Special Populations in Health Care

Special Populations in Health Care
Bridgepoint Education, Inc.
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About the Author xv Acknowledgments xvii
Chapter 1 Identifying the Vulnerable 1
Chapter 2 Comparing Vulnerable Groups 39
Chapter 3 Why Are Some More Vulnerable Than Others? 79
Chapter 4 Seeking an Effective Care Continuum 111
Chapter 5 Paying for Health Care 149
Chapter 6 Accessing Health Care 173
Brief Contents
Chapter 7 Evaluating the Cost of Care 195
Chapter 8 Monitoring the Quality of Care 219
Chapter 9 Studying Vulnerable Populations 233
Chapter 10 Where Do We Go From Here? 259
Glossary 275 References 281
About the Author xv Acknowledgments xvii
Chapter 1 Identifying the Vulnerable 1 Introduction 2 1.1 Social Theory and Public Policy in Health Care 3 Social Attitudes Versus Individual Choice 5 1.2 Considerations for Studying Vulnerable Populations 7 Community and Personal Values 7 Access to Resources 8 Social Status 8 Social Capital 9 Human Capital 10 Health Indicators 11 Risk Potential 13 Public Policy 13 1.3 Statistical Data on the Population Totals and Growth Trends of Identified Vulnerable Populations 15 Considerations in Studying Data 15 Connections Between Vulnerable Groups 16 1.4 Defining Vulnerable Populations in American Health Care 18 Vulnerable Mothers and Children 19 Abused Individuals 21 Chronically Ill and Disabled People 24 People Diagnosed With HIV/AIDS 26 People Diagnosed With Mental Conditions 28
Contents
CONTENTS
Suicide- and Homicide-Liable People 29 People Affected by Alcohol and Substance Abuse 30 Indigent and Homeless People 33 Immigrants and Refugees 33 Chapter Summary 35 Additional Resources 37 Web Exercise 37 Key Terms 38
Chapter 2 Comparing Vulnerable Groups 39 Introduction 40 2.1 Common Factors 41 2.2 Comparing Vulnerable Groups by Age 43 Vulnerable Mothers and Children 44 Abused Individuals 45 Elder Abuse 45 Domestic Violence 46 Chronically Ill and Disabled People 46 People Diagnosed With HIV/AIDS 47 People Diagnosed With Mental Conditions 47 Suicide- and Homicide-Liable People 48 People Affected by Alcohol and Substance Abuse 48 Indigent and Homeless People 49 Immigrants and Refugees 50 2.3 Comparing Vulnerable Groups by Gender 51 Vulnerable Mothers and Children 52 Abused Individuals 52 Child Abuse 53 Elder Abuse 53 Chronically Ill and Disabled People 53 People Diagnosed With HIV/AIDS 54 People Diagnosed With Mental Conditions 54 Suicide- and Homicide-Liable People 54 People Affected by Alcohol and Substance Abuse 56 Indigent and Homeless People 57 Immigrants and Refugees 57
CONTENTS
2.4 Comparing Vulnerable Groups by Culture and Ethnicity 59 Vulnerable Mothers and Children 59 Infant Mortality 60 Maternal Mortality 60 Teenage Mothers 60 Abused Individuals 61 Child Abuse 62 Elder Abuse 63 Chronically Ill and Disabled People 63 People Diagnosed With HIV/AIDS 64 People Diagnosed With Mental Conditions 65 Suicide- and Homicide-Liable People 65 People Affected by Alcohol and Substance Abuse 65 Indigent and Homeless People 66 Immigrants and Refugees 67 2.5 Comparing Vulnerable Groups by Education and Income Levels 69 Vulnerable Mothers and Children 70 Abused Individuals 70 Chronically Ill and Disabled People 70 People Diagnosed With HIV/AIDS 71 People Diagnosed With Mental Conditions 71 Suicide- and Homicide-Liable People 72 People Affected by Alcohol and Substance Abuse 72 Indigent and Homeless People 72 Immigrants and Refugees 73 Chapter Summary 75 Additional Resources 76 Web Exercise 77 Key Terms 77
Chapter 3 Why Are Some More Vulnerable Than Others? 79 Introduction 80 3.1 Portrait of the Nation 81 3.2 How We Live 83 Housing 83 Education 84 Income and Poverty 84
CONTENTS
