Health and Social Care Needs of Vulnerable Persons - Essay Example

Examining the Health and Social Care Needs of Vulnerable Persons -The Elderly- 1. Vulnerability “The human condition of vulnerability is a concept of vital concern” (De Chesnay 2005, p.111). Generally, vulnerability simply refers to susceptibility to harm but if we use it in this sense, every person is vulnerable because all human beings are capable of being hurt in various ways. Harm can be social, economic, legal, psychological, and physical and within each category, there are fundamentally different measures of harm. For example, psychological harms may extend from slight humiliation to a psychotic degeneration with significant consequential harms across all other categories. However, the concept of vulnerability according to Bankert and Amdur (2006, p.337) has nearly nothing to do with kind or sternness of harms because vulnerable persons are those who are somewhat or completely powerless in safeguarding their own interests. For that reason, vulnerability pertains primarily to threats to an individual’s ability to grant voluntary, informed consent. 2. Vulnerability and the Elderly 2.1 Vulnerable Persons The concept of vulnerability traverses risk intensities and has something to do with factors that restrict a person’s ability to defend him or herself. While it may be correct that nearly everyone are at risk one way or another and not just those in a few select groups, it is also true that individual must be clearly aware of the issues that can reduce an individual’s ability to protect him or herself through informed consent (Bankert and Amdur 2006, p.340). Conventional characterizations of vulnerability are ‘framed within an epidemiological approach’ to classify individuals and groups at risk for harm. Groups usually considered as vulnerable include the elderly, children, the poor, people with chronic illness, people from minority cultures, and captive populations such as prisoners and refugees. Labels of vulnerability are normally use relative to socioeconomic, minority, or other humiliating status and reflect a tendency to hold the victim responsible rather than blaming the existing social structure (De Chesnay 2005, p.122).. The commonly acknowledged indicator for vulnerability has been the incapacity to act independently in harmony with the norms of a particular culture. Vulnerable groups are social groups that suffer differential patterns of morbidity, mortality, and life expectancy because of inadequate resources and exposure to risks. Social groups identified as vulnerable include women and children, ethnic people of colour, immigrants, gay men and lesbians, homeless persons, the elderly, and those living in poverty. Also included are disabled persons and those exposed to inequity, bigotry, subordination, and disgrace and those who are politically demoralized, discarded, and deprived of human rights (De Chesnay 2005, p.123). Vulnerable populations are those at risk at any particular point in time for unequal chance to achieve better health and quality of life because of disparities in getting resources that are related with good health. Vulnerability may be classified by economic situation, place of residence, social background and ethnicity, age, and state of health such as incurable disease or psychological incapacities, injuries, and disability, such as the lack of ability to correspond effectively. Vulnerable persons are weaker than others are and unable to grab opportunities and protect their rights effectively. These people may also suffer various health effects coming from needless inequalities in acquiring goods and services or to cultural mind-set, special needs for care, or barriers to care. Features of those segments of the population that are most at risk have been identified in many states. They include high-risk mothers and children, people with chronic illness, disabilities, AIDS, or mental illness, alcohol or drug dependants, abused or battered, homeless, and settlers and refugees. The phrase ‘vulnerable populations’ bring to mind that the characteristic of vulnerability is permanent and irreversible. In the passing of time, however, nearly every person in the population is vulnerable because of one characteristic or another, specifically about poor health or disability because of chronic conditions or being too old. In creating health strategies that takes into consideration common vulnerability, the concept of vulnerability applies to nearly every person in the population (Danis et. al. 2002, p.312). 2.2 Vulnerability and Social Status The idea of risks fundamental to the concept of vulnerability was described in various models. Some proposed that risk of vulnerability might be predicted by social status, social capital, and human capital. Social status confers differential accessibility of personal and political control, and related human and social capital for various social groups based on age, gender, race and ethnicity. Health inconsistencies are disseminated casually through social norms and behavioural expectations or cultural systems, or officially through legally authorized variations in access and value of human resources. Social status and social capital of individuals or society will influence the extent of efforts made in relation to schools, employment opportunities, housing, recreation facilities, neighbourhood safety, and overall quality of life. When people in a neighbourhood come together and become concerned in activities of mutual interests and purpose, the prospect for social and human capital formation is empowered, and the consequence vulnerability of individual constituent within it is reduced. Essentially, vulnerability exhibit the relational consequence of numerous factors over which individuals may have lesser power (Fitzpatrick and Nyamathi 2007, p7). 