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124 Healthcare Essay Topic Ideas & Examples

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Healthcare is a diverse and complex field that encompasses a wide range of topics, issues, and challenges. Whether you are studying healthcare as a student, working in the healthcare industry, or simply interested in learning more about this important area, there are countless essay topics that you can explore. To help you get started, here are 124 healthcare essay topic ideas and examples that you can use for inspiration:

• The impact of healthcare disparities on patient outcomes
• Strategies for improving access to healthcare in underserved communities
• The role of technology in transforming healthcare delivery
• The ethics of healthcare rationing
• The importance of diversity and inclusion in healthcare organizations
• The rise of telemedicine and its implications for patient care
• The impact of the opioid epidemic on healthcare systems
• The role of nurses in promoting patient safety
• The challenges of providing mental health care in a primary care setting
• The future of healthcare: personalized medicine and precision healthcare
• The role of healthcare providers in addressing social determinants of health
• The impact of climate change on public health
• The role of public health campaigns in promoting healthy behaviors
• The challenges of healthcare delivery in rural areas
• The impact of healthcare reform on the uninsured population
• The role of healthcare informatics in improving patient outcomes
• The importance of cultural competency in healthcare delivery
• The ethical implications of genetic testing and personalized medicine
• The impact of healthcare costs on patient access to care
• The role of healthcare administrators in shaping the future of healthcare delivery
• The challenges of implementing electronic health records in healthcare settings
• The impact of healthcare privatization on patient care
• The role of healthcare providers in promoting patient autonomy
• The challenges of providing end-of-life care in a healthcare setting
• The impact of healthcare disparities on maternal and child health outcomes
• The role of healthcare providers in addressing the opioid crisis
• The challenges of providing healthcare to undocumented immigrants
• The impact of the COVID-19 pandemic on healthcare systems
• The role of healthcare providers in promoting vaccination uptake
• The challenges of healthcare delivery in conflict zones
• The impact of healthcare disparities on LGBTQ+ populations
• The role of healthcare providers in promoting healthy aging
• The challenges of providing healthcare to homeless populations
• The impact of healthcare disparities on rural communities
• The role of healthcare providers in addressing food insecurity
• The challenges of providing healthcare to refugees and asylum seekers
• The impact of healthcare disparities on people with disabilities
• The role of healthcare providers in promoting mental health awareness
• The challenges of providing healthcare to incarcerated populations
• The impact of healthcare disparities on immigrant populations
• The role of healthcare providers in promoting sexual health education
• The challenges of providing healthcare to indigenous populations
• The impact of healthcare disparities on veterans' health outcomes
• The role of healthcare providers in promoting healthy lifestyles
• The challenges of providing healthcare to low-income populations
• The impact of healthcare disparities on minority populations
• The role of healthcare providers in promoting preventive care
• The challenges of providing healthcare to elderly populations
• The impact of healthcare disparities on women's health outcomes
• The role of healthcare providers in promoting maternal health
• The challenges of providing healthcare to children and adolescents
• The impact of healthcare disparities on mental health outcomes
• The role of healthcare providers in promoting substance abuse treatment
• The challenges of providing healthcare to homeless youth
• The impact of healthcare disparities on LGBTQ+ youth
• The role of healthcare providers in promoting healthy relationships
• The challenges of providing healthcare to LGBTQ+ youth
• The impact of healthcare disparities on transgender populations
• The role of healthcare providers in promoting gender-affirming care
• The challenges of providing healthcare to LGBTQ+ elders
• The impact of healthcare disparities on people of color
• The role of healthcare providers in promoting racial equity
• The challenges of providing healthcare to immigrant populations
• The impact of healthcare disparities on refugee populations
• The role of healthcare providers in promoting cultural competency
• The challenges of providing healthcare to non-English speaking populations
• The role of healthcare providers in promoting disability rights
• The challenges of providing healthcare to people with mental illnesses
• The impact of healthcare disparities on people experiencing homelessness
• The role of healthcare providers in promoting housing stability
• The challenges of providing healthcare to people living in poverty
• The impact of healthcare disparities on incarcerated populations
• The role of healthcare providers in promoting criminal justice reform
• The challenges of providing healthcare to veterans
• The impact of healthcare

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Health And Social Care Essays

Critical reflection on health and safety policies in health and social care, level 5 diploma in leadership for health and social care and children and young people, enhancing professional development through reflective practice in health and social care, comprehensive risk assessment and review of health and safety practices in health and social care, popular essay topics.

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• Substance Abuse
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• Telemedicine
• Vaccination

Look at Argumentative Essay Topics on Health Care and Choose

After applying to medical schools, essays start to appear frequently as an essay about health care. Your writing skills may affect your discipline scores. You must therefore be proficient in writing in the field of health care if you want to impress your lecturers. Here are some crucial procedures that can be used.

Topics are one of the most crucial aspects of writing your essay on health care. You just go to the following step if your instructors provide you with a specific topic to write on. If there isn’t a clear theme, consider some subjects that catch your attention.

There is something regarding health care that you like when you study in medical school. Writing your universal health care essay, you have the chance to look into such issues and offer personal suggestions now. Additionally, students are more motivated to produce these texts.

Finding good topics in the field is frequently a difficult task. Review numerous health care essay examples on our website on any topic in any field. That’s how you make this procedure simpler. They might offer some guidance and examples of topics.

