Abstract
There is a large number of older adults who are abused and neglected in their own private homes, nursing homes, and even medical facilities such as hospitals. Abuse and neglect is currently expanding because the relative population of older adults is currently increasing compared to younger adults and children. In the U.S., it is estimated that about 10% of older adults are exposed to abuse or neglect by a caregiver each year. Professional healthcare members believe that abuse and neglect by healthcare staff in an institution is worse than by family or friends because those older adults come to the hospital to receive care. Abuse and neglect is underreported in nursing homes and extremely underreported in private homes because family members may be involved. Intervention plans with a patient are determined based on each unique situation, which may involve but are not limited to: creating an honest conversation with the patient, notifying authorities, documenting a report, and educating older adults.
There is a large number of older adults who are abused and neglected in their own private homes, nursing homes, and even medical facilities such as hospitals. Many people and even some medical caregivers may underestimate the situation, which is further expanding because the relative population of older adults is currently increasing compared to younger adults and children. Therefore, there will be a larger number of geriatric care over the next 20 years and thereby a larger number of potentially abused and neglected older adults (Robert and Michol, 2014, p. 453).
In the U.S., it is estimated that about 10% of older adults are exposed to abuse or neglect by a caregiver each year (Robert and Michol, p. 453). Quinn and Tomita (1986) described 5 types of elder abuse: physical, psychological, financial, violation of rights, and sexual abuse (Shirley et al, 2010, p. 284). Physical and psychological abuse are the most common. However, physical abuse occurs much less frequently than psychological abuse. The definition of abuse is the “intentional actions that cause harm or a risk of harm to a person who takes care of the elderly,” or as “failure to meet the basic needs of the elderly or inadequate protection from danger or distress” (Graziamaria et al, 2014, p. 299). The definition and concept of geriatric neglect is still undergoing controversy (Tova-Band, 2012, p. 55). Abuse and neglect does not necessarily have to be caused by healthcare staff. There are many cases where older adults have been abused and neglected by their own family or friends. This kind of abuse and neglect occurs most commonly at their own private homes (www.apa.org).
Professional healthcare members believe that abuse and neglect by healthcare staff in an institution is worse than by family or friends because these older adults come to the hospital in order to receive care. These people are helpless and dependent on staff members. Staff who abuse and neglect these men and women are “neglectful because of lack of responsibility … people want to finish their work quickly and the patient doesn’t really matter to them” (Tova-Band, p. 59). Unfortunately, it was observed that elderly abuse in nursing homes is still underreported in both articles and reviews compared to elderly abuse in hospital institutions. Attention is paid to this phenomenon only when reports of medical malpractice occurs, which give rise to only part of the problem, and often leads to incorrect observations and conclusions about the activities of health workers as well as the nature of the event (Graziamaria et al, p. 297). It is even more unfortunate that elderly abuse in their own private homes are very rarely reported, reviewed, or even known about. However, based on current information, emotional abuse, financial abuse, and general neglect is more likely to occur at home by family members—more commonly by grandchildren—rather than healthcare providers (Nancy et al, 2012).
Evidence based intervention is currently limited but it if suspicion arises concerning abuse or neglect of an older adult, it is important to first determine whether the patient is in imminent danger, able to openly and fearlessly talk about the situation, and cognitively able to make decisions concerning his or her own care. In addition, it is crucial to understand the potential possibility for future abuse or neglect and whether or not it can be prevented (Sharon, 2000, p. 28). Notify the correct authorized reporting agency to ensure the patient’s safety. However, this may result in hospitalizing or alternating the living arrangements of the patient. Furthermore, it is recommended to focus and “stick your nose in” on the relationship between the patient and potential abuser/neglecter in order to develop useful indications concerning the situation. Reading the patient’s tone of voice and body language is very important because it may provide cues regarding whether he or she is nervous and scared or relaxed and happy. Finally, accurately and objectively document all results and finding according to the facility policy (Sharon, p. 28).
It is important to educate and prepare older adults in the misunderstood case of abuse and neglect and how to prevent such a situation from occurring to themselves or somebody else.
