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ETHICS AND DISABILITY

ETHICS AND DISABILITY. Susan Fox Project Director Institute on Disability/UNH May 23, 2006. Presentation Goals. Students will Gain an awareness of NH’s system of care for older adults and persons with disabilities;

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ETHICS AND DISABILITY

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  1. ETHICS AND DISABILITY Susan Fox Project Director Institute on Disability/UNH May 23, 2006

  2. Presentation Goals • Students will • Gain an awareness of NH’s system of care for older adults and persons with disabilities; • Gain an understanding of some of the trends and challenges around disability and aging; and • Discuss ethical dilemmas related to disability and aging.

  3. NH’s System of Care for Persons with Developmental Disabilities • Prior to 1981 • Laconia State School (LSS) • Several local agencies established by parent groups • 1990’s • LSS closed • Area Agencies for Developmental Services in each region of the state • Fully community-based system of care • 2000’s • Community Engagement

  4. NH’s System of Care for Persons with Mental Illness • 1960’s: JFK: Community Mental Health Center Act • Deinstitutionalization • Community Mental Health Centers in each region • State hospital in Concord and Designated receiving facilities in selected communities (Acute Care) • Community based system of care focused on evidenced based practice and recovery • Increasing numbers and access to services

  5. NH’s System of Care for Older Adults • No organized system of care at the community level • Senior centers, Meals on Wheels, RSVP, Adult Day Care, Residential Options, Home Health, VNA’s, Nursing Homes, Service Link Resource Centers….. • Disproportionate expenditures for institution-based long-term care vs. home and community based care

  6. NH’s System of Care for Children • Families • Education/Schools • Health and Human Services • Developmental Disabilities • Mental Health • Child Protection • Juvenile Justice

  7. Role of the Department of Health and Human Services • Promulgate Rules to Implement Laws and Legislative Mandates • Contract with Community Providers and Monitor Services Provided • Allocate Available Resources • State Funds • Medicaid Funds • Federal Grant Funds • Monitor Quality Outcomes • Provide Leadership and Vision

  8. Current Trends and Challenges • Increased Demand for Services: Waiting Lists for services. Federal Litigation. • Competing demands for services • Advances in Medical Procedures and Treatment • Changing Expectations of Families and Individuals • Lack of an Adequate Workforce • Limits of Human Service Systems • Information Technology Advancements

  9. Aging Demographics • Dramatic projected growth for age 65+ • New Hampshire growth for age 65+ will rank 12th in USA for 2000-2020 • Most rapidly growing group: Age 85+ • Physical and mental disability associated with advancing aging • Decrease in working age population

  10. Ethical Dilemmas • Disability and stigma and how it impacts quality of care • Efforts to de-link disability and poverty • Institutional vs. home and community based care • Choice and control: Whose? Dignity of Risk • Lack of availability of medical and home care professionals

  11. Ethical Dilemmas • Funding and the cost of care: Who receives services and how much? • Advances in medical science which save lives and increase longevity and who pays • Lack of universal health care coverage • Cost of long term care as baby boomers age: How will the US afford it? Crisis in Social Security, Medicaid, Medicare. • State budget issue: Education vs. Elders vs. Mental Health vs. Developmental Disabilities

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