• Do sugary drinks increase the risk of cancer?
• Can a young child’s eating habits indicate autism?
• Is legalizing euthanasia a good idea?
• Benefits and drawbacks of medical marijuana.
• Alternative medicine: is it risky?
• Is participating in sport always healthy?
• Which diet, low-fat or low-carb, is preferable?
• Preventative measures against infectious diseases.
• Social variables affecting people’s wellbeing.

Think of speaking with tutors on an argumentative essay about health care. They can make recommendations based on your preferences.

Don’t Know What to Write in Your Essay on Health Care? Answered Below

Do not get into writing as soon as you have chosen the issue to address in argumentative essay topics on health care. You can write if you have enough thoughts only.

Next, include all insightful ideas on the subject by writing an argumentative essay about health care. They will serve as the basis of your text. Students frequently experience situations where they are writing.

Structure to Follow for Coherent Essay About Health Care Problems

Following health care essay examples and making a thorough outline enables you to keep track of every concept. Always pay attention to the introduction and conclusion. The major text portion might effortlessly mix in with other parts.

Once all the preparations are complete, you can start writing on health care argumentative essay topics right away. You won’t stray too far from the basic idea if you simply follow our example.

More Details of Writing an Argumentative Essay About Health Care Area

Readability also affects text quality, though, and free health care essay examples are presented here. Long and short sentences must constantly be balanced for students. Writers with experience advise switching them up.

Their size is also important. Good examples exclude long phrases or pausing after a few words. Do not be hesitant to divide or enlarge them. When it comes to citations, texts on health care essay topics demand extreme caution.

To emphasize the significance of the subject, cite a few well-known quotes or statements once or twice. Any free health care argumentative essay examples are often brief samples. It takes a lot of words to reference a lot of things. You won’t be able to define the issue as a result adequately.

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13.1 Sociological Perspectives on Health and Health Care

Learning objective.

• List the assumptions of the functionalist, conflict, and symbolic interactionist perspectives on health and medicine.

Before discussing these perspectives, we must first define three key concepts—health, medicine, and health care—that lie at the heart of their explanations and of this chapter’s discussion. Health refers to the extent of a person’s physical, mental, and social well-being. As this definition suggests, health is a multidimensional concept. Although the three dimensions of health just listed often affect each other, it is possible for someone to be in good physical health and poor mental health, or vice versa. Medicine refers to the social institution that seeks to prevent, diagnose, and treat illness and to promote health in its various dimensions. This social institution in the United States is vast, to put it mildly, and involves more than 11 million people (physicians, nurses, dentists, therapists, medical records technicians, and many other occupations). Finally, health care refers to the provision of medical services to prevent, diagnose, and treat health problems.

With these definitions in mind, we now turn to sociological explanations of health and health care. As usual, the major sociological perspectives that we have discussed throughout this book offer different types of explanations, but together they provide us with a more comprehensive understanding than any one approach can do by itself. Table 13.1 “Theory Snapshot” summarizes what they say.

Table 13.1 Theory Snapshot

The Functionalist Approach

As conceived by Talcott Parsons (1951), the functionalist perspective emphasizes that good health and effective medical care are essential for a society’s ability to function. Ill health impairs our ability to perform our roles in society, and if too many people are unhealthy, society’s functioning and stability suffer. This was especially true for premature death, said Parsons, because it prevents individuals from fully carrying out all their social roles and thus represents a “poor return” to society for the various costs of pregnancy, birth, child care, and socialization of the individual who ends up dying early. Poor medical care is likewise dysfunctional for society, as people who are ill face greater difficulty in becoming healthy and people who are healthy are more likely to become ill.

For a person to be considered legitimately sick, said Parsons, several expectations must be met. He referred to these expectations as the sick role . First, sick people should not be perceived as having caused their own health problem. If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather.

Second, sick people must want to get well. If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself.

Third, sick people are expected to have their illness confirmed by a physician or other health-care professional and to follow the professional’s instructions in order to become well. If a sick person fails to do so, she or he again loses the right to perform the sick role.

Talcott Parsons wrote that for a person to be perceived as legitimately ill, several expectations, called the sick role, must be met. These expectations include the perception that the person did not cause her or his own health problem.

Nathalie Babineau-Griffith – grand-maman’s blanket – CC BY-NC-ND 2.0.

If all these expectations are met, said Parsons, sick people are treated as sick by their family, their friends, and other people they know, and they become exempt from their normal obligations to all these people. Sometimes they are even told to stay in bed when they want to remain active.

Physicians also have a role to perform, said Parsons. First and foremost, they have to diagnose the person’s illness, decide how to treat it, and help the person become well. To do so, they need the cooperation of the patient, who must answer the physician’s questions accurately and follow the physician’s instructions. Parsons thus viewed the physician-patient relationship as hierarchical: the physician gives the orders (or, more accurately, provides advice and instructions), and the patient follows them.

Parsons was certainly right in emphasizing the importance of individuals’ good health for society’s health, but his perspective has been criticized for several reasons. First, his idea of the sick role applies more to acute (short-term) illness than to chronic (long-term) illness. Although much of his discussion implies a person temporarily enters a sick role and leaves it soon after following adequate medical care, people with chronic illnesses can be locked into a sick role for a very long time or even permanently. Second, Parsons’s discussion ignores the fact, mentioned earlier, that our social backgrounds affect the likelihood of becoming ill and the quality of medical care we receive. Third, Parsons wrote approvingly of the hierarchy implicit in the physician-patient relationship. Many experts say today that patients need to reduce this hierarchy by asking more questions of their physicians and by taking a more active role in maintaining their health. To the extent that physicians do not always provide the best medical care, the hierarchy that Parsons favored is at least partly to blame.