References
Corbi, G., Grattagliano, I., Ivshina, E., Ferrara, N., Solimeno Cipriano, A., & Campobasso, C.     (2015). Elderly abuse: Risk factors and nursing role. Internal and Emergency Medicine, 10(3), 297-303. *
Elder Abuse and Neglect: In Search of Solutions. (2012). Retrieved July 20, 2015, from http://www.apa.org/pi/aging/resources/guides/elder-abuse.pdf
Falk, N. L., Baigis, J., Kopac, C., (August 14, 2012) “Elder Mistreatment and the Elder Justice Act” OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 3 *
Hoover, Robert M., & Polson, Michol. (2014). Detecting elder abuse and neglect: Assessment and intervention. American Family Physician, 89(6), 453.
Lo, S., Lai, C., & Tsui, C. (2010). Student nurses’ perception and understanding of elder abuse.International Journal of Older People Nursing, 5(4), 283-289.
Stark, S. (2012). Elder abuse: Screening, intervention, and prevention. Nursing, 24-29.
Winterstein, T. (2012). Nurses’ Experiences of the Encounter with Elder Neglect. Journal of Nursing Scholarship, 44(1), 55-62. *
Henry Ford as a Transformational Leader
           Alexander the Great, Buddha, Julius Caesar, Jesus Christ, Confucius, John F. Kennedy, and many others were great leaders. However, they didn’t simply follow any type of leadership, they were transformational leaders. Transformational leadership is a unique style of leadership where the leader is able to identify necessary changes within a certain situation or society. He or she builds and executes a vision that influences inspiration and innovation. The leader helps his or her members by guiding them, understanding them, and caring for them. Transformational leaders are commonly seen as energetic, enthusiastic, intuitive, passionate, and, most of all, communicative. Henry Ford was a unique and one of the greatest innovators that many, of course, know about but would not recall him as a transformational leader, which he certainly was.
Transformational leadership can be broken down into 4 elements: individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence (Joseph, 2006). Individual consideration represents the degree of how the leader attends to each individual’s requirements and needs, expresses empathy and emotional support, strongly and genuinely communicated with his or her members while showing respect and, most importantly, motivation. Intellectual stimulation is the degree of how the leader challenges public assumptions, engages in educated risk, encourages innovation and creativity, and helps the members think and learn. Inspirational motivation is the degree of how the leader expresses a vision through eloquence and articulation, provides a meaning behind each task, and enthusiasm to further work and claim victory. Finally, idealized influence is the degree of how the leader delivers him or herself as a role model for good ethical behavior, pride, respect, and trust between one another.
Henry Ford met all four elements of a transformational leader, but he expressed individual consideration and intellectual stimulation more much more than the other two. He revolutionized how cars were sold, and he did this by being attentive toward each individual among both his workplaces and the public. Henry Ford built a widespread and branched out network of dealership to provide vehicles for people across the countries, not just in one state. He focused on identifying and understanding his worker’s and consumer’s point of views. From this, Henry Ford more than doubled the factory worker’s minimum wage from 2.34 dollars to 5.00 dollars per hour. In addition, he reduced the 9-hour work day to a more comfortable 8 hours. These actions motivated and animated his employees to work much more efficiently. The understanding of his intellectual stimulation comes into play when realizing the challenges and risks he had taken. By decreasing the cost of his universal model, the Ford Model T, and increasing the hourly pay for factory workers, Henry Ford was able to sell more vehicles than ever before. The public gradually began to look up to him as a great leader of the twentieth century.
Henry Ford excelled at practical creativity. Using ideas of how the peat packing industry had worked, he built the moving assembly line for production of vehicles. However, his empathy, support, and respect toward the public excelled just as equally as his creativity. Henry Ford introduced interchangeable parts for vehicles, which provided availability of car parts everywhere that his model was being sold. He wanted everybody, lower-class, middle-class, and upper-class, to be able to get their hands on cheap and reliable vehicles. When asked to build an exclusive model for only the upper-class, Henry Ford declines and said that he believes in equality. He understood the financial as well as the work life of the public. Most extraordinarily, he employed women, Spanish, African-Americans, Chinese, and handicapped people before any other companies and businesses did.
“When everything seems to be going against you, remember that the airplane takes off against the wind, not with it” is a famous quote by Henry Ford. He believed in inspiration and motivation. He wasn’t as great of an inspirational leader as Martin Luther King, Jr., but he inspired business men and the future success in the production of vehicles. His idealized influence wasn’t as narrow as his inspirational motivation. In fact, Henry Ford maintained a very strict, genuine, and peaceful attitude with a tenacious vision for the future, which may be what had eventually brought him down. Henry Ford may have been a little too peaceful; he attempted to end the First World War by executing a peace ship toward Europe. The mission failed and his leadership become controversial. It was not long until the stock market had crashed and the Great Depression hit the Western World and Henry Ford’s role as a great leader had completely vanished.
