Cover -- Title Page -- Copyright Page -- Dedication -- Contents -- Foreword -- Introduction -- Section Part One : The crisis of suffering for older Americans -- Chapter 1: Social ecology of aging -- I. Introduction -- II. Framing the social problem of elder suffering: Social ecological and environmental contexts -- III. Social ecology of aging and its ecosystems: Interaction of macro- and microsystems -- A. Social ecological perspective on human development -- B. Ecosystems in the social ecology of aging -- 1. Macrosystem: Law, policy, structures, and barriers to accessing care -- a. Sociopolitical Movements and Paradigm Shifts -- b. Demographic Trends -- i. Growth in older adult population According to the AoA Report, from 2005 to 2015, the older adult population, aged 65 and over, grew to 47.8 million people, a 30% increase since 2005. That number is projected to double by 2060 to 98.2 million (AoA et al -- ii. Racial and ethnic data Trends among older Americans in racial and ethnic minority groups are noteworthy. Racial and ethnic minority populations increased from 6.7 million in 2005, making up 18% of the older adult population, to 10.6 million in 2015, o -- iii. Marital status and living arrangements Older men are more likely than older women to be married. Only 45% of older women are married, compared to 70% of men. Less than a third (29%) of the total number of noninstitutionalized older persons live alone -- iv. Income and poverty data A Profile of Older Americans (AoA et al., 2016) also provides critical information about the income and poverty levels of older persons, as detailed below: -- c. Personal Health Status, Chronic Conditions, and Functional Limitations -- d. Caregiving Resources and Risks of Elder Abuse, Maltreatment, and Neglect -- e. Social and Economic Determinants of Health and Inequities in Access to Care.

i. Health care spending and social and economic determinants of health An overview of the macro health care environment within which older Americans must navigate, including trends in health care spending and escalating health care costs at the end of lif -- f. Inadequacy of Aging, Health, and Social Systems, and Community-Based Services and Supports -- g. Workforce Gaps -- h. Climate Ecology -- i. Assessment and Measurement of Suffering Among Older Adults -- 2. Elder microsystem-frailty, multimorbidity, and dependency -- 3. Mesosystem -- IV. Elder-centered care framework -- V. Public health and global public health strategies for aging comfortably and palliatively -- Thomas Frieden's public health impact pyramid -- Public health strategy for palliative care -- VI. Conclusion -- References -- Chapter 2: Philosophic science theory -- I. Introduction -- II. Phenomenology: Schutz's philosophic science theory-Theory of the cultural sciences -- A. Role of moral intuition in cultural science theories -- B. Moral experience and moral phenomenology -- C. Levinas's sociality and ethical relation -- D. Intersubjectivity and sociality: The pragmatist perspective -- III. Social ecology of suffering: The maternal as possibility for older persons' agency, resilience, and generativity -- A. The character of the Anthropocene Period and its impacts -- B. The person-centered focus on suffering: Fashioning a maternal cosmos and maternal systems of care -- C. Husserlian phenomenology and Fink's transcendental theory of method: Transcendence of consciousness -- C.1. Understanding of suffering in the natural attitude: Reflecting on consciousness of suffering -- C.2. Phenomenological research -- C.3. Explication of transcendental phenomenology, transcendental subjectivity, and transcendental theory of method: Relationship of suffering to the maternal.

C.4. The "I of reflection" in theoretical attitude -- C.5. Primary and secondary enworlding: Transcendence -- C.6. Eidetic analysis: Mundane and transcendental levels -- C.7. Suffering and the intentional spectrum: Transcendental eidos -- IV. Implications of theorizing for older adults' agency, resilience, and generativity: The example of dementia -- A. Framing the problem of dementia: Public health perspective -- B. Evidence-based public health strategies to build capacities and environments -- C. Ethical issues -- D. Care issues -- E. Research issues -- F. Education -- V. Conclusion -- References -- Bibliography -- Section Part Two : Paradigm shifts in delivery systems and financing -- Chapter 3: Moving from fragmentation to integrated, community-based services -- I. Introduction: Long-term services and supports -- II. Medicare and Medicaid -- A. Older Americans Act (OAA) -- B. HCBS waiver programs -- III. Newer legislation and initiatives -- A. Americans with Disabilities Act -- B. Affordable Care Act -- IV. Economic and social arguments for aging in place -- V. Hospice as a model -- VI. Conclusion -- References -- Chapter 4: Development of elder-centered systems of care -- I. Introduction: Importance of delivery systems -- II. System dimensions and integration -- A. Preventive health and population management-Changing role of the health care system -- B. The health care team -- C. Medical home -- D. Subacute and long-term care -- E. Continuum of care -- F. Quality and safety -- G. Palliative care and hospice -- III. Conclusion -- References -- Chapter 5: Evolution of financing models and impact on quality and services for older adults -- I. Introduction: Financing, reimbursement, and cost-saving models -- II. Insurance financing and coverage -- III. Reimbursement models -- A. Hospital reimbursement model -- B. Provider reimbursement models.