3.3 Social Conditions: Social Capital 86 Vulnerable Mothers and Children 87 Abused Individuals 88 Chronically Ill and Disabled Persons 89 Persons Living With HIV/AIDS 89 Persons Diagnosed With Mental Conditions 90 Suicide- and Homicide-Liable Persons 90 Persons Affected by Alcohol and Substance Abuse 91 Indigent and Homeless Persons 91 Immigrants and Refugees 92 3.4 Political Conditions: Social Status 93 Vulnerable Mothers and Children 93 Abused Individuals 95 Chronically Ill and Disabled Persons 95 Persons Diagnosed With HIV/AIDS 96 Persons Diagnosed With Mental Conditions 96 Suicide- and Homicide-Liable Persons 96 Persons Affected by Alcohol and Substance Abuse 97 Indigent and Homeless Persons 97 Immigrants and Refugees 98 3.5 Economic Conditions: Human Capital 99 Vulnerable Mothers and Children 99 Abused Individuals 100 Chronically Ill and Disabled Persons 100 Persons Diagnosed With HIV/AIDS 100 Persons Diagnosed With Mental Conditions 101 Suicide- and Homicide-Liable Persons 101 Persons Affected by Alcohol and Substance Abuse 102 Indigent and Homeless Persons 104 Immigrants and Refugees 104 Chapter Summary 107 Additional Resources 108 Web Exercise 109 Key Terms 109
Chapter 4 Seeking an Effective Care Continuum 111 Introduction 112 4.1 The Need for an Effective Continuum of Care 113 4.2 Health Maintenance Through Preventive Care Services 116 Vulnerable Mothers and Children 117 Abused Individuals 119
CONTENTS
Chronically Ill and Disabled Persons 119 Persons Diagnosed With HIV/AIDS 120 Persons Diagnosed With Mental Conditions 122 Suicide- and Homicide-Liable Persons 123 Persons Affected by Alcohol and Substance Abuse 124 Indigent and Homeless Persons 125 Immigrants and Refugees 126 4.3 Reclaiming Health Through Treatment Services 127 Vulnerable Mothers and Children 128 Abused Individuals 128 Chronically Ill and Disabled Persons 129 Persons Diagnosed With HIV/AIDS 130 Persons Diagnosed With Mental Conditions 131 Suicide- and Homicide-Liable Persons 132 Persons Affected by Alcohol and Substance Abuse 132 Indigent and Homeless Persons 133 Immigrants and Refugees 134 4.4 Maintaining Quality of Life Through Long-Term Care 135 Vulnerable Mothers and Children 136 Abused Individuals 137 Chronically Ill and Disabled Persons 138 Persons Diagnosed With HIV/AIDS 139 Persons Diagnosed With Mental Conditions 140 Suicide- and Homicide-Liable Persons 141 Persons Affected by Alcohol and Substance Abuse 141 Indigent and Homeless Persons 142 Immigrants and Refugees 143 Chapter Summary 145 Additional Resources 147 Web Exercise 147 Key Terms 148
Chapter 5 Paying for Health Care 149 Introduction 150 5.1 Private Payers 151 Vulnerable Mothers and Children 152 Abused Individuals 152 Chronically Ill and Disabled Persons 153 Persons Diagnosed With HIV/AIDS 153 Persons Diagnosed With Mental Conditions 153 Suicide- and Homicide-Liable Persons 154
CONTENTS
Persons Affected by Alcohol and Substance Abuse 154 Indigent and Homeless Persons 155 Immigrants and Refugees 155 5.2 Public Payers 156 Vulnerable Mothers and Children 158 Abused Individuals 159 Chronically Ill and Disabled Persons 159 Persons Diagnosed With HIV/AIDS 160 Persons Diagnosed With Mental Conditions 161 Suicide- and Homicide-Liable Persons 162 Persons Affected by Alcohol and Substance Abuse 162 Indigent and Homeless Persons 163 Immigrants and Refugees 163 5.3 Uninsured People 164 Vulnerable Mothers and Children 165 Abused Individuals 166 Chronically Ill and Disabled Persons 166 Persons Diagnosed With HIV/AIDS 166 Persons Diagnosed With Mental Conditions 166 Suicide- and Homicide-Liable Persons 167 Persons Affected by Alcohol and Substance Abuse 167 Indigent and Homeless Persons 167 Immigrants and Refugees 167 Chapter Summary 169 Additional Resources 171 Web Exercise 171 Key Terms 172
Chapter 6 Accessing Health Care 173 Introduction 174 6.1 Organizational Barriers 175 Vulnerable Mothers and Children 175 Abused Individuals 176 Chronically Ill and Disabled Persons 177 Persons Diagnosed With HIV/AIDS 178 Persons Diagnosed With Mental Conditions 179 Suicide- and Homicide-Liable Persons 180 Persons Affected by Alcohol and Substance Abuse 180 Indigent and Homeless Persons 181 Immigrants and Refugees 182
CONTENTS