References
Boyett, J. (2006). The Science of Leadership. Retrieved July 30, 2015, from http://www.veritaslg.com/assets/files/Articles/Leadership/The Science of Leadership.pdf
Snow, R. (n.d.). I invented the modern age: The rise of Henry Ford.
Introduction
Before I began providing health care and education service at my community sites, I had expected that I will be communicating, educating, diagnosing, and constructing solutions to the diagnoses. I expected that I will be working in collaboration with peers and potentially other community health care students. My initial goals were to begin understanding the communities and any problems that the community members may have. In addition, I wanted to educate those members regarding their problems as well as other common problems within similar communities. Concerning diagnoses, I was expecting the possibility of some members experiencing psychological problems such as the use of alcohol and excessive smoking of cigarettes. My end goal was to create a change for the better concerning health and health education in the communities before I am to complete my student services. The following are nine objectives I have completed in order to achieve the goals of this course:
• Demonstrating individual professionalism through personal behaviors and appearance
• Employing analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting
• Effectively communicating with diverse groups and disciplines using a variety of strategies regarding the health needs of individual and families in the community setting
• Establishing an environment conductive to learning and use a plan for learners based on evidence-based practice
• Utilizing informational technology when managing individual and families in the community
• Demonstrating a commitment to professional development
• Incorporating professional nursing standards and accountability into practice
• Collaborating with clients, significant support persons, and members of the health care team
• Recognizing the impact of economic, political, social, and demographic forces that affect the delivery of health care services
Abstract
I demonstrate professionalism through my behavior and appearances in the clinical setting. I demonstrate and employ analytical and critical reasoning skills whenever I provide care to clients and their families. I aspire to provide effective communication to clients by understanding and relating with them not only in a professional and educational but also in a motivational and emotional fashion. These types of communication allow me to properly establish an environment that is conducive to both the learning and practical understanding for each client. A conducive environment provides comfort and satisfaction for each client; this allows me to build a trust and understanding with the clients and thereby allowing me to be capable of recognizing common situations and then their solutions. I apply all necessary standards within clinical practice, and I hold myself accountable for all actions committed or concerning by me. I understand the significance of collaboration very well as a result of first-hand experience that I have gained with my peers within the clinical community.
Clinical Evaluation Tool and Self-Reflection
Demonstrates individual professionalism through personal behaviors and appearance.
In my opinion, I maintain confidentiality with clients and their family members in a very professional manner. Each client has their right to privacy. I have been strongly influenced and taught to maintain their right to privacy with outmost effort. Efficiently reporting and analyzing patient safety events help lead myself toward being more capable of properly applying HIPAA rules and regulations. For each clinical group, I was able to prepare learning materials for the clients concerning nutrition and diet, BMIs, risk factors and prevention of high blood pressure, hydration during hot weather, and exercising. All assignments are completed and given or posted in a timely manner. Whenever I require guidance, I search for assistance and ask questions to my professor and my peers; in addition, I may explore online for answers or solutions. I attend each clinical pre and post conference. I participate in these conferences by being attentive and actively engaged during any given questions or explained answers. If I cannot absolutely comprehend a certain topic being mentioned during a conference, I follow up by researching and refreshing my knowledge regarding that topic. I believe that I maintain good accordance with school policy and clinical punctuality. I aim toward being as honest, punctual, professional, and ethical as possible concerning all of the school and clinical settings which I am in. Professional attire is crucial and thereby I always maintain to dress in a professional manner by wearing casual yet professional attire. I exclude from wearing any form of clothes that are overly casual or inadequate and deemed inappropriate.
Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Utilizing client interview, nursing and medical records, staff nurses, and other health professionals to collect client information is difficult in my situation as a student studying communities because many clients from these communities do not have medical records and other similar information. However, I do utilize any client interview and professional help when possible considering the situation and circumstances. I believe that I assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status, and I think that I sometimes do so subconsciously. Providing care for clients is an objective that I carry out by determining and evaluating not only a client’s clinical condition but as well their psychological conditions, which may concern his or her culture and religion. During times when I have taken a client’s blood pressure or height and weight, I attempted to collect relevant information to the client’s self-care needs. Based on my analysis of the client’s medical history, I have tried to prioritize their need by implementing safe and certain care and nursing interventions in a timely manner. At the particular clinical settings where I am, I am not responsible for administrating medication or treatments, but I am responsible in educating clients regarding safe use of medication. I evaluate two different groups based on weekly monitoring of their blood pressure screening, ability to verbalize low-sodium diet, appropriate nutritional and daily water intake. Outcomes of certain clients are met, but others require modification of the given timeframe. I believe that I am providing and maintaining a safe environment for the clients within the community by becoming familiar with the surroundings such as knowing the location of the closest exits and being able to work with the allowed scope of practice as a student nurse.
Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individual and families in the community setting.
Nursing is a caring profession, and therefore I utilize therapeutic communication with individual clients based on their unique needs for certain care and education. In the settings where I am expanding my knowledge, I mostly use face-to-face interaction that focus on advancing the physical and emotional well-being of a client. My purposes are mainly designed to collect information, determine illness, assess and modify behavior, and provide health education. My communication with instructors and peers concerning significant data is very productive and clear because we are all skilled practitioners. I adapt my communication skills by being courteous, understanding, and having non-judgmental attitude towards my clients. The only written documentation that I am able to obtain concerns general and anonymous health surveys, blood pressure screening, and BMIs.
 Establish environment conductive to learning and use a plan for learners based on evidence-based practice.
I implement education with my clinical group to clients and their families based the nursing plan. Every time that we were able to provide presentations concerning various health subjects such as nutrition and staying hydrated during hot weather. Based on the unique environment among each community, I was able to use certain factors that I believed would been advantageous such as using body language with non-English speaking clients and being able to provide brochures that were written in the client’s native language. Based on the clients and families that were able to verbalize or demonstrate in return the information provided during the presentations, I was able to evaluate their learning outcomes.
Utilize informational technology when managing individual and families in the community.
I was not requires to utilize principles of nursing informatics in the clinical area because I obtain relatively little amount of data and information that would be considered necessary to process into a computer. However, any records and information that I do obtain from clients are subject to strict confidentiality.
Demonstrates a commitment to professional development.
I try to use the most appropriate and up-to-date literature when planning care for clients in the community setting. Presentations and communication provided to clients are built on such literature. I enjoy assuming responsibility for lifelong learning, especially when it concerns clinical education and practical engagement of that which I have learned. I engage in self-evaluation on a daily basis because it helps me recognize and improve my strengths and weaknesses toward my next clinical session. I believe that honest self-evaluation is very important. Self-evaluations help me to grow not only as a person but also as a professional in different community settings. I try to commit myself toward adjusting to the challenges of independent practice in community health nursing by not only recognizing but by also being sensitive toward cultural diversity as a non-Hispanic and non-Haitian speaking person.
 Incorporate professional nursing standards and accountability into practice.
I utilize American Nurses Association Standards as well as the agency’s standards in clinical practice by providing excellent ethics, standards, practices, and by creating a healthy and non-judgmental environment considering that there is a large population of homeless men and women who attend soup kitchen at Salvation Army. As a professional, at any given time I am accountable for my actions in the clinical area. I recognize each action that I commit and my responsibility concerning the lives of other people. I am aware of the assigned mission by my agency for the Salvation Army, which is to motivate and aid human needs without discrimination. I am also aware of the assigned mission by my agency for Our Lady of Refuge Church, which after the Great Depression began its mission on focusing more on service to the community and providing aid to those in need.
Collaborate with clients, significant support persons, and members of the health care team.
I collaborate effectively with active health care groups who address and help solve client problems. Collaboration is important because it provides each member with unique knowledge and experience given by all the collaborating members. A great example of collaboration is when my peer and I had to provide presentations, which she performed in Spanish and I performed in English. Another good example that I recognized was when one person was measuring the weight and height of a client and another peer was calculating their BMIs. Each member within a collaboration team was able to contribute toward teaching of clients and family members based on our different nursing backgrounds, cultural backgrounds, and age group as well as gender. Once a month, in Our Lady of Refuge Church, there is a person who is able to assist with establishing medical insurance clients in need. Volunteers are able to provide information of local clinics and services within the area.
Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
I have recognized that some communities have a great number of challenges compared to other communities based on economic, political, social, and demographic influences. In both communities, which were Spanish, Asian, and Haitian, some of the primary struggles were the language barrier, lack of insurance and knowledge. Once I have been able to recognize these issues, I understood that educating, setting realistic goals, and providing emotional support. I believe that advocating for clients to change their daily habits concerning nutrition and personal health will provide only positive results to both the clients and their families.