The Conflict Approach

The conflict approach emphasizes inequality in the quality of health and of health-care delivery (Weitz, 2013). As noted earlier, the quality of health and health care differs greatly around the world and within the United States. Society’s inequities along social class, race and ethnicity, and gender lines are reproduced in our health and health care. People from disadvantaged social backgrounds are more likely to become ill, and once they do become ill, inadequate health care makes it more difficult for them to become well. As we will see, the evidence of disparities in health and health care is vast and dramatic.

The conflict approach also critiques efforts by physicians over the decades to control the practice of medicine and to define various social problems as medical ones. Physicians’ motivation for doing so has been both good and bad. On the good side, they have believed they are the most qualified professionals to diagnose problems and to treat people who have these problems. On the negative side, they have also recognized that their financial status will improve if they succeed in characterizing social problems as medical problems and in monopolizing the treatment of these problems. Once these problems become “medicalized,” their possible social roots and thus potential solutions are neglected.

Several examples illustrate conflict theory’s criticism. Alternative medicine is becoming increasingly popular, but so has criticism of it by the medical establishment. Physicians may honestly feel that medical alternatives are inadequate, ineffective, or even dangerous, but they also recognize that the use of these alternatives is financially harmful to their own practices. Eating disorders also illustrate conflict theory’s criticism. Many of the women and girls who have eating disorders receive help from a physician, a psychiatrist, a psychologist, or another health-care professional. Although this care is often very helpful, the definition of eating disorders as a medical problem nonetheless provides a good source of income for the professionals who treat it and obscures its cultural roots in society’s standard of beauty for women (Whitehead & Kurz, 2008).

Obstetrical care provides another example. In most of human history, midwives or their equivalent were the people who helped pregnant women deliver their babies. In the nineteenth century, physicians claimed they were better trained than midwives and won legislation giving them authority to deliver babies. They may have honestly felt that midwives were inadequately trained, but they also fully recognized that obstetrical care would be quite lucrative (Ehrenreich & English, 2005).

According to conflict theory, physicians have often sought to define various social problems as medical problems. An example is the development of the diagnosis of ADHD, or attention deficit/hyperactivity disorder.

birgerking – What I Really Do… ADD/ADHD – CC BY 2.0.

In a final example, many hyperactive children are now diagnosed with ADHD, or attention deficit/hyperactivity disorder. A generation or more ago, they would have been considered merely as overly active. After Ritalin, a drug that reduces hyperactivity, was developed, their behavior came to be considered a medical problem and the ADHD diagnosis was increasingly applied, and tens of thousands of children went to physicians’ offices and were given Ritalin or similar drugs. The definition of their behavior as a medical problem was very lucrative for physicians and for the company that developed Ritalin, and it also obscured the possible roots of their behavior in inadequate parenting, stultifying schools, or even gender socialization, as most hyperactive kids are boys (Conrad, 2008; Rao & Seaton, 2010).

Critics say the conflict approach’s assessment of health and medicine is overly harsh and its criticism of physicians’ motivation far too cynical. Scientific medicine has greatly improved the health of people around the world. Although physicians are certainly motivated, as many people are, by economic considerations, their efforts to extend their scope into previously nonmedical areas also stem from honest beliefs that people’s health and lives will improve if these efforts succeed. Certainly there is some truth in this criticism of the conflict approach, but the evidence of inequality in health and medicine and of the negative aspects of the medical establishment’s motivation for extending its reach remains compelling.

The Symbolic Interactionist Approach

The symbolic interactionist approach emphasizes that health and illness are social constructions . This means that various physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members (Buckser, 2009; Lorber & Moore, 2002). The ADHD example just discussed also illustrates symbolic interactionist theory’s concerns, as a behavior that was not previously considered an illness came to be defined as one after the development of Ritalin. In another example first discussed in Chapter 7 “Alcohol and Other Drugs” , in the late 1800s opium use was quite common in the United States, as opium derivatives were included in all sorts of over-the-counter products. Opium use was considered neither a major health nor legal problem. That changed by the end of the century, as prejudice against Chinese Americans led to the banning of the opium dens (similar to today’s bars) they frequented, and calls for the banning of opium led to federal legislation early in the twentieth century that banned most opium products except by prescription (Musto, 2002).

In a more current example, an attempt to redefine obesity is now under way in the United States. Obesity is a known health risk, but a “fat pride” or “fat acceptance” movement composed mainly of heavy individuals is arguing that obesity’s health risks are exaggerated and calling attention to society’s discrimination against overweight people. Although such discrimination is certainly unfortunate, critics say the movement is going too far in trying to minimize obesity’s risks (Diamond, 2011).

The symbolic interactionist approach has also provided important studies of the interaction between patients and health-care professionals. Consciously or not, physicians “manage the situation” to display their authority and medical knowledge. Patients usually have to wait a long time for the physician to show up, and the physician is often in a white lab coat; the physician is also often addressed as “Doctor,” while patients are often called by their first name. Physicians typically use complex medical terms to describe a patient’s illness instead of the more simple terms used by laypeople and the patients themselves.