2.3 Vulnerable Adults, Poverty, and the Law Children and some adults are considered vulnerable to poor or harmful care. In the U.S. and Canada, it is obligatory to report actual incidents or suspected abuse of children and vulnerable adults. Moreover, most countries protect persons identified as vulnerable and nearly any hospitalized persons through some form of laws. These laws are essential for those people who work for the mentally ill, retarded, or confused persons. The law protects the elderly from injury, abuse, or neglect when receiving care in healthcare facility, nursing home, school, or their own home because they are considered vulnerable adults. This is because a person alone or in isolation even in his own home is vulnerable to injury by a family member. “Families can also be charge with abuse of vulnerable adult laws” (Rosdahl and Kowalski 2007, p.39). In application, according to Brearley and Hall (1982, p.26) vulnerability is a term widely used to emphasise the strong possibility of loss or harm to some people. The commonly recognised difficulty in the elderly is poverty since many believe that older people are poor citizens. However, this assumption does not need careful examination since we all know that not all old people are poor. Another obstacle for older people is the lack of close supporting family or friends. In a study of people over sixty-five years of age, thirty percent live in isolation; almost twenty seven percent live with an elderly spouse only and a additional seven percent with a non-elderly spouse. The chances of living alone increases with increasing age as twenty five percent of those aged between sixty five to seventy four live alone and this proportion increases to thirty seven percent among those aged seventy five to eighty four and forty-four percent of those over eighty five years of age. However, although it has been recognized that being alone predispose to isolation, living alone is not essentially a depressing experience because many people at all ages want to live alone (Brearley and Hall 1982, p.26). Age, according to Apospori and Millar (2003, p.116), was one of the reason that heightened the risk of experiencing income poverty or deprivation. For instance, being a single parent or being over state retirement aged increased the risk of becoming poor and the danger of suffering extreme levels of scarcity. The sick or disabled persons in income poverty were more likely to be older than other poor adults. The retired population presented the highest income poverty and deprivation rates both among the groups under study. Survey data of the UK population shows that there has been a steady ageing of people since the turn of the century. These changes are the result of declining mortality and fertility rates, which is actually a characteristic of all Western societies (Alexander et. al. 2000, p.1001). In the UK, nine percentof the population falls within the age group sixty-five to seventy-four years and seven percent are seventy-five years over. In view of these changes, there has been a regrettable trend in Western society to perceive its aging population as a social predicament rather than as an advantage. Age has turn into an important deciding factor for determining social status including rights and obligations. “Social status is defined largely by wealth, power, and prestige” (Alexander et. al. 2000, p.1001), and many believe that the strong relationship linking wealth and power indicate that elderly people have little or no influence on social development and have inadequate capacity to manage their own future and existence. Ultimately, because the capacity to do a job and to generate wealth is the key determinant of social status, obligatory retirement displace elderly people to a low standing in the social class structure (Alexander et. al. 2000, p.1001). 2.4 Aging, Disease, and Policies Although aging does not necessarily comes with illness, the elderly are vulnerable to ailments because of diminishing physiologic reserve, less adaptable homeostatic processes, and less efficient resistance mechanisms of the body. An estimated eighty five percent of elderly have some type of chronic illness where more than one disease may be present. During the closing years of a very old person’s life, health problems and illness tend to cluster because of depression and dementia. The fundamental psychological requirements of all people according to (Brunner and Suddarth 1986, p.905) include “respect, security, self-esteem, and the need to feel appreciated and valued by others” thus preserving self-continuity, integrity, and identity is imperative to the emotional endurance of the elderly. The elderly person is vulnerable to psychological and mental stress from numerous losses such as losses through death of spouse, children, and other significant persons. Loss of social roles and possessions, where a person tend to depart and separate himself from the conventional way of life, affects status and prestige. Uselessness or the feeling of non-participation caused by loss of work role and health that includes loss of self-esteem (Brunner and Suddarth 1986, p.905). ‘Vulnerable adult’, is a phrase generally used in the UK in relation to the abuse of adults in both legislation and policy guidelines. It is a term to represent people who, by virtue of their conditions and because of the way care services are organised and operated, and in the way that wider society treats adults who are differently able, are to be consign in a position that makes them vulnerable. Above all, this situation is likely to be the case corresponding to society in general. The Care Standards Act 2000 describes vulnerable adults as a person whom accommodation and nursing or personal care is provided in a care home. An older person to whom personal care is given in their own home under arrangements made by a home care agency and those to whom prescribed services are provided by an autonomous hospital, independent clinic, independent medical agency or National Health Service body. In this characterization, we will notice the underlying meaning that services can make a person vulnerable as vulnerability seem to be observed basically relative to service conditions. It is therefore essential for social care specialist to be cautious in ensuring that their practice enables supports and protects people rather than generating or perpetuating any vulnerability for that person (Penhale and Parker 2007, p.23). 