Conclusion
Many of my expectations that I have mentioned in my introduction did happen. I now understand the communities and their members at both Our Lady of Refuge Church and Salvation Army. I analyzed their diagnoses and recognized both the issues and solutions to those issues. Many of these were as I had expected; poor nutrition, poor hydration during hot weather, lack of exercise, and lack of general knowledge concerning personal health. However, I also recognized a few other issues such as lack of motivation to continue living a healthy lifestyle, and language barriers between the community health care nursing students and the members of those communities. By recognizing these problems, collaborating with peers, and being organized and informative, the language barrier no longer posed a threat to our goals. I am hoping that our continuous education and communication with the community members will improve their motivation. On the bright side, I noticed very little use of alcohol as well as excessive smoking of cigarettes, which makes me happy. Overall, I have really enjoyed my experience at both communities. The feeling of helping these people in a way that can impact the rest of their life for the better pleased me a lot.
Coping with Emerging Technology in Nursing Practice
Medicaid is a jointly-funded federal and state health insurance program which provides health coverage to eligible individuals. It was created in 1965 during the Social Security Amendment. The objective of this action was to aid the states by providing medical assistance to citizens whose income were below par. However, it is not mandatory for a state to participate in expanding medical coverage within its region. If a state accepts to participate, it gains the authority to administer its own eligibility requirements and more. Recently, in 2010, the Patient Protection and Affordable Care Act (PPACA) has been passed. which helped revise and further expand medical coverage beginning 2014. States who accept to participate are required to expand the eligibility requirements. As of September 1, 2015, thirty-one states have accepted to expand Medicaid, which means that nineteen states have rejected in participation. These states are Alabama, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, Oklahoma, N. Carolina, S. Carolina, S. Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming, and Utah, which currently stands undecided (kff.org).
Of course, there are pros and cons for a state to either opt for or against Medicaid expansion. Each state’s decision may be influenced by it’s current situation concerning financial stability, health care stability, history with the federal government and et cetera. However, more states have decided to accept Medicaid expansion compared to the states who have rejected it, which issues the idea that Medicaid expansion may offer more pros than cons. The following are several of the many common pros that are being presented by people across the country. The federal government covers 100% of finances for each state during its first three years of medicaid expansion (2014 – 2016). After those first three years, the federal government will cover 95% of finances with a reduction of 1% for each subsequent year until 2020, which from there it will cover only 90% of medical coverage finances. However, the percentage will not decrease after 2020. The federal government promises to provide 90% coverage regarding financial support with medicaid expenses. This agreement is much more beneficial compared to other agreements that many states have or had (before Medicaid expansion) because those agreements only covered for ranges between 50 and 77% of the total cost for medical care.
Another very popular pro concerns the number of individuals, specifically minorities, that will receive medical care and coverage. Current situations without Medicaid expansion include racial and geographical disparities within healthcare, which are improved by application of Medicaid expansion because more impecunious and minority individuals are eligible for medical coverage. One of the primary goals of Medicaid expansion is the attempt to provide health care for many, many more citizens and residents within the United States. Although many lower-class and minorities already had access to free health insurance, Medicaid expansion widens these doors for the individuals that did not have access for whatever reason being.
Underneath these popular supporting ideas are the more complicated and intricate ones. They may involve hospitals, individual states and cities, businesses, and patient outcomes. Recently, there have many many studies done by comparing states that have and have not agreed to expand Medicaid. These studies are then implemented into a deeper issue. However, the purpose of this essay is to discuss whether Medicaid expansion is overall beneficial to states and cities as well as why it is or is not.
Before PPACA was passed, Medicaid expansion was being spoken of as if it were a universal rumor. Everybody kept asking if the rates of uninsured clinic visits will decrease in states that accept to expand Medicaid, how will hospitals be affected, and if the rates of mortality and diseased patients (or patient outcome in general) decrease. One study in particular analyzed ~1.6 million patients as soon as Medicaid expansion began to take place. As a result, the data had shown a 40% decrease of uninsured individuals within clinics and a 36% increase of Medicaid-covered individuals within those same clinics based on visitation (Angier, H. et al). This was very expected but good news nonetheless. However, these changes took place only in the states that have accepted to expand Medicaid at that current time. Other states that have not yet expanded Medicaid were suffering. Their residents began to experience “unfairness” and continued to receive poor or no health coverage. As of today, Texas and Florida experience the most relatively significant effects from deciding to not expand Medicaid within their state. Non-expanding states have families fall into something called the “coverage gap,” which is when an individual’s or family’s income is above the maximum allowed for Medicaid eligibility but still below the lower limit for tax credits. Nation-wide, over 3 million individuals are experiencing the coverage gap because of their non-expanding states (Garfield, R. Et al). Texas, out of all the states in U.S., exhibits the highest percentage of individuals who fall into the coverage gap (25%).