Management of the situation is perhaps especially important during a gynecological exam, as first discussed in Chapter 12 “Work and the Economy” . When the physician is a man, this situation is fraught with potential embarrassment and uneasiness because a man is examining and touching a woman’s genital area. Under these circumstances, the physician must act in a purely professional manner. He must indicate no personal interest in the woman’s body and must instead treat the exam no differently from any other type of exam. To further “desex” the situation and reduce any potential uneasiness, a female nurse is often present during the exam.

Critics fault the symbolic interactionist approach for implying that no illnesses have objective reality. Many serious health conditions do exist and put people at risk for their health regardless of what they or their society thinks. Critics also say the approach neglects the effects of social inequality for health and illness. Despite these possible faults, the symbolic interactionist approach reminds us that health and illness do have a subjective as well as an objective reality.

Key Takeaways

• A sociological understanding emphasizes the influence of people’s social backgrounds on the quality of their health and health care. A society’s culture and social structure also affect health and health care.
• The functionalist approach emphasizes that good health and effective health care are essential for a society’s ability to function, and it views the physician-patient relationship as hierarchical.
• The conflict approach emphasizes inequality in the quality of health and in the quality of health care.
• The interactionist approach emphasizes that health and illness are social constructions; physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members.

For Your Review

• Which approach—functionalist, conflict, or symbolic interactionist—do you most favor regarding how you understand health and health care? Explain your answer.
• Think of the last time you visited a physician or another health-care professional. In what ways did this person come across as an authority figure possessing medical knowledge? In formulating your answer, think about the person’s clothing, body position and body language, and other aspects of nonverbal communication.

Buckser, A. (2009). Institutions, agency, and illness in the making of Tourette syndrome. Human Organization, 68 (3), 293–306.

Conrad, P. (2008). The medicalization of society: On the transformation of human conditions into treatable disorders . Baltimore, MD: Johns Hopkins University Press.

Diamond, A. (2011). Acceptance of fat as the norm is a cause for concern. Nursing Standard, 25 (38), 28–28.

Lorber, J., & Moore, L. J. (2002). Gender and the social construction of illness (2nd ed.). Lanham, MD: Rowman & Littlefield.

Musto, D. F. (Ed.). (2002). Drugs in America: A documentary history . New York, NY: New York University Press.

Parsons, T. (1951). The social system . New York, NY: Free Press.

Rao, A., & Seaton, M. (2010). The way of boys: Promoting the social and emotional development of young boys . New York, NY: Harper Paperbacks.

Weitz, R. (2013). The sociology of health, illness, and health care: A critical approach (6th ed.). Thousand Oaks, CA: Wadsworth.

Whitehead, K., & Kurz, T. (2008). Saints, sinners and standards of femininity: Discursive constructions of anorexia nervosa and obesity in women’s magazines. Journal of Gender Studies, 17 , 345–358.

Social Problems Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Take a ‘Social in All Policy’ Approach to Bring Better Health to More People

Joneigh Khaldun

Globally, simultaneous health crises have prompted a heightened focus on improving population health. Yet the Centers for Disease Control and Prevention acknowledges that medical care and genetics are not the largest contributors to health; it is social factors. The global COVID-19 pandemic brought greater awareness of how important social contact is for our well-being—yet decades of robust scientific evidence demonstrates that social connection is a major contributor to individual and population health. Indeed, one of the strongest predictors of morbidity and mortality across social species in nature, including humans, is the social environment. Experimental studies demonstrate that social interactions can causally alter physiology, disease risk, and life span itself.

The recent US Surgeon General’s Advisory Our Epidemic of Loneliness and Social Isolation points to the far-reaching consequences and emphasizes social connection as a critical and underappreciated contributor to health, well-being, safety, and prosperity.

When it comes to public health, we must move beyond operating in crisis mode to sustained efforts to ensure that individuals and communities aren’t just surviving but thriving.

Social health is more than just a personal issue.

By operating in crisis mode, we tend to focus on the problem rather than the goal. Notably, the evidence points to a social gradient, so instead of a dichotomy of being lonely or not, we are all somewhere along a continuum of social connection. Further, there is a corresponding risk reduction for every unit increase in social connection. In other words, the evidence points to a continuum from risk to protection across the social gradient—which applies to the entire population.

Targeted approaches to reach individuals most at risk are needed; however, tertiary approaches are often the most expensive and least successful. Even if successful, we only reach a small portion of the population. In contrast, larger efforts that focus on the protective power of social connection via population-based prevention efforts, instead of just affecting the extreme ends of the spectrum, may shift population-level risks. We need to go from targeted to broad approaches.

Social health is more than just a personal issue. For far too long, we have viewed social connection as a personal issue. Of course, our experience is deeply personal, so understandably, many may view this as a private matter—believing that the government and other institutions have no business getting involved. While we value our autonomy, it has simultaneously placed an enormous burden on individuals to deal with problems such as social isolation or loneliness alone—when sometimes the underlying cause is outside an individual’s control.

The pandemic demonstrated two crucial clues that can inform approaches to advancing social health. First, an individual’s social connectedness can be profoundly influenced by external factors. Second, social contact is part of almost every aspect of society. These became clear when policies aimed at reducing social contact altered nearly every aspect of our lives. We saw changes in how we work, attend school, travel, shop, get entertainment, and so much more. This collective experience highlights the social relevance of every sector of society and offers important clues to enhancing health by adopting a whole-of-society approach.

