ETHICS AND DISABILITY

Susan FoxProject DirectorInstitute on Disability/UNHMay 23, 2006

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.

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

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

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

NH’s System of Care for Children

Families Education/Schools Health and Human Services

Developmental Disabilities Mental Health Child Protection Juvenile Justice

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

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

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

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

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