Besides the financial situation of individuals living within the Medicaid-expanding and non-Medicaid-expanding states, hospitals also undergo financial changes. As an agreement by the PPACA, public hospitals which are located in states that have accepted Medicaid expansion are forced to help fund the PPACA by offering their Medicaid and Medicare reimbursements, which is cut down by 10.4%. In return, these hospitals will receive new and productive revenue. Medicaid expansion should provide hospitals with an additional sum of $294 billion from the years 2013 to 2022. This sum is an additional 23% of what these states would have received if they were to not accept Medicaid expansion and the PPACA (Dorn, S. et al). However, Medicaid expansion creates high costs concerning private payments because the PPACA shifts patients from subsidized private coverage and employer plans into Medicaid plans. Considering both effects, hospitals receive significant financial benefits if they are located in a state that has decided to expand Medicaid. This means that both hospitals and individuals are benefiting from the PPACA.
As mentioned before, income eligibility is a very critical topic regarding Medicaid or medical coverage. Many people fall within coverage gaps, which can really affect an individual’s life. However, expansion of Medicaid has treated this situation very well. In states where Medicaid has expanded, income eligibility percentages has increased from 82.6% to 144.2% of the federal poverty level. Also, poor or difficult health care access has decreased from 8.5% to 7.3%, and use of emergency departments have decreased by 1.1% meaning that emergency-related situations have been occurring less frequently since states began to expand Medicaid (Ndumele CD. et al). These results are great news especially for individuals who were not able to apply for Medicaid prior to expansion. Now, people are questioning whether this increase of coverage across states actually provides increased patient outcome.
One study has shown that Medicaid expansions results in adjusted reduction of all-cause mortality rates by about 20 deaths per 100,000 individuals who contained low-incomes (Sommers, B. et al). Although these numbers do not appear to be as significant as expected, this study focused only on mortality rates. Another focus of patient outcomes may also have increased by a small number, and another, and so on. All-together, a little goes a long way.  For example, another study has focused on the effects of Medicaid expansion on HIV infected individuals. African-Americans and Latinos account for a combined 65% of all newly HIV-infected individuals. The National HIV/AIDS Strategy (NHAS) proposed a goal to reduce the number of new HIV infections, increase easier access to care, and optimize health outcomes. However, situations began to arise when it was clearly evident that many people living with HIV (PLWH) did not have access to any care or treatment. In fact, only a quarter of PLWH were receiving optimal healthcare that were necessary to meet the NHAS’ goals. Low-income individuals have always been less likely to receive medical care prior to Medicaid expansion. This resulted in a high mortality caused by HIV/AIDS infections. PPACA aided this problem and brought significant outcomes. Now, in states that have decided to expand Medicaid, PLWH are able to apply for Medicaid before having their infection to progress to AIDS and becoming disabled, which was the only time PLWH were able to attain Medicaid prior to expansion. This allows NHAS to perform and complete their goals by treatment PLWH during early stages and thereby providing quicker and more effective treatments. In addition, Medicaid expansion has reduced financial barriers regarding HIV screening and testing. Less financial worry is always a benefit. Thirdly, Medicaid expansion has improved access to medications through the Medicare Part D program and thereby also closing the coverage for PLWH as well as other individuals (Abara, W. et al).
When the same study compared states that have expanded Medicaid and states that have not expanded Medicaid, they focused on HIV-patient outcomes and saw that non-expanded states showed significantly poorer results in all cases concerning HIV/AIDS-infected individuals. PLWH in these states expressed higher mortality rate, larger amount medical expenses (because only the very seriously ill were able to apply for Medicaid and thereby will require the most expensive treatment at those stages of the disease), and overall poorer results. States that have expanded Medicaid have done a great deed to their residents who live with HIV and therefore benefiting their entire state and every individual who lives there.