To improve the overall health of the population it will be necessary to adopt a "social in all policy" approach. Since social contact permeates every aspect of society, policies across every sector can promote or hinder connections. We must carefully study the social repercussions of a program in the same way that we assess its economic ramifications. Will this residential zoning, telework, transit, curriculum, or workplace leave policy facilitate or become barriers to social connection? This approach should entail a comprehensive strategy that emphasizes fostering a healthy environment through education, employment, health-care access, community engagement, and addressing social disparities.

To truly impact population health, we must extend our focus beyond health care to encompass policy and initiatives that strengthen social bonds, empower communities, reduce inequalities, and ultimately enhance the overall health and well-being of the population.

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Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

• The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
• The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
• The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

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Tackling the continuing issue of ageism in health care

By Kathy Quirk

“Well, at your age, that’s to be expected.”

“How are we today sweetie?”

“Are we ready for our checkup?”

Those are comments older adults sometimes hear from medical professionals, and they reflect ingrained ageism, according to Andrew Steward, assistant professor of social work in the Helen Bader School of Social Welfare. His research focuses on the social justice issues involved in ageism as well as ways to counter implicit assumptions that affect older people.

His paper, “Age Discrimination in Healthcare” was published earlier this year in the Certified Senior Advisors Journal.

He talks about the paper and his work in this interview.

What made you decide to publish the paper?

I had worked with this journal previously on another article , and they suggested I write this piece. This journal is targeted to practitioners rather than academics. Unlike peer-reviewed journal articles which often have a paywall, it was easily accessible to those working in the field.

How are older patients impacted by ageism in health care settings ?

In health care, ageism can be displayed in everyday conversations, physical spaces and policy choices. Making change means responding at each level.

Why is this important to understand?

Research has shown ageism in health care can literally have life or death implications, given that older patients who experience it have a higher probability of death than younger patients.

What are the issues around how medical professionals respond to older patients when they bring up concerns?

It’s not uncommon for doctors to say something like, ‘Well, at your age this is normal.” That can be very dismissive, especially in a health care setting where you need a service and the way the message is delivered is dismissing your concerns about your own health and dismissing potential interventions to stay healthy. Many times, older people have to go and get a second or third opinion, just to talk to a doctor who will talk to them and listen to them.

Many times, older people have to go and get a second or third opinion, just to talk to a doctor who will talk to them and listen to them.

In the article you talked about “elderspeak.” What exactly is that?

Elderspeak is an infantilizing way of communicating with older adults based on stereotypes that assume older people lack competence or intelligence. It’s essentially “baby talk” with older people. Health care providers may speak in a in a high pitched or sing-songy voice. Or they may address patients as “honey” or “sweetie,” rather than using their names. That can be very patronizing. One study I mentioned in the article showed that 84% of health care workers interacting with older adults used elderspeak.

You also mentioned the use of “we” instead of “you” in making suggestions to older adults, especially in residential care settings.

A good example of that is saying, “we need to take our medications,” or “we need to take a bath, rather than simply saying “you need to take medications or take your bath,” or better yet asking the older adult when they would like to schedule these within their daily routine.

You talk about the issue of rationing health care, which can especially impact older people…

When providers are under pressure to decide who receives services, they may favor younger people due to an assumption that illness and death is more common or even considered more acceptable among older adults. Rationing of health care when resources are limited is a complex and nuanced issue and one I discuss with students. It’s been a debate for a long time, but in my view basing decisions on age alone should is too simplistic. We should be making decisions about allocating health care resources based on a variety of factors, including not only age but also need, equity, environmental factors and individualized care plans.

We should be making decisions about allocating health care resources based on a variety of factors, including not only age but also need, equity, environmental factors and individualized care plans.

How was this issue highlighted during the Covid-19 pandemic?

As the virus was initially spreading, voices in the media and elsewhere expressed sentiments that the threat was not severe because it would primarily affect older people, that medical interventions should target younger generations, and that a targeted lockdown of older adults offered a promising solution to reopening the economy. When resources like ventilators were in short supply at the beginning of the pandemic, for example, the state of Alabama used age as a criteria in limiting their use, which was subsequently found to be a form of age discrimination.

How can health care systems improve the way they handle these issues?

It’s a matter of education and changing the culture. In long-term care, for example, some systems have changed the culture of nursing homes from cold, institutional settings to places where older people can feel at home and have a sense of community. These health care environments can give older people more autonomy and self-determination. I worked in Denver in an area that was really at the cutting edge of a culture change in nursing homes. One change in the philosophy of care – the Eden Alternative – has become a national and international model.

(Editor’s note: Anne Basting, UWM professor of English, has done innovative work with arts and the aging and their caregivers. That work has been recognized by a MacArthur Fellowship, an Ashoka Fellowship, a Rockefeller Fellowship and multiple major grants. Her latest book is “Creative Care.”)

What projects and research are you working on?

In my current work, I am partnering with several community organizations to pilot a 10-session anti-ageism peer support program for adults 50+ years of age called Aging Together . This program offers education about how ageism impacts health, and gives older adults the opportunity to tell their story of aging in a new way within a small, supportive peer group. In the research, we are exploring whether the Aging Together program may help to reduce internalized and relational ageism while enhancing self-efficacy, a sense of purpose in life, social connectedness and cognitive function. This is important since a lot of stereotypes about aging are so prevalent and insidious, and we all internalize them to some degree. But education and storytelling can be powerful ways to counteract the myths around aging and promote enhanced well-being for older adults.

