Introduction
There is a growing concern regarding the availability and quality of healthcare services, particularly palliative care, in the United States. Significant growth in older people causes increased pressure on the healthcare system (Chand & Markova, 2019). For older adults with severe illnesses, palliative care is essential to healthcare. It concentrates on alleviating symptoms and stress associated with the illness, enhancing the patient’s and their family’s well-being (Mercadante, 2018). However, the lack of access to palliative care and the low Medicare reimbursement rates for this type of medical care are becoming increasingly pressing issues.
The current shortage of healthcare professionals trained in palliative care is a major challenge further exacerbated by the aging population. This shortage makes it difficult for older adults to access palliative care when required most, leaving them to suffer needlessly with limited medical support (Mills & Ven, 2019).
Additionally, financial constraints resulting from low Medicare reimbursement rates for palliative care services have led to many healthcare providers being unable to offer this service to their patients (Duckett, 2018). This lack of access to palliative care has significant consequences for patients and their families, including an increased risk of hospitalization, unnecessary pain and suffering, and reduced quality of life.
Furthermore, this problem will only worsen as the number of elderly persons in the population keeps increasing. A report from the National Institute on Aging forecasts that 70 percent of individuals aged 65 and older will need long-term care at some point in their lives (Ferraro et al., 2021). This report indicates a need to design the problem identifier and develop a policy solution that includes procedures for evaluating and assessing its impacts and measuring its outcomes.
Considering Key Stakeholders
The aging process has implications for various stakeholders, and each individual has an important role in ensuring that the aging population can maintain health and quality of life. Various stakeholders have a vested interest in how the aging population health policy would impact the healthcare and social service systems. Each stakeholder has a unique view on the issue and the ability to support or oppose the associated policies. For the development of effective healthcare policy that would ensure older people are well protected, it is therefore important to analyze and comprehend the views of these different stakeholders.
The key stakeholders who are directly impacted by the healthcare policy are the aging persons. They have physical and non-physical needs that the policy must address, for instance, managing chronic illnesses and daily living activities (Bao et al., 2022). Hence, they are inclined to support policies that enhance the availability of long-term care services, caregiver assistance, and general health and well-being.
Apart from the aging population, healthcare professionals are also concerned stakeholders about the healthcare policy affecting the aging population. The demand for their services may increase, making it more difficult for them to provide the care that elderly people with complex needs need (Lester et al., 2019). Healthcare practitioners may therefore be both proponents and opponents of the programs, depending on how the policies pertaining to the aging population impact their practices and financial stability.
Finally, policy lobbyists are also interested in the policy affecting the aging population. They promote laws that advance the interests of their clients to influence legislators directly. By highlighting pertinent news and opinions, media outlets can affect how the general public views aging and healthcare legislation (Shu & Woo, 2020). They can potentially have positive and harmful effects on developing policies. On the one hand, they can highlight important issues and provide decision-makers with essential information to help them make informed decisions (Mattig, 2019). However, they may also promote particular interests that aren’t always the greatest for society as a whole.
Weighing the Policy Alternatives
Addressing healthcare problems associated with palliative care requires a concerted effort from policymakers, healthcare providers, and the wider public. Therefore, it is essential to increase funding for palliative care programs, increase public awareness of the importance of palliative care, and promote initiatives that train healthcare professionals in palliative care to ensure that they are well-equipped to meet the needs of the aging population. Ultimately, improving access to palliative care is crucial for the well-being and quality of life of older adults with serious illnesses and is a key challenge that must be addressed through policy formulation.
Alternative 1: Increasing Awareness of Training and Education of Palliative Care Courses
The alternative is based on social issues affecting the sector, such as inadequate staffing and stressful working conditions. Lester et al. (2019) argue that the primary challenge in the shortage of palliative caregivers is knowledge deficits and a lack of awareness about palliative care among the public, which leads to an inadequately trained workforce. Creating awareness of palliative care through education can help with issues of lack of understanding, distress, and the stigma linked to the subject, inhibiting providers from offering the services and families and patients from requesting the services. These services are designed to support individual health.
A state like Minnesota, for instance, has developed a website where people can get information about palliative care. This website provides valuable information to the public, which helps them plan their health and also enables them to understand palliative care (MN Dept. of Health, n.d.). Other states have also developed policies that require healthcare providers to identify and reach out to a person who may need palliative care services. Vermont, for instance, needs caregivers to show competency in recognizing and engaging patients who may benefit from palliative care (Vermont Department of Health, n.d.).
Consequently, the workforce shortages in the sector are due to the inadequate absorption of fresh professionals, while the current experts in the industry are old and nearing retirement. According to Kamal et al. (2019), the number of professionals exiting the sector is 60 percent more than the number of fresh professionals joining palliative caregiving. Thus, a vast professional gap leads to staff shortages for effective caregiving. Changing the requirements will effectively enhance knowledge about palliative caregiving among healthcare professionals, such as nurses, social workers, physicians, and case workers (Kamal et al., 2019). Thus, increasing workforce personnel through training and recruiting fresh individuals ensures adequate caregivers and less workload for effective services, allowing more individuals to access palliative care.