6.2 Financial Barriers 183 Vulnerable Mothers and Children 184 Abused Individuals 185 Chronically Ill and Disabled Persons 185 Persons Diagnosed With HIV/AIDS 186 Persons Diagnosed With Mental Conditions 186 Suicide- and Homicide-Liable Persons 187 Persons Affected by Alcohol and Substance Abuse 187 Indigent and Homeless Persons 188 Immigrants and Refugees 188 Chapter Summary 191 Additional Resources 192 Web Exercise 193 Key Terms 193
Chapter 7 Evaluating the Cost of Care 195 Introduction 196 7.1 Totaling the Cost of Care 197 Vulnerable Mothers and Children 198 Abused Individuals 200 Chronically Ill and Disabled Persons 201 Persons Diagnosed With HIV/AIDS 203 Persons Diagnosed With Mental Conditions 203 Suicide- and Homicide-Liable Persons 204 Persons Affected by Alcohol and Substance Abuse 204 Indigent and Homeless Persons 205 Immigrants and Refugees 206 7.2 Analyzing the Cost of Care 207 Vulnerable Mothers and Children 209 Abused Individuals 209 Chronically Ill and Disabled Persons 210 Persons Diagnosed With HIV/AIDS 211 Persons Diagnosed With Mental Conditions 211 Suicide- and Homicide-Liable Persons 212 Persons Affected by Alcohol and Substance Abuse 212 Indigent and Homeless Persons 213 Immigrants and Refugees 213 Chapter Summary 215 Additional Resources 217 Web Exercise 217 Key Terms 218
CONTENTS
Chapter 8 Monitoring the Quality of Care 219 Introduction 220 8.1 Monitoring the Quality of Care 221 Vulnerable Mothers and Children 222 Abused Individuals 222 Chronically Ill and Disabled Persons 223 Persons Diagnosed With HIV/AIDS 225 Persons Diagnosed With Mental Conditions 225 Suicide- and Homicide-Liable Persons 226 Persons Affected by Alcohol and Substance Abuse 226 Indigent and Homeless Persons 227 Immigrants and Refugees 228 Chapter Summary 230 Additional Resources 231 Web Exercise 232 Key Terms 232
Chapter 9 Studying Vulnerable Populations 233 Introduction 234 9.1 Descriptive Research: Identifying the Vulnerable 235 Vulnerable Mothers and Children 236 Abused Individuals 236 Chronically Ill and Disabled Persons 237 Persons Diagnosed With HIV/AIDS 237 Persons Diagnosed With Mental Conditions 238 Suicide- and Homicide-Liable Persons 239 Persons Affected by Alcohol and Substance Abuse 239 Indigent and Homeless Persons 240 Immigrants and Refugees 241 9.2 Analytic Research: Understanding Vulnerability 242 Vulnerable Mothers and Children 243 Abused Individuals 243 Chronically Ill and Disabled Persons 244 Persons Diagnosed With HIV/AIDS 244 Persons Diagnosed With Mental Conditions 245 Suicide- and Homicide-Liable Persons 245 Persons Affected by Alcohol and Substance Abuse 245 Indigent and Homeless Persons 246 Immigrants and Refugees 246
CONTENTS
9.3 Evaluative Research: Studying Program Efficacy 248 Vulnerable Mothers and Children 248 Abused Individuals 248 Chronically Ill and Disabled Persons 249 Persons Diagnosed With HIV/AIDS 249 Persons Diagnosed With Mental Conditions 249 Suicide- and Homicide-Liable Persons 250 Persons Affected by Alcohol and Substance Abuse 250 Indigent and Homeless Persons 251 Immigrants and Refugees 251 Chapter Summary 254 Additional Resources 256 Web Exercise 256 Key Terms 257
Chapter 10 Where Do We Go From Here? 259 Introduction 260 10.1 The Community-Oriented Approach 261 Cross-Disciplinary Solutions 262 10.2 The Market-Oriented Approach 264 Changing the Health Care System 264 10.3 Improving Accessibility, Cost, and Quality 267 Policy Changes to Improve Social Capital 268 Policy Changes to Improve Human Capital 269 Chapter Summary 272 Additional Resources 274 Web Exercise 274 Key Terms 274
Glossary 275 References 281

D. Miles Burkholder, MBA, LNHA As Administrator of The Altenheim, Miles Burkholder is responsible for efficiently running all facets of the business. Miles has turned around a 106-year-old 501c(3) private foundation from losing a sizable amount to within Board mandated limits in his 5 years with the company. His department directors nominated him for Kentucky Association of Homes and Services for the Aging—Administrator of the Year in 2011. He has seen the facility receive three straight-zero deficiency surveys from the Office of the Inspector General.