Your Turn: Social Work Licensure Compact puts Kansas’ mental health first

Kansas ranked last in the “State of Mental Health in America 2023” report. The need for improved mental health care is impossible to ignore. Kansas took an important step to create social worker jobs and facilitate care across the state by joining the Social Work Licensure Compact in April.

The compact creates a multistate license that allows licensed social workers to offer telehealth services in all participating states. Currently, licensed social workers must complete a months-long licensing process to practice in any additional states, draining valuable time away from caring for clients. The compact will allow social workers to efficiently expand their care across the 22 states that have joined the compact.

Multistate licenses are hardly a new idea. In fact, almost every American over the age of 16 has one in their wallet — driver’s licenses are an accepted form of multistate licensing. In health care alone, there are already interstate licenses for psychologists, nurses, physicians, physical therapists and more. Similar to a driver’s license, licensed social workers will abide by the specific requirements of the state in which their client resides. Applying this familiar, well-tested model to social work is a long overdue change that is integral to addressing our mental health care shortage.

The compact allows licensed social workers and clients to continue benefiting from their relationship, even as life requires out-of-state relocations. Building trust with social workers or any mental health professional takes time. When clients move out of state under the current licensing structure, social workers are faced with two choices: give up the relationship or spend months getting licensed in another state. Due to the nationwide shortage of social workers, it is likely that the client would spend months languishing on waiting lists while needs go unaddressed. The compact allows uninterrupted access to continued care. This is essential for clients already undergoing a crisis that could feel exasperated by the demands of moving to a new state.

Multistate licenses especially benefit rural communities, which bear the brunt of the shortage. In Southeast Kansas, for example, there are only 35 licensed social workers serving 16 counties. The compact will allow rural Kansas residents to remotely access care from states across the country, rather than being limited to those within one state.

The licenses also benefit the families of service members. Social workers who are military spouses find themselves relocating every few years, creating a significant strain as they regularly lose their license and clientele. Their sacrifice is great enough without needlessly handicapping their professional lives. Now, under a multistate licensing structure, military spouses can continue serving their clients even as our country calls them from state to state.

While the bill is a significant step toward addressing Kansas’ mental health needs, policymakers must address the factors keeping would-be social workers from joining the field. Social workers have low salaries that make the debt incurred during graduate school difficult to pay off. Initiatives such as paid internships, scholarships and loan forgiveness programs are the next step.

The compact is an important step in making tangible improvements for licensed social workers and their clients across the state. While Kansas has a long way to go before its most vulnerable members have sufficient access to the proper resources, it has started enacting meaningful change.

— Betsy Cauble is a board member at Preferra Insurance Company RRG, a behavioral health liability insurance company overseen by social workers, and the retired department head and associate professor of social work emeritus at Kansas State University.

Kansas ranked last in the “State of Mental Health in America 2023” report. The need for improved mental health ...

Your Turn: Proposed cuts put residents, firefighters at risk

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Trans care debate influenced by misinformation, doctors say

Though attacks on gender-affirming care have increased over the past few years, many of the medical procedures under the umbrella of gender-affirming care are not new.

Puberty blockers were first approved by the FDA in 1993. Originally approved to temporarily delay puberty in children who were going through it too early, they block the release of hormones leading to puberty-related changes in the body. Such treatments are also reversible — a child who was taking them would be able to eventually go through puberty if they stopped taking them, Weeden said.

“Essentially, puberty is paused. And basically, that allows that youth or that child to kind of explore their gender, explore if they really want to pursue hormones or not. And so puberty-pausing medications are reversible,” Weeden said.

Weeden said that one misconception people have about gender-affirming care is how long it takes for people to start certain aspects of care, such as puberty blockers or hormone replacement therapy.

Unlike other medications, the process isn’t as simple as getting a prescription after one appointment — people will see multiple providers, including a behavioral health specialist, before they start the medication. The process, Weeden said, can take weeks to months.

“It is a multidisciplinary approach in that you have input from behavioral health specialists and clinicians, psychiatrists, sometimes an endocrinologist . . . A lot of different specialties come together in agreement to support this view in their transition,” he said.

In the case of minors, all aspects of gender-affirming care, from puberty blockers to hormone replacement therapy, are done only with parental consent, Weeden said.

But for Sen. Ted Cruz, R-Texas, the guidance from major medical organizations and from physicians like Weeden is insignificant.

“​​It is never medically necessary to sterilize or castrate a child. And it is only adults in pursuit of a political agenda who do that to little boys and little girls, even though an eight-year-old lacks the emotional maturity to make lifelong decisions and give up the ability to be a mother or father because of peer pressure in the moment,” Cruz said.

“My opposition has been really on the minors side of it,” said Sen. James Lankford, R-Okla.

Many Republicans, like Cruz, often point to surgery for youth as a driving force behind their objections, portraying it as a common procedure for trans youth.

But most transgender youth who receive gender-affirming care do not have surgery as minors. A study published in 2023 in JAMA Network Open tracked more than 48,000 patients who had operations in hospitals and outpatient surgery centers. It found that, of those who had gender-affirming surgery from 2016-20, fewer than 8 percent — 3,678 — were aged 12-18. Surgeries in younger patients were primarily breast and chest procedures, while genital surgical procedures were more common in older patients.

Such procedures for youth are rare, and when they do happen, happen only with the consent of parents and in consultation with multiple other health providers, Weeden said.

