Vulnerable Population in the Workplace
Noy-Starra Edge
Nur/440
May 7, 2012
Mrs. Mendez

Vulnerable Population in the Workplace
Long term acute care hospitals (LTACHs), give extended medical, rehabilitative, and intensive care to individuals with clinically complex problems that need hospital level care for greater than 25 days (American Hospital Association, 2012). Many LTACH admissions are elderly patients, which is a vulnerable population. “Elderly and aged patients are considered to be capable and competent, they should be treated as a vulnerable group of patients, who may need additional care and protection of their interests because of their possible incapability to realize their rights themselves (Pishchita, 2007, p.350). Most LTACH take Medicare and Medicaid payments and all take private insurance. The government provides insurance for low-income seniors and younger persons with disabilities that are govern by the state of the individual. According to Caring for Vulnerable Populations (2011), these persons are among the sickest and poorest individuals making them rely on dual enrollment in Medicare and Medicaid government programs for necessary services. “55% of this population has an annual income below $10,000 and sixty million Americans currently obtain coverage through state-based Medicaid programs. These individuals come from lower socioeconomic backgrounds and pose unique care coordination challenges. They disproportionately face chronic diseases and challenges to access health care as compared to the overall population. Even when care is provided, the complexity of the patients often prevents application of appropriate care standards” (Caring for Vulnerable Populations, 2011). Pasco county area in Florida is a Select Medical ran LTACH that holds 50 patients. Land O’ Lakes, FL is where the LTAC is located with 75.2% of the population being of the Caucasian race, 15.2% if the Hispanic race, 4.6% of the Black race and 2.9% of the Asian race (Land O" Lakes, Florida, 2012). The majority of the patients admitted to this hospital are over the age of 55. Among the nursing staff there has been conversations regarding the discharge of patients who are not ready medically to be discharge from the hospital to a rehabilitation center, home with home healthcare, nor to an assisted living facility. The conversations starts by noticing a yellow sticky note attached to the first page of the patient chart on discharge order sheets. The note reads similar to “Doctor please sign below, this patient is over their 27 days, no insurance.” The note is place on the patient chart by case management requesting the doctor release the patient due to no insurance, with no regards to the health status of the patient.
To address this population, government-insured elderly patients, a short presentation on vulnerable populations, demographics of their city, and the common admission illnesses to their hospital was given to the case managers and nurses. An overview of how the government insurance works were given to the attendees and explain on how the state polices have made it complicated to have both Medicare and Medicaid insurances. A focus point was made to have all outside resources contacted to assist the patient if the patient is unable to continue to pay but too sick to leave the LTACH. For those staff members who could not attend the meeting, copies of the PowerPoint presentation (handouts) were left on the table for the staff to read and sign a paper that goes to the education department in their records, stating they have read and understand the information. Three focus concepts that were used were to identify barriers in the workplace against vulnerable population, the elderly, that’s affecting the disparities in promoting health care delivery, to identify patient health expectations prior to discharge, and discuss the nurse and case mangers role in meeting the needs of various populations within this facility.
The meeting consists of three registered nurses and two case managers. Question and answer session were provided at the end of the meeting and the staff expresses their concern of readmission if patients were discharge too soon. With regards to the patients with Medicaid; state-ran Medicaid have little to no incentive to improve coverage on long-term and supplemental services which would reduce the readmissions in question (Caring for Vulnerable Populations, 2011). Also they express their understanding of what vulnerable populations exists in their community and there understanding of the healing process on the elderly. Possibilities for future change included having the nurses and the case mangers talk with each other in weekly meeting to discuss the patient readiness for discharge and if so what type of care would be needed after discharge, which would determine what kind of facility needs to be contact regarding the type of insurance the patient has; nurses agree to talk with the doctors on the patient health status and potential for discharge to the right facility; and the type of insurance should only be a determining factor is all other resources are exhausted.
While hospitals have made considerable strides in caring for vulnerable populations, both onsite and through partnerships with other institutions, true care coordination remains a challenge. Hospitals have the opportunity to address the patient, provider, and system barriers that have impeded the progress toward improved care coordination and a positive impact on the quality of care and cost for the vulnerable populations they serve (Munoz-Price, 2009).

References
American Hospital Association. (2012). Long-term acute care hospitals (LTACHs). Retrieved from http://www.aha.org/advocacy-issues/postacute/ltach/index.shtml
Caring for vulnerable populations. (2011). Retrieved from http://www.aha.org/research/cor/content/caring_vulnerable_populations_report.pdf
Land o" Lakes, Florida. (2012). Retrieved from http://www.city-data.com/city/Land-O-Lakes-Florida.html
Munoz-Price, L.S. (2009, August). Long-term acute care hospitals. Clinical Infections Diseases, 49(1), 438-443.
Pishchita, A.N. (2007, December). Elderly patients as a vulnerable category of the population requiring special legal protection with respect to the provision of medical care. European Journal of Health Law, 14(4), 349-354