Currently Miles serves on the Finance, Public Relations, and Non-Proprietary Committees with the Kentucky Association of Health Care Facilities. He serves on the Finance, Legislative and Regulatory, and Awards Committees with Leading Age (formerly the Kentucky Association of Homes and Services for the Aging). Miles is a member of The Rotary Club of Downtown Louisville after being a volunteer at Scout-O-Rama for 25 years. He is a member of The College of Health Care Administrators, a twice graduate of The University of Louisville (Accounting and MBA). He is also a Board Member of Goodwill Industries of Kentucky’s Cars to Work Program. He is the father of a son, Connor (4), and a daughter, Addison, born in May 2012. He is married to Rachel Wilson Burkholder.
Nicole Bremer Nash, BA Nicole Bremer Nash has authored multiple books including several from Jones & Bartlett Learning’s The Art and Science of Photovoltaics series. In addition to research-based authoring, Nicole writes general interest articles for print and Web publishing. She has a Bachelor of Arts in English from Transylvania University (2001), and over 10 years of experience in research and writing. As an advocate and community volunteer, Nicole has a particular interest in women’s and children’s issues including housing, education, and health care access and quality, and the ways these issues affect individuals’ well-being and success.
Nicole is active in her community through advocacy and volunteer work for multiple nonprofit organizations, including Junior League, Women for Habitat for Humanity, and StageOne Family Theatre. Nicole’s hobbies include reading, crafting, and conducting science experiments with her family.
About the Author

From D. Miles Burkholder To my loving wife, beautiful children, and outstanding co-author. —DMB
From Nicole Bremer Nash I owe a life of gratitude to my mom, who was once a vulnerable mother with a vulnerable child, and who worked hard to make sure every door was open to me, so I would never have to be a vulnerable adult. Gratitude and love also to my ever-supportive husband, Chris, and our amazing son, Ezra, who both shudder when I begin a new book and smile the most when my books are complete.
Special thanks to Dr. Michael Shaw for being the best, most supportive project manager a writer could ever dream of; and to Karen Annett for her skill, talent, and patience in editing this book. I also appreciate the research help I received from Regan Hunt at Metro United Way (Louisville) for helping me hunt down, access, and comprehend difficult data; and to Medearis Robertson at the Kentucky Fatality Assessment and Control Evaluation (FACE) Program for providing the book with meta-sources and research. Of course, this book couldn’t have happened without my co-author, Miles, who works hard every day to address the needs of one of America’s most vulnerable and often most ignored populations.
This book is dedicated to all the people who give time, energy, and donations to address the needs of America’s most vulnerable people. We would all be worse off without you.
Acknowledgments
ACKNOWLEDGMENTS
The authors would also like to thank the following peer reviewers for their feedback and helpful guidance:
Quynh Dao Dang, Texas A&M University Howard J. Eng, The University of Arizona Patricia Gray, University of Houston Law Center Fran Henton, Nebraska Methodist College John Janowiak, Appalachian State University Martha E. Jennings, Ashford University Jeanette Pack, Ashford University Justine Pawlukewicz, NYC College of Technology Robert Schroeder, Ashford University Monica L. Vargas, Ashford University
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