“This is an informed-consent process with consent from parents and support from providers and professionals. So we cannot do any of this without the consent from their parents,” Weeden said.

Legislation

Seventy-five anti-trans bills have been introduced during this Congress, including bills that would prohibit trans people from serving in the military and a bill that would make it a felony for doctors to perform gender-affirming care on minors, according to the Trans Legislation Tracker , an independent database tracking bills affecting transgender people across the United States.

At the state level, 638 bills have been introduced across 43 states in 2024, with 45 of them having passed. Of those introduced, 466 failed. The remainder have yet to move.

Although there has yet to be a federal law restricting access to gender-affirming care, 25 states have laws that limit youth access to gender-affirming care, according to KFF, a health care think tank.

Restrictions on gender-affirming care have made their way into a series of must-pass appropriations bills.

They’ve also been attached to must-pass authorizations: An amendment to the fiscal 2025 National Defense Authorization Act that would prohibit TRICARE from covering and the Defense Department from furnishing gender transition surgeries and gender hormone treatments for individuals who identify as transgender. The House adopted the amendment June 13 by a vote of 213-206. The bill ultimately passed the House by a vote of 217-199.

The Senate Armed Services Committee approved its version of the NDAA last month, which also included an amendment to prohibit the Defense Department from providing gender-affirming surgeries to transgender servicemembers or insurance coverage for any gender-affirming medical care for transgender youth whose parents are serving in the military.

The bill would likely not pass the full Senate with such an amendment, let alone get signed into law by President Joe Biden.

But for Branstetter and others, that doesn’t make the existence of these bills any less frightening.

“Part of the effort is again dehumanizing trans people from a kind of person into a toxic influence that can be stamped out,” Branstetter said.

Ariel Cohen contributed to this report.

Impact of Foundation Degree in Health and Social Care Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Description, action plan.

This reflective essay is based on my progression in the past two months, where I have been undertaking a Foundation Degree in Health and Social Care. In this essay, I intend to cover many issues relating to this course. The discussion includes frequent assessments, the importance of coming together in groups, and talking about what I need to work on to improve my personal growth and development professionally. The reflection will also enable me to be a better practitioner by learning from my previous mistakes and bettering myself as a person. I will implement a consistent act in developing and growing efficiency and effectiveness within the context of what is considered a desirable practice. The concepts I have grasped will make me easily use the abilities I learned and implement the skills effectively related to my learning and training.

Gibb’s Reflective Cycle has enabled me to break down the reflection with ease because of its systematic flow, which is easy to understand. The model is effective because it ensures every detail in the reflective essay is covered effectively (Adeani, Febriani, and yafryadin, 2020). Some of the areas I will reflect on include time management, assignment writing, referencing, critical thinking presentation, and module evaluation. More details on my development in specific areas are elaborated on in the sections below, as per Gibb’s Reflective Cycle throughout the paper.

When the semester started, and I had my first module, I was buzzing and ready for the course. The introductory part was interesting, as everything seemed to be easy and encouraged me to set my mind ready for completing the next semester. This part was a great introduction to the course, as I learned that I would be handling more topics than I had expected. The professor was brilliant in all aspects. It was easy to note that he had simplified the work to enable everyone to understand the course concepts and ways of handling various topics. At some point, the professor taught about literature management, and that is when I learned the value of taking short notes as the lecture continued. I discovered that short notes are easy to go through and remember during any revisions. The lecturers/tutors provided various assignments during the course, including group work, which were very insightful. The different learning styles that the tutors have introduced are helpful, and I find them useful. Based on this knowledge, I can now choose the best approaches to studying per my learning style. Having specific learning styles is that it assists with proper time management. It is necessary to involve proper timing as I participate in group discussions and project management, and it will be proper to save time for the other aspects of my studies.

The individual assignment was a bit easier than what I did to do for the group work; however, I enjoyed the group tasks even more. The group assignment made me ha acquire good presentation skills. Once one has enough knowledge on a topic, presenting it becomes easy. The first major group project enabled me to learn and get to know some of my classmates better; though most were younger than me, they were extremely brilliant in their assignment input. We divided the workload so that everyone would be able to handle a specific topic and present it effectively. However, there was confusion whereby three people picked e same topic, so we had to quickly gather and do the pending work in the shortest period possible. That was when I realized how smart my group mates were and could critically think and analyze a question to give the best assignment’s answers. I have to admit that the first group assignment that was theoretical made me better in every aspect. Most significantly, it honed my critical and analytical skills in various assignments. When the results came for the written group assignment, we had passed. Nevertheless, the sections we scored even more highly are the areas we handled together as a group; one of the benefits of group work.

As one of the older students in the class, the entire period’s experience has enabled me to uplift my confidence. Engaging with younger learners in the class brings out some level of confidence (Ford et al., 2015). However, as Edwards and Best (2020) observe, personal growth and improvement build on awareness. Of late am always alert and updated on a variety of issues with regards to what I learn and how I do it. Close association with my tutor outside and inside the class has been essential to understanding specific topics and having diverse opinions n certain topics. That is among the reasons until today, my results have been top-notch, always striving to do more and become a better learner. The entire faculty is very friendly, so it is easy to seek assistance in any matter. I have acquired more knowledge and skill in Health and Social Care in the past two months than I ever had anticipated.

