ETHICAL AND POLICIES FACTORS IN CARE COORDINATION In administering care to elderly patients in nursing homes, several ethical considerations and policies directly affect the conduct of nurses. Worth noting is that the healthcare system has come under much criticism and faces challenges caused by ethical and policy issues. Also, healthcare reforms have been implemented to promote care coordination and improve the quality of care patients receive. As patients and the community take the central position in care administration, it becomes increasingly crucial for staff working in nursing homes to be cognizant of codes of ethics and the government policy (particularly the Affordable Care Act) affecting their work. We acknowledge that ethics is an integral part of the nursing foundation, considering our distinguished history of concern for the welfare of the sick and vulnerable in society. The American Nurses Association (ANA) developed codes of ethics for nurses working in all healthcare facilities (nursing homes included). These codes of ethics that nurses must adhere to guide them in their relation with different patients. As far as coordinated care is concerned, the primacy of the patient’s interests under the current healthcare system is not debatable. According to the National Institute of Health, a nursing home is set like a hospital, with medical staff available around the clock to provide medical care and physical, speech, and occupational therapy (NIS, 2021). As the word suggests, nursing homes are considered homes for anyone who requires 24-hour care, not necessarily the elderly. Therefore, it is mandatory to understand the basic rules governing a nursing home while running its operations per federal regulations. The several government policies that directly influence the coordination of care include the Affordable Care Act (ACA), MEDICAID, and the 1996 Health Insurance Portability and Accountability Act (HIPAA). The HIPAA establishes the national standards for safeguarding the health information of patients, which bars healthcare providers from sharing patients’ health ETHICAL AND POLICIES FACTORS IN CARE COORDINATION information without their consent (CDC, 2018). This policy directly affects how nurses in a nursing home handle patients’ health details. We may view the policy as a constraint to care coordination because, under coordinated care, information sharing for the betterment of patients’ health is critical. Besides, medical staff at the nursing home need to share their patients’ health information with other medics outside the premise when seeking proper intervening methods. The second policy with a significant impact on care coordination is the Affordable Care (ACA)policy. A glance at the status quo of access to healthcare since 2010 will inform you that the ACA policy is the most effective policy the government implemented to promote care coordination. This comprehensive health policy enacted in 2010 emphasizes three main goals; to reduce insurance costs and make it available to many U.S. citizens regardless of their economic status. affordable health insurance is available to more people. The policy makes healthcare affordable to patients by providing consumers with subsidies (“premium tax credits”), which reduce costs for households with incomes between 100% and 400% of the federal poverty level (HealthCare.gov, n.d.). The second goal of ACA is to enlargen the Medicaid program to cover all adults whose income is under 138% of the Federal Poverty Level (FPL). With this law, the number of patients needing 24-hour care at nursing homes has tremendously grown. The last aim of the policy was to support innovative medical care delivery methods designed to lower the costs of health care generally (HealthCare.gov, n.p). The ACA policy triggered Medicare and Medicaid reforms, which increasingly encouraged success in our healthcare system. All these reforms and policies, as we have observed, focus on prioritizing patients’ safety through quality care and improves nurses’ practice. However, despite the praises to the health, these policies have presented ethical dilemmas to nurses, which some of you may have experienced while providing coordinated care. As caregivers of nursing homes, you play a ETHICAL AND POLICIES FACTORS IN CARE COORDINATION significant role in helping patients navigate the healthcare system to have better outcomes and experiences. However, as government policies emerge and keep changing, they pose a challenge to you in coordinating care and the continuum of care in nursing homes. The primary challenge you may have encountered is when dealing with the Health Insurance Portability and Accountability Act (HIPAA), which, as I mentioned earlier, requires you to ensure patients’ health information is safe and not shared without their consent. You often find yourself having a difficult time ensuring patients’ data is protected. Agents from the HIPAA conduct inspections in most nursing homes and often report non-compliance regarding patients’ health information safety. The challenge elevates when you know that you are responsible for ensuring the patient under your care gets proper treatment as a healthcare provider. In the process, you share the patient’s information with another healthcare provider to help get necessary care, which ethically threatens the safety of the patient’s privacy. In line with the HIPAA, the Affordable Care Act assumes that almost every American citizen accesses health services in all care facilities. You often encounter patients within your nursing home who need 24-hour care but do not afford to pay for the services. Admittedly, many poor Americans can barely access proper health services because they are uninsured despite the coverage expansions under the ACA policy that has been around for a decade (Collins Saylor, 2018). Even Americans with private insurance covers have found it challenging to fund them due to increasing premiums and the associated cost-sharing that undermined wage gains while driving many households into debt and even bankruptcy. Despite these insurance issues, the number of patients visiting your facilities keeps increasing while you are understaffed. For instance, the Medicare program has also increased the number of patients visiting nursing homes, even as the costs increase, posing an ethical challenge for the healthcare provider. ETHICAL AND POLICIES FACTORS IN CARE COORDINATION Nurses are at the frontline of healthcare giving, armed with professional skills to assess the social determinants of health and health disparities in our care system. We acknowledge that social and socio-economic factors influence access to health services in our country. Healthy People 2020 has listed the various social determinants of health in an initiative to identify measures to create a safe environment for the general population. The organization identifies race and ethnicity, geographic location, education level, health insurance status, and family income as the leading social determinants of health access (HealthPeople.gov, 2020). For instance, the widening economic gap between the haves and have-nots in the USA causes an increase in health outcomes disparities (Dickman, Himmelstein & Woolhandler, 2017). Due to the ethical issues in the healthcare system, the American Nurses Association (ANA) formulated and enacted care coordination protocols designed to reduce costs and improve patient outcomes. However, the ANA regulations, which emphasize that your profession’s ethical standards are nonnegotiable, have forced some nursing homes to conduct a work redesign. With management change and work, redesign comes disturbances in the coordination of care and the attainment of high-quality care (Dickman, Himmelstein, & Woolhandler, 2017). Most of our nursing homes are understaffed, which increases ethical dilemmas for you as staff members. Further, as the number of patients visiting your facilities increases daily, they increase the chances of patients’ negligence as workers are overwhelmed with duties. Therefore, in the future, we, as essential stakeholders in administering coordinated care, have a responsibility to advocate for policy change that ensures all participants are concerned about the wellbeing of a patient benefit.