Discussion- Over and under regulation

Chapter 13 Ethical Issues in Long-Term Care

Learning Objectives

1. Understand the social and emotional impact of changes caused in the lives of individuals when long-term care is needed

2. Discuss the ethical aspects of access to care

3. 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

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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.