At the beginning of the module, I did not know what to make of some situations while in class. I was a bit nervous and silent and did not participate much. In the past month, I was able to illustrate a different presentation by myself brilliantly. The attitude has grown from then, and I feel more rejuvenated and ready to work on any assignment or presentation. People often overlook the importance of professors and tutors (Veine et al., 2018). The way I can break down information now shows pure growth and development, all thanks to my professors (Dhaliwal, Singh, and Singh, 2017).

During the first major group work, where we had assigned portions for everyone to handle, I was a bit mad and frustrated when some group members had not done part of their assignment and instead did what was assigned to others. Everything was in shambles and the fact that I could not previously work well under pressure. The three who had messed up were also nervous and full of guilt. What made me change my view on my group members’ is the unity and work rate they put in to ensure that the project was done efficiently using the least possible time. That group project created a bond that made us closer even when out of school.

This module has been beneficial to my growth, and I am already buzzing about what awaits in the next module. The good and bad things about a situation always create ripple effects depending on the circumstances. As I evaluated the results with my group members today, I realized that we made a mistake in assigning different projects to the group members. We could have done the best thing to join our minds and do all the assignments from start to finish together. However, the upside of the situation is that even though the deadline was approaching fast, we managed to work on the assignments effectively. There was a revelation that the people in that group had an intense work rate. On realizing that everyone was focused and intended to work hard, it was clear that we would pass the project and beat the deadline.

I believe everything is currently on the right track for me because of the work rate and dedication that I am putting in so that I can be among the best in the field. It is not easy to be ranked as one of the best in a field without major dedication. That is what I have my eyes focused on, being the best in my field so that I may be able to work with other greats. The reason why things were hard for me, in the beginning, was my naivety. But now, with all the confidence in me, I can achieve anything. Even with the group, things did not previously go well as planned because there was no common ground at first. Since everyone was new, everyone opted to handle their work section, which caused significant confusion. What drove the group members in producing their best is the joint effort that brought out the work rate and discipline from everyone.

There was also no groupthink element, whereby the most dominant answer was not contested (Bassot, 2020). This never happened in our group, and a matter of fact is that everyone fairly gave their ideas, and if it was convincing enough, then it is what we used.

On reflection, I believe that I have overachieved what was initially in my work schedule. Knowing clinical practices is a breakthrough as I ready myself for my career. It is essential to have basic knowledge of all career requirements. (Husebø, O’Regan and Nestel, 2015). I have surpassed the expected standards that I had initially planned. This is a hallmark, and it shows just how much dedication I have put in working on my major. The progress I have in just the two months has enabled me to acquire various health-related skills, get more knowledge on clinical practices, and acquire new insights and ideas regarding my major. Frequent reflection of what I have accomplished is essential as it will necessitate professional and personal development, as Wain (2017) emphasizes. When I look back at the group assignments and workshop, I smile a bit because they are not only exciting but there are lots of new information that I get to know during the workshops.

The two months have been very fruitful, and I have gained valuable skills and knowledge from the modules. By reflecting, we develop reflective skills such as self-awareness, ability to describe, critically analyze, synthesize, and evaluate (Béres and Fook, 2020). This reflection is important for any scholar as it helps identify strengths and areas which need improvement.

I want to do more in order to keep growing in the field of health and social care practice. All this is achievable if I continue with the work ethic I am currently putting in. Slowing down will make me lose focus on the end goal. By following my professors’ advice, frequently practising through placements, and implementing all that I have learned and keep learning, I will undoubtedly reach my targets. Through my evaluation and analysis, it is evident that my learning curve is on a steady rise. Because I am still in my learning process, I must acquire substantial knowledge to fit my professional portfolio and assist during job hunting in the future. The referencing skills acquired will push me to be a better researcher.

In all honesty, despite everything going on well currently, if I had an opportunity to change anything, the only thing I would change is how I first present myself as a timid person. I now believe that there was nothing to be nervous about, and all that counted was me being able to express myself. Thankfully to those involved with the school, right from the faculty, the professors, and fellow learners, who have made me more confident and courageous when undertaking an array of activities. The next time I am in the same situation, I will act accordingly and make my presence felt right from the beginning. Regarding the group situation, with the little experience from my first group rodeo, I will be able to take charge and assist the group member in making appropriate decisions regarding the different projects we are handling. I will also ensure that every member is awarded the appropriate time to express themselves without any form of prejudice. By following my action plan, I believe I will supersede all my set goals and be an excellent example to everyone out there.

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IvyPanda. (2022, February 23). Impact of Foundation Degree in Health and Social Care. https://ivypanda.com/essays/impact-of-foundation-degree-in-health-and-social-care/

"Impact of Foundation Degree in Health and Social Care." IvyPanda , 23 Feb. 2022, ivypanda.com/essays/impact-of-foundation-degree-in-health-and-social-care/.

IvyPanda . (2022) 'Impact of Foundation Degree in Health and Social Care'. 23 February.

IvyPanda . 2022. "Impact of Foundation Degree in Health and Social Care." February 23, 2022. https://ivypanda.com/essays/impact-of-foundation-degree-in-health-and-social-care/.

1. IvyPanda . "Impact of Foundation Degree in Health and Social Care." February 23, 2022. https://ivypanda.com/essays/impact-of-foundation-degree-in-health-and-social-care/.

Bibliography

IvyPanda . "Impact of Foundation Degree in Health and Social Care." February 23, 2022. https://ivypanda.com/essays/impact-of-foundation-degree-in-health-and-social-care/.