-x. [PMID: 38141153 DOI: 10.1007/s10730-023-09518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
Caring for unrepresented patients encompasses legal, ethical, and moral challenges regarding decision-making, consent, the patient's values, wishes, best interest, and the healthcare team's professional integrity and autonomy. In this article, I consider the impact of the aging population and the effects of the social determinants of health and suggest that without preventive intervention, the number of unrepresented patients will continue to increase. The health, social, and legal risk factors for becoming unrepresented require a multidisciplinary response. Medical-Legal Partnerships (MLPs) bring healthcare and legal professionals together to address risk factors and health-harming legal needs. The article discusses the role of MLPs in identifying at-risk individuals, providing preventive interventions, and providing support. I make recommendations and conclude that proactive MLPs offer a sustainable approach to the ethical challenges in caring for unrepresented patients by providing interventions to prevent individuals from becoming unrepresented.
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Affiliation(s)
- Cathy L Purvis Lively
- The University of Miami Institute for Bioethics and Health Policy, Miami, Florida, US.
- Associate in Professional Studies in the Bioethics Program, Columbia University, NY, Florida, US.
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Moye J, Cohen AB, Stolzmann K, Auguste EJ, Catlin CC, Sager ZS, Weiskittle RE, Woolverton CB, Connors HL, Sullivan JL. Guardianship Before and Following Hospitalization. HEC Forum 2023; 35:271-292. [PMID: 35072897 PMCID: PMC10281591 DOI: 10.1007/s10730-022-09469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p < .001). Length of stay was lower following guardianship appointment (11.65, SD = 12.02, t = 15.16, p < .001); while higher than the comparison group (M = 7.60, SD = 8.46), differences were not associated with guardianship status. In a separate analysis involving 35 individuals who were hospitalized both prior to and following guardianship, length of stay was longer in the year prior (M = 23.00, SD = 37.55) versus after guardianship (M = 10.37, SD = 10.89, F = 4.35, p = .045). In qualitative analyses, four themes associated with lengths of stay exceeding 45 days prior to guardianship appointment were: administrative issues, family conflict, neuropsychiatric comorbidity, and medical complications. Our results suggest that persons who are admitted to hospitals, and subsequently require a guardian, experience extended lengths of stay for multiple complex reasons. Once a guardian has been appointed, however, differences in hospital lengths of stay between patients with and without guardians are reduced.
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Affiliation(s)
- Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA.
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Andrew B Cohen
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kelly Stolzmann
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Elizabeth J Auguste
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
| | - Casey C Catlin
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Boston VA Research Institute, Inc., Boston, MA, USA
| | - Zachary S Sager
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel E Weiskittle
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cindy B Woolverton
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Jennifer L Sullivan
- VA Boston Healthcare System, 150 South Huntington, Jamaica Plain, MA, 02130, USA
- Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Serdenes R, Arana F, Karasin J, Kontos N, Musselman M. Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion. Gen Hosp Psychiatry 2023; 83:75-80. [PMID: 37119781 PMCID: PMC10121076 DOI: 10.1016/j.genhosppsych.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/20/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE COVID-19 conspiracy theories have become widespread since the onset of the pandemic and compound the existing challenges of decisional capacity assessment. This paper aims to review the literature pertaining to decisional capacity assessment in the context of COVID-19 conspiracy beliefs and synthesize a practical approach with an emphasis on differential diagnosis and clinical pearls for the practicing physician. METHODS We reviewed papers on decisional capacity assessment and differential diagnosis in the context of COVID-19 conspiracy beliefs. A literature search was conducted using the US National Library of Medicine's PubMed.gov resource and Google Scholar. RESULTS The resulting article content was utilized to synthesize a practical approach to decisional capacity assessment in the context of COVID-19 conspiracy beliefs. Specifically, aspects related to the history, taxonomy, evaluation, and management are reviewed. CONCLUSIONS Appreciating the nuanced differences between delusions, overvalued ideas, and obsessions while with integrating the non-cognitive domains of capacity into the assessment are crucial to navigating the wide differential diagnosis of COVID-19 conspiracy beliefs. It is important to attempt to clarify and optimize patient decision-making abilities by addressing circumstances, attitudes, and cognitive styles specific to patients with seemingly irrational beliefs about COVID-19.
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Affiliation(s)
- Ryan Serdenes
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
| | - Francesca Arana
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Jamie Karasin
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Meghan Musselman
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
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Jackman M, McDermott F, Sadler J, El Hage N, Lee H. Guardianship patient characteristics and outcomes in geriatric social work practice: Australian context. SOCIAL WORK IN HEALTH CARE 2021; 60:614-630. [PMID: 34698618 DOI: 10.1080/00981389.2021.1990189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
This study explored the patient characteristics and outcomes in relation to guardianship in a large-scale sub-acute Australian hospital. Fifteen patients who appointed a guardian at The Kingston Center, Monash Health, participated through exploratory data collection and analysis utilizing a de-identifiable template. The findings revealed both diverse and complex patient characteristics, and ethical dilemmas in patient outcomes for social workers. Patient outcomes post-guardianship appointment and discharge highlighted a negative impact from long length of stay and the iatrogenic impact on patient wellbeing in hospital. The study reflected a disparity between patients' discharge goals and their outcomes indicating significant ethical dilemmas and complexities for social workers in ensuring rights to autonomy and responsibility for safety are balanced.
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Affiliation(s)
- Matthew Jackman
- Monash University, Department of Social Work,Caulfield East, Victoria, Australia
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