Teaching Ethical and Legal Frameworks to Support Healthy Aging

As adults age, the issues they encounter can range from emotionally stressful, such as loneliness and isolation, to legally complex, such as facing ageism in the workplace and gaining access to health care services, including long-term care. These issues impact not only individuals, but also family members, friends and health care professionals whose careers are dedicated to supporting people as they age. 

At the University of Arizona Health Sciences, researchers and educators in the Innovations in Healthy Aging initiative are dedicated to supporting aging adults by expanding the workforce tasked with caring for an aging population. The Aging Law and Policy Graduate Certificate program was recently launched through the University of Arizona James E. Rogers College of Law to address a range of social justice issues, from systemic barriers that make it difficult for older adults to access government services such as Social Security and Medicare, to emerging legal issues around elder mistreatment, guardianships and privacy.

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The online certificate comes at a critical time. The number of adults age 65 or older in the U.S. grew by one-third in the past decade, reaching 54.1 million. In addition, Americans age 65 and older are expected to outnumber those under the age of 18 by 2034, according to the U.S. Census Bureau.

“Students from different professions and backgrounds are impacted by the needs and preferences of an older population, and they are looking to better understand the ethical issues, regulations and governing statutes that carry tremendous weight on how we age,” said Tara Sklar, JD, MPH, director of the Health Law and Policy Program and senior faculty advisor for Innovations in Healthy Aging.

“Employers across the health care field need their staff to be able to identify red flags and opportunities around compliance, reimbursement, liability, and implications for privacy and consent with innovations in health technology as Americans increasingly prefer to age in place,” added Sklar, creator of the certificate program and professor of law whose scholarly research examines legal, regulatory and ethical issues that arise in adapting to a diverse aging population with a focus on the integration of health technology.

Unraveling a complex issue

Brigette Quinn, a registered nurse for 36 years and former faculty member in the UArizona College of Nursing, was one of the first students to enroll in the graduate certificate program. She felt she needed to improve her understanding of law and policy to better advocate for and guide the older adults she supports as a nurse care manager.

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“It is so incredibly complex and confusing,” Quinn said of navigating the health care system.

There is much to unpack: from watching older adults lose cognitive capacity, to seeing someone with no medical or legal background become a caretaker to a friend or family member after a stroke, for example.

Many health care professionals advise patients on topics including advanced directives, power of attorney and the appointment of health care agents. The graduate certificate offers guidance to those who need to understand the best options for older adults.

“All nurses are leaders at the bedside, and it’s a professional and personal responsibility to understand better where the law affects all of us, from a regulatory perspective and at the bedside,” Quinn said. “There’s a desperate need for health care literacy and for understanding the junction between health care and health policy.”

Quinn offers perspectives to friends, loved ones and neighbors, including Larry Losey, 81, an avid cyclist and motorcyclist whom she regularly speaks with about health and aging.

An all-encompassing look at aging

The certificate program comprises four courses: Aging in America, Aging and Social Justice, Technology and Aging: Legal and Ethical Developments, and Aging and the Law.

Aging in America delves into the role and function of regulatory agencies and laws that govern eligibility and benefits for health care, long-term care and hospice. Christopher Mathis, JD, MPA, MPH, professor of practice in the James E. Rogers College of Law and an elder law attorney in Tucson, Arizona, teaches the course that covers emerging trends such as working later in life, loneliness and isolation, opioid addiction, and emergency preparedness for older adults.

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Aging and Social Justice covers age discrimination, social conceptions of the elderly as burdensome and cultural biases that reject the role of the elderly as valuable contributors. Laura Howard, PhD, who teaches courses covering medical ethics as a professor of practice in the Rogers College of Law, teaches Aging and Social Justice. 

In Aging and the Law, students learn about elder mistreatment, ranging from abuse, neglect and financial exploitation to health care decision making, including advance directives and end-of-life issues from Sklar. The course also addresses how the law intersects with health equity and the social determinants of health, where students consider the role of law in maintaining a safety net for older adults to have economic security, housing and access to care.

Kathryn Huber, MD, MBE, professor of practice in the Rogers College of Law and an internal medicine resident at the University of Colorado Health Systems, teaches Technology and Aging: Legal and Ethical Developments, which provides an in-depth look at the ethical, legal and social challenges facing aging adults amid the rise of novel technologies.

With 88% of Americans saying they prefer to age at home or in a loved one’s home, according to the Associated Press-NORC at the University of Chicago Center for Public Affairs Research, technology-related issues become more urgent.

“Technology offers a way for people to live longer independently, which is going to become increasingly important with continued workforce shortages in health care, including long-term care,” Sklar said. 

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Once adults begin to experience chronic diseases, such as diabetes, hypertension and other serious health issues, advances in health technology are helpful to support medication adherence, fall detections and other monitoring to improve patient safety. But user consent and understanding, privacy and equitable access are all becoming issues.

“Continuous, granular detail of health information and biometric data can be collected, so it’s important for individuals to understand what is being collected, for what purpose, and what will happen with that data after it is no longer needed for that purpose,” Sklar said.

Sklar hopes the graduate certificate in Aging Law and Policy results in more people becoming aware of the complex subjects around aging to gain greater access to care, economic security and support as people age.

“There’s a certain amount of denial when it comes to aging,” Sklar said. “Individuals and families don’t want to think about it, and suddenly there is a medical emergency where decisions need to be made, which can be costly and even potentially detrimental to a person’s health and wishes. This program offers legal training to better prepare and navigate difficult situations so that we can all age well.”

Quinn said she and other students like her who already work with and support older adults feel the Aging Law and Policy graduate certificate fulfills an important need at the perfect time.

“We have to understand the basics to evoke change,” Quinn said. “One of the deficits I had was understanding health care law. The program has helped me build that understanding. I'm hoping that with a better understanding, I'll be able to evoke change as we find better ways to support seniors.”