There have been some studies done concerning the future and potential uses of Medicaid expansion. One interesting study focuses on how Medicaid-expanded states can consider informing prisoners about Medicaid eligibility and prepare them for Medicaid application after release from jail (Somers, S. et al). This allows these convicted men and women to make changes in their lives. They can take advantage of federal grants, receive psychological services, and overall gain better health. Good health results in more rational thinking and decision-making, which is a critical goal to implement on individuals who have recently been released from jail.
PPACA has shown no incentives toward specialty medical services such as, for example, musculoskeletal surgical procedures. When an analyses was made concerning this question, the results were actually surprising. Many people expected to see little to no significant changes. However, it was observed that there has actually been a slight but steady decline in musculoskeletal surgical patients before Medicaid expansion and a slightly more drastic increase after Medicaid expansion. Results show that states which accepted Medicaid expansion show improved access to specialty services especially in NY state (Aliu, O. et al).
So why are states deciding to accept or reject Medicaid expansion? well, state affluence is one factor that poses a significant influence. Others are past policy trajectories and administrative capacities (Jacobs, L. et al). In a much more general statement, each state has it’s own history and experience that creates their own unique bias toward the PPACA and expansion of Medicaid. This decision may not necessarily be the decision of the people. However, some states went beyond their own biased opinion and saw the benefits, such as the increase in federal funding, and decided to accept Medicaid expansion. Federal and state Medicaid spending is rising in both states whether they have or have not expanded Medicaid, which is due to ACA provisions that increase enrollment. It is clearly evident that non-expanding states are setting themselves into detrimental positions that may only become worse in the future.
An increase of medically-covered patients requires an increase in workforce. This may result in extra hours or extra jobs, which either way is beneficial for the working individuals. Medicaid expansion will create jobs while also extending care. It is evident that Medicaid expansion has the potential to drastically improve physical, psychological and financial health of states.
One topic that has not yet been discussed is morality. Health and life is about taking the next step forward and becoming better than yesterday. Medicaid expansion is  a perfect example of this. Medicaid expansion saves many people and offers many new positions. From a moral standpoint, a state’s decision to expand Medicaid is viewed as a highly ethical decision. This makes these states look better. States that have declined Medicaid expansion are only further influencing poor health and health care imbalances between residents.
States that do not expand Medicaid will begin to grow disappointed residents who will eventually become angry. Anger will become aimed at somebody, which will most likely be the governor of that state. New situations may arise and therefore rejection of Medicaid expansion is the first ingredient for a recipe for disaster. If all states were to decide to accept Medicaid expansion, there would be no rivalry, comparison, disparity, and et cetera. United States as a whole would exhibit high quality care for a very large majority of it’s country.
In conclusion, states that have accepted the PPACA agreement to expand Medicaid benefit in numerous way. Those states receive fiscal gains, financial gains, increased patient outcomes, increased number of jobs, increased support from residents, stronger relationship between the state and the federal government, increase support for prisoners, increased overall education in health care, and finally pave a much more successful future for the states and the individuals living within those states.
Reference Page
Abara, W., & Heiman, H. J. (2014). The Affordable Care Act and Low-Income People Living   With HIV: Looking Forward in 2014 and Beyond. The Journal of the Association of Nurses in AIDS Care : JANAC, 25(6), 476–482. http://doi.org/10.1016/j.jana.2014.05.002
Aliu, O., Auger, K. A., Sun, G. H., Burke, J. F., Cooke, C. R., Chung, K. C., & Hayward, R. A. (2014). The Effect of Pre-PPACA Medicaid Eligibility Expansion in New York State on Access to Specialty Surgical Care. Medical Care, 52(9), 790–795. http://doi.org/10.1097/MLR.0000000000000175
Angier, H., Hoopes, M., Gold, R., Bailey, S. R., Cottrell, E. K., Heintzman, J., … DeVoe, J. E. (2015). An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act. Annals of Family Medicine, 13(1), 10–16. http://doi.org/10.1370/afm.1741
Dorn, S., Buettgens, M., Holahan, J., & Carroll, C. (2013, March 1). The Financial Benefit to Hospitals from State Expansion of Medicaid. Retrieved September 30, 2015.
Garfield, R., Damico, A., Stephens, J., & Rouhani, S. (2015, April 17). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. Retrieved October 1, 2015.
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Jacobs, L., & Callaghan, T. (2013, June 21). Why States Expand Medicaid: Party, Resources, and History. Retrieved October 4, 2015.
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