Week 6&7 Legal & Ethical

Economic and Legal Issues in Gerontological Nursing

Learning Objectives

Upon completing this chapter, the reader will be able to:

• Explain the disparities in health insurance for out-of-hospital health care services across Canadian provinces and territories.

• Describe the financing of the Canadian health care system.

• Compare the Old Age Security (OAS) program, Canada Pension Plan (CPP), and Quebec Pension Plan (QPP).

• Compare and discuss the roles of a power of attorney and a guardian.

• Explain the process for assessing mental capacity and detect elder abuse.

• Discuss strategies for preventing and detecting elder abuse in older adults.

The Canada Health Act

The Canada Health Act of 1984 serves as the backbone of Canada's national health insurance plan, outlining federal, provincial, and territorial responsibilities within the health care system. Provinces and territories are primarily responsible for the administration and delivery of health care. Medically necessary services, including primary health care, hospitalization, and surgical-dental services, are publicly insured under this act. The federal government plays a supporting role by setting national principles, collaborating on health policies, and providing funding through transfer payments, while significant variability may exist among provinces in terms of available services, particularly in home care, long-term care, and medication provision outside hospitals.

Principles of the Canada Health Act

The key principles include:

1. Public Administration: Insurance programs must be managed by a public authority on a non-profit basis.

2. Comprehensiveness: All necessary health services must be insured, which includes hospital, physician, and surgical care.

3. Universality: All residents are entitled to the same level of health care regardless of the province.

4. Portability: Canadians retain their insured health services when moving across provinces.

5. Accessibility: Reasonable access to health care facilities must be provided to all insured individuals.

Health Care Financing

In 2019, Canada's health care expenditure was approximately $265.5 billion, with government funding accounting for about 70% of the total spending. Notably, older adults (65+) received significant health care funding, with per capita spending at $11,599, just behind infants. This demonstrates that health care spending increases with age, particularly as older adults typically experience more health challenges.

Social Security Retirement Income Programs

• Old Age Security (OAS) Program: This program supports older Canadians with monthly pensions, indexed for inflation. Eligibility requires a minimum of 10 years of residency in Canada. In 2021, the maximum monthly benefit was $615.37.

• Guaranteed Income Supplement (GIS): For those with limited income, the GIS provides additional financial support. The maximum monthly benefit in 2021 was $919.12 for single recipients.

• Allowance and Allowance for the Survivor: These are income-based benefits for those aged 60-64, with maximum benefits of $1,168.65 and $1,393.05 respectively, helping ensure financial support during retirement.

• Canada Pension Plan (CPP) and Quebec Pension Plan (QPP): These plans provide retirement and disability benefits contingent upon contributions made during employment. The maximum monthly benefit was $1,203.75 in 2021.

Implications for Gerontological Nursing

Gerontological nursing plays a crucial role in ensuring older Canadians do not fall into poverty, although disparities in access to services can exist based on income and geography. Nurses should assess total income sources and help clients navigate OAS and CPP/QPP application processes. Understanding the financial frameworks is essential for promoting age-friendly attitudes and combating ageism.

Legal Issues in Gerontological Nursing

Legal Capacity refers to an individual’s ability to make informed decisions and is critical to gerontological nursing practice. Nurses must understand that individuals are presumed capable unless legally deemed otherwise. Their capacity can vary by the context of decisions, requiring careful assessment by the nurse or other relevant professionals.

• Power of Attorney: This document allows one person to act on behalf of another, and it can be continuous or temporary. A guardian may also be appointed through a court if incapacity is established.

Elder Abuse

Elder abuse encompasses actions by trusted individuals that result in harm or distress, prevalent across various demographics in Canada. It includes:

• Physical: Direct harm to the person.

• Emotional: Psychological distress, frequent intimidation, or degrading treatment.

• Financial: Mismanagement of finances or coercion regarding matters of assets.

• Neglect: Failing to provide necessary care.

Risk Factors for Abuse

Some factors associated with increased risk include:

• Social Isolation

• Cognitive Impairment

• Dependency on caregivers for daily activities

• Previous negative experiences in relationships.

Signs of Elder Abuse

Indications of elder abuse may include behavioral changes such as anxiety, unexplained injuries, neglect in personal care, and sudden changes in financial status.

Intervention and Prevention

Nurses must be alert to the signs of possible elder abuse. When abuse is suspected, a thorough assessment should be conducted, ensuring the victim’s voice and safety are prioritized. Interventions may include stopping mistreatment, ensuring victim safety, rehabilitating offenders, and providing resources for prevention.

Reporting Obligations

In Canada, legal frameworks may mandate reporting suspected abuse, particularly in long-term care settings. This underscores the importance of proactive measures from health professionals to ensure elder safety and security.