Alternative 2: Timely and Sufficient Reimbursement for Palliative Caregivers
The policy addresses social and economic issues that have an impact on the sector. Duckett (2018) argues that Palliative care programs and nursing homes for the aging cut nursing positions to reduce costs increasing nursing to patient ratio to 1:4 or 1:6. Cutting the cost places caregivers at a loss since they end up with a huge workload that leads to burnout, stress, and possible quitting from the sector. At the same time, Medicare does not pay hospitals that are not accredited by accrediting bodies such as the Joint Commission. According to Duckett (2018), very few palliative care programs meet the accreditation standard, leading to inadequate financial support for health workers. Hence, they depend on institutional funds and charities to fund the positions, which is insufficient.
Palliative care programs also rely on informal or unpaid caregivers, which may include family members or friends. These categories of people are the backbone of the palliative care provided in people’s homes. Unfortunately, unpaid caregivers may also be at risk of experiencing negative health outcomes, which may include stress and depression due to difficulty in maintaining their lifestyles.
In the United States, it is estimated that 25 percent of people above 18 years have provided care to people with long-term illness in the past 30 days (Centers for Disease Control and Prevention, 2022). According to the Centers for Disease Control, informal caregiver services’ one-year value was estimated at 450 billion dollars in 2009 (Centers for Disease Control and Prevention, 2022). In addition, unpaid caregivers often incur losses to their caregiving service as they experience economic hardship due to lost wages. Centers for Disease Control and Prevention estimated that 27 percent of the caregivers taking care of palliative patients reported economic hardship due to unpaid caregiving.
Enhancing palliative care compensation raises the financial and social standing of caregivers, encouraging them to provide the best care possible to the elderly and ill despite their heavy workload. Similarly, more people will be encouraged to train as palliative caregivers, leading to an increased workforce (Kamal et al., 2019). In addition, the policy can be effective as it ensures a conducive working environment with reduced burnout and stress levels, which are detrimental to caregivers and can lead to quitting. Sustainable reimbursement from Medicaid and Medicare can act as an incentive to enable greater access to palliative care.
It can also be a source of information for states as the authorities can trace to understand and develop policies to help better deliver care services. For example, California made palliative care access to all age groups through state Medicaid to target the benefits (Dhcs.ca.gov, n.d.). Conversely, Arizona, for instance, changed its policy, the Care Cost Containment System, by ensuring that the population that depends on Medicaid can get palliative care services (Azahcccs.gov, n.d). Therefore, reimbursement policies must change to ensure caregivers’ sustainability and quality of services in palliative care.
Alternative 3: Ensure Advanced Learning for Palliative Care
Issues regarding this policy include political and economic factors supporting palliative care fellowships. Although the policy exists, the training and funding resources are insufficient to train a large population. There is not enough infrastructure or human capital in the training system to handle the large number of healthcare professionals pursuing advanced palliative care training (Flaherty & Bartels, 2019). Likewise, existing palliative care fellowships for advanced training have limited funds to support the cause, leading to few individuals attending the training courses (Dudley et al., 2018).
In addition, a lack of trained providers often causes limited access to palliative care services. This is very common in rural areas and smaller hospitals in the country. There is a need to increase the availability of the services, and the state may consider investing in advanced learning to train more professionals in the sector. Rhode Island, for instance, requires doctors to advance their studies and to complete at least four hours of continuous studies every two years in compulsory areas of the medical field, which include end-of-life and palliative care. Therefore, the federal government, healthcare institutions, and health organizations should invest in sufficiently funding the training programs for professionalism and an increased workforce. The policy’s strengths lie in ensuring a future with an adequate workforce and enhancing access to palliative care for the aging population.
Alternative 4: Not Taking Any Action by Decision-Makers and Shareholders Due to Various Social, Economic, and Political Reasons
For financial reasons, the policy would prohibit hiring more people to provide palliative care. According to a report by the National Institute of Aging, it is estimated that 70 percent of people over 65 will require long-term care in their lifetime (Ferraro et al., 2021). the shortage of caregivers in the sector results from the increased aging population, which occurs naturally and may decline with time. Therefore, there is no need to invest in increasing the workforce and using the economic resources in other areas.
This alternative may not be effective as it does not provide a solution to the immediate crisis. Ignoring the problems increases the workload on existing caregivers and staffing issues, which affects service delivery and accessibility to palliative care. Thus, the ‘do nothing policy is not viable in the present circumstance.
Evaluation Criteria for the Proposed Alternative to Current Policy.
Recommendations
The best practice recommendation for the aging population is to introduce fresh palliative care professionals in the health sector to reduce workforce shortages. The gap left by retirees and the increasing aging population significantly influenced the crisis. Data from Kamal et al. (2019) shows that more than 41 percent of palliative care professionals are 56 years and above, approaching their retirement age, while the intake of fresh palliative caregivers is less than 10 percent annually. Thus, the number of fresh intakes does not match that of those leaving the sector, leading to staffing and burnout.
Also, the state and federal government can train fresh individuals to fill the gap left by retirees to ease the workload, leading to a conducive work environment and fewer cases of quitting. This policy alternative will ensure adequate personnel for palliative care who are young to replace the retired, creating a diverse and energetic workforce for effective palliative care (Dudley et al., 2018). The recommendation is based on its economic and social feasibility, which makes it suitable for solving the immediate crisis.
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