Epidemiology Case Study 

Access to Care: Older, Developmentally Delayed Patient With Several Chronic Illnesses and New Onset of Perceived Hearing Loss

Ms. Renee Sharrod is 65 years old and developmentally delayed. Ms. Sharrod has always been considered high functioning although she is unable to read or write. In the past, Ms. Sharrod was able to respond to straightforward questions and follow direct instructions. However, as she has gotten older, she has developed hearing and speech difficulties as well as some mild cognitive decline. When Ms. Sharrod’s mother passed away, Ms. Sharrod no longer had a direct caregiver to assist her with activities of daily living (ADLs) or with healthcare concerns. Shortly following the death of Ms. Sharrod’s mother, Ms. Sharrod was moved into an apartment in an assisted-living facility.

The assisted-living facility does a marginal job of supporting Ms. Sharrod’s ADLs, such as providing meals, assisting with bathing, and administering medications. However, when it comes to managing and facilitating treatment for Ms. Sharrod’s many chronic health conditions, the facility falls short. The assisted living facility does not have well-trained or adequate caregiving staff to stay on top of healthcare visits, procedures, or equipment orders. Although Ms. Sharrod has adequate health insurance, she has no one to assist her with navigating the “red tape” involved, such as prior authorizations, and with understanding when and where she can seek services and how often. Additionally, Ms. Sharrod needs assistance with scheduling appointments, arranging transportation, and communicating with healthcare providers.

As mentioned previously, Ms. Sharrod has developed what is perceived as hearing loss. Ms. Sharrod’s caseworker schedules an appointment for Ms. Sharrod to have her hearing checked. The assisted-living facility arranges the visit and sends an aide with Ms. Sharrod to the visit. Ms. Sharrod’s hearing is evaluated at this visit, and it is determined that she has moderate hearing loss and needs hearing aids. Although this same healthcare facility also provides hearing aids, Ms. Sharrod’s insurance will not cover the hearing aids from this healthcare facility; she can only receive hearing aids from a select few places. Ms. Sharrod goes home with an order for hearing aids but needs another appointment at a separate facility to be fitted for them. A few months go by, with the overworked caseworker attempting to find out from the insurance company where Ms. Sharrod can go to be fitted for hearing aids. Prior authorization is submitted and is finally obtained from Ms. Sharrod’s insurance company. At this point, Ms. Sharrod is assigned a new caseworker, who is unaware of the prior authorization and the need to schedule an appointment to have Ms. Sharrod fitted for hearing aids, so several more weeks go by. Once Ms. Sharrod is finally scheduled and goes to be fitted for the hearing aids, she is informed that the hearing evaluation and order for hearing aids have expired. She now needs a new hearing evaluation and an order for hearing aids. Although this current facility can perform hearing evaluations, Ms. Sharrod’s insurance will not cover testing at this facility, only the hearing aids. Ms. Sharrod now needs another hearing test at yet another facility, essentially starting all over again.

This entire process has taken more than 9 months, and Ms. Sharrod still does not have hearing aids or any one person available to her to facilitate and connect the various steps it takes to use her health insurance and access appropriate care. COVID-19 emerges about 2 months later and all efforts cease; there are not enough staff to address Ms. Sharrod’s hearing loss issues. It has now been almost 2 years and Ms. Sharrod still does not have hearing aids; by all accounts, her hearing has gotten significantly worse. Her speech is now being impacted by the hearing deficit. Of note, hearing loss is only one of Ms. Sharrod’s health issues, which include diabetes, hypertension, and pulmonary hypertension. Although Ms. Sharrod has what would be considered adequate health insurance, her being older, developmentally delayed, and lacking a caregiver or advocate to coordinate her care means that she ultimately does not have adequate access to healthcare.

Case Study Questions

1. What other barriers might older persons or persons with disabilities face when trying to access healthcare?

2. What are steps you could take, both as an individual nurse and at the systems level, to improve access to care for older or developmentally delayed patients?

3. What could be done in situations where a lack of advocacy resources and “red tape” restrict needed healthcare access?

4. Develop a policy that health professionals could create and implement to address the needs of individuals in assisted living facilities. Provide a rationale for your proposed policy.

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DUE DATE JANUARY 16, 2024

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