2.5 Health and Social Care for the Elderly The rapid increase of weaker and economically deprived group that is also a major consumer of health care resources has presented problems to health care planners. Mostly, elderly people in the UK have not made any financial provision for receiving private medical care, and even those who have often discover that their health care insurance mainly covers severe, self-limiting disorder and does not provide protection for chronic disease and disability necessitation ongoing medical intervention. Consequently, the elderly are almost completely reliant on the National Health Service for the provision of their medical care. This result to significant problems for a system that many believe does not have adequate funds. Though it is acceptable that expenditure on health care has indeed improved in real terms, it cannot keep cope with the increasing requirements of the elderly (Gormally 1992, p.14). Over five hundred thousand older people in the UK live in some form of institutional setting; the mainstream is in private nursing or residential care homes. The prestige of older people residing within these homes and the quality of this accommodation according to Baxter (2001, p.153) has become an ‘emotive subject’. Individual shocking accounts come out regularly in the media yet legislations on care homes has been in place for some time, setting down the minimum quality standards and actual requirements supported by law which should at least guarantee decent living. One of the principal variations between the nations is where the centre of responsibility for care resides. Consequently, even if in the 1990s all of the countries have become sincerely interested with the increasing costs of helpful services for the elderly; they differ on the issue of who should shoulder the costs. Alongside, the privatization of human services brings motive to the forefront. As a result, access to services is often based on the capacity to pay, consequential in great inequities between need and the accessibility of service. Where the public sector funds proprietary care, “accountability and the quality of services may be negatively affected as well” (Olson 1993, p.3). Although pensioners represents only fifteen percent of the UK population according to Rai and Webster (2000, p.143), they are responsible for forty-two percent of NHS consumption. This is because an older person is more likely to need help and social care and the most expensive patients are those who require a prolonged period of long-term care in an institution. Community care in one’s own home is encouraged to some extent because it seems to be an economical option. Actually, most expenses will be bear by family and friends, both psychological and financially. Formal care in the community is intended to be a partnership among statutory bodies, the local authority, social services, the NHS, and the independent sector. The social services departments have slowly changed from providers of services to administrators, the independent sector currently being the main provider of hands-on services, such as domestic care and personal care. Domiciliary occupational therapy and social workers are nearly the only personnel still working directly with the local authorities (Rai and Webster 2000, p.144). Attendance at day centres and luncheon clubs may be accessible to home-based elderly persons and may help temporary alleviate their typical way of life of being ‘under house arrest’. Respite care in an institution is available for dependent clients in order to relieve informal carers who are the main or sole carer. Although ninety four to ninety five percent of elderly people live at home, only about ten percent of them are in receipt of community services. Four to five percent of elderly people live in care homes. Officially, even people in nursing homes and residential homes are classified as receiving community care. Altogether, “about five hundred thousand elderly people are in care homes” (Rain and Webster 2000, p.144). 3. Bibliography Alexander Margaret, Fawcett Josephine, and Runciman Phyllis.2000, Nursing Practice: Hospital and Home: the Adult, Elsevier Health Sciences, Spain Apospori Eleni and Millar J. 2003, The Dynamics of Social Exclusion in Europe: Comparing Austria, Germany, Greece, Portugal and the UK, Edward Elgar Publishing, U.K. Bankert Elizabeth and Amdur Robert. 2006, Institutional Review Board: Management and Function, Jones & Bartlett Publishers, U.S. Baxter Carol. 2001, Managing Diversity and Inequality in Health Care: Six Steps to Effective Management Series, Royal College of Nursing (Great Britain), Elsevier Health Sciences, U.K. Brearley Paul and Hall Michael. 1982, Risk and Ageing: C. Paul Brearley with M. R. P. Hall ... [et Al.]., Routledge, U.K. Brunner Lillian Sholtis and Suddarth Doris Smith. 1986, The Lippincott Manual of Nursing Practice, Taylor & Francis, U.S. Danis Marion, Clancy Carolyn, and Churchill Larry. 2002, Ethical Dimensions of Health Policy, Oxford University Press, U.S. De Chesnay Mary. 2005, Caring for the Vulnerable: Perspectives in Nursing Theory, Practice, and Research, Jones & Bartlett Publishers, U.S. Fitzpatrick Joyce, Nyamath, Adeline, and Koniak-Griffin Deborah. 2007, Annual Review of Nursing Research Volume 25: Vulnerable Populations, Springer Publishing Company, U.S. Gormally Luke. 1992, The Dependent Elderly: Autonomy, Justice, and Quality of Care, Cambridge University Press, U.K. Olson Laura Katz. 1994, The Graying of the World: Who Will Care for the Frail Elderly?, Haworth Press, U.S. Penhale Bridget and Parker. 2007, Jonathan Working with Vulnerable Adults, Community Care (Organization : Great Britain), Routledge, 2007, U.K. Rai, Gurcharan and Webster.2000, Stephen Elderly Care Medicine for Lawyers, Routledge Cavendish, U.K. Rosdahl Caroline Bunker and Kowalski Mary. 2007, Textbook of Basic Nursing, Lippincott Williams & Wilkins, U.S. Read More