C. Long-term care reimbursement models -- IV. Cost-saving models -- V. Conclusion -- References -- Section Part Three : Challenges in policy implementation -- Chapter 6: Landscape for new models of care -- I. Introduction -- II. Challenges in environment -- A. Financial resources / Cost of care -- B. Affordable senior housing -- C. Reliance on caregiving -- III. Programs and best practices -- A. Home and community-based services -- B. The aging in place movement -- C. The integration of medical and social supports -- The challenge of person-centered cancer care: Shift to elder-centered care -- D. Enhancing collaboration and communication -- A partnership between an organization that offers support to people with cancer and the medical teams treating those patients -- IV. Conclusion -- References -- Bibliography -- Chapter 7: The palliative turn in elder-centered care -- I. Introduction -- II. Health and human rights framework: The right to health -- A. The right to palliative care and pain relief -- III. International palliative care frameworks and recommendations -- A. WHO Public Health Strategy for Palliative Care -- B. WHO definition of palliative care -- C. 67th World Health Assembly Resolution on Palliative Care -- D. Lancet Commission Report on Palliative Care -- IV. Palliative care and hospice movements in the United States -- A. Palliative care -- B. Hospice care -- C. Hospital-based care -- D. Nursing home care -- E. Community-based care -- VII. Futile treatment: How is it defined? -- VIII. Case Study: Nursing home resident with dementia -- A. Discussion and analysis -- B. Description of older person, older person's history and diagnosis -- C. Capacity, prior directives, and surrogacy -- D. Proposed alternative treatments -- E. Goals of care, promise for recovery, and evaluation of suffering burden.

F. Social history and social and cultural contexts -- G. Health care justice -- IX. Recommendations: The four-pronged approach of the public health strategy for palliative care -- A. National-level policy -- B. Availability of essential medicines -- C. Education -- D. Policy implementation and systems-level change -- 1. Improved care coordination, communication, and interdisciplinary team care planning processes -- 2. Ethics consultation and ethics committee review -- X. Conclusion -- Acknowledgment -- References -- Bibliography -- Chapter 8: A more humanistic approach to relational decision making -- I. Introduction -- II. Case study: New York policy implementation-Health care decision making, surrogacy, ethics committees, and interprofessional education -- A. Implementation challenges: The example of surrogate decision making -- B. Experience of a frail nursing home resident: Care transitions -- 1. Medical, social, and family history -- 2. Case findings -- i. Relationships with health care professionals -- ii. Types of health care decisions -- iii. Admission and discharge from hospice -- 3. Discussion and analysis -- i. Capacity issues -- ii. Legal and ethical responsibilities of surrogate -- iii. Honoring wishes, values, and preferences of resident -- C. Recommendations -- III. Ethics committees and ethics committee education -- A. Core curricula areas for ethics review committee education -- 1. Legal and ethical consensus: Principles and goals of palliative care -- 2. Paradigm shift: Relational framework in decision making -- 3. Paradigm shift: Function of ethics review committees -- 4. Targeted review of FHCDA and PCIA: Decision-making standards and patient rights -- 5. A more humanistic response to conflict negotiation and resolution -- 6. Best practice and recommendations for research -- IV. Conclusion -- Acknowledgment -- References.

Section Part Four : Setting the stage for transforming elder care.

With more people living longer lives, there is increased importance in the health care industry on improving services for the elderly. This comprehensive book gives an expert overview of the topics and challenges, along with imperative ethical and legal frameworks. The book also details existing programs and benefits in relation to a realistic portrayal of population needs. Other important issues are covered such as long-term palliative care and hospice, other vulnerable populations, elder abuse, public-private collaboration, evidence-based policy-making, and much more.

Description based on publisher supplied metadata and other sources.

Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2021. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.

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