Understand the social and emotional impact of changes caused in the lives of individuals when long-term care is needed
Chapter 13
Ethical Issues in
Long-Term Care
Learning Objectives
Understand the social and emotional impact of changes caused in the lives of individuals when long-term care is needed
Discuss the ethical aspects of access to care
Define autonomy and the relationship between independence and self-determination
Learning Objectives (continued)
4. Identify end-of-life issues and discuss their ethical and legal implications
5. Understand the magnitude of day-to-day needs of consumers and providers’ efforts to meet them
6. Discuss management ethics and its role in a long-term care organization
Emotional Impact on Consumers
Chronic illness or disability means:
Can no longer do things that were important, resulting in feeling of loss
Must rely on others for assistance with most intimate activities
Loss of privacy
May need to move, be separated
from family
Most important – loss of self-worth
Access to Long-Term Care
Access-related issues include:
A reimbursement-driven system
Cost-cutting efforts
Inequitable distribution of services
Institutional vs. non-institutional options
Balancing obligation to provide care with obligation to use resources wisely
The Ethics of Rationing
Explicit rationing:
Government allocation of limited funds
Insurance and managed care don’t cover certain conditions and procedures
Implicit rationing:
Favors one type of provider over another to influence service delivery
– e.g., home health care vs. nursing care facilities
Transfer of Assets
Is transferring assets to qualify for Medicaid ethical?
Right to leave assets to children?
Should the wealthy be subsidized?
Is it ethical to penalize frugal savers?
Autonomy
The concept of autonomy as the right to self-determination
- Impact of cultural change
The autonomy-beneficence conflict
Other autonomy-related conflicts
Informed consent
End-of-Life Issues
Competency and decision-making capacity
Protecting the interests of the consumer
Advance directives
Patient Self-Determination Act
Ethics committees
Providing “futile care”
Everyday Life Issues
Privacy
Shared space
Confidentiality
Food
Activities
Restraints
Types of restraints
Regulatory requirements for their use
The ethics of using restraints
Abuse
Types of abuse in long-term care:
Physical abuse
Sexual abuse
Fiduciary abuse
Emotional abuse
Preventing abuse
© 20 Jones and Bartlett Publishers, LLC
© 20 Jones and Bartlett Publishers, LLC
Other Settings
The level of dependence of nursing facility residents makes them more vulnerable, but the same ethical issues apply to other settings.
Management Ethics
Important for any management setting
Of particular importance where consumers are so vulnerable
Ethics Management Programs
Codes of ethics
Codes of conduct
Policies and procedures
Summary
Many ethical issues surround the provision of long-term care to vulnerable populations. These issues seldom have single right answers, but provider and consumer groups are working toward resolution.