Monday, November 15, 2010

Ethics in LTC

In chapter 12 of Long-term Care: Managing Across the Continuum, several ethical issues were mentioned such as emotional impact on consumers, access to care, rationing, “spending down”, patient autonomy, informed consent, end of life issues, and everyday issues including privacy, confidentiality, and restraints.  I think it’s important to touch on each of these issues because ethics in long-term care is an issue that will constantly need to be approached.

First, I want to discuss the emotional impact on consumers. The text states emotional impacts resulting from loosing independence, being separated from loved ones, and the vast change in environment (Pratt, 322-323). When providing care to this fragile population, it is important that we also address their emotional needs and provide support. I couldn’t imagine what it would be like to be separated from a loved one, live in a room with a complete stranger, and need assistance with the most basic daily functions such as dressing, toileting, and eating. When caring for patients in a LTC setting, I think it’s important to think about ourselves in that position and how we’d like to be cared for if it was us.

Next is access to care. We all know that access to any form of care is usually limited by reimbursement. Those with greater ability to pay have better access to care. As the aging population continues to increase, access to LTC will continue to be a problem. We need to start thinking about how we’re going to approach this problem in the upcoming years when the ratio of elderly to workers is 2:1. Somehow, access will need to be increased and the problem of funding this access will also become an issue needing to be addressed.

“Spending down” is another controversial issue. To gain access to public funding, those who previously would not qualify are required to spend down their assets. In the text, this section compares the ideas of elderly being required to use up their assets on paying for their own care, or the right to pass down their life savings and gain public funding although they could pay for themselves (Pratt, 327). This section reflects on a very tough issue. I do feel that the elderly have a right to keep their assets safe and to pass their life savings down to children and grandchildren, but at the same time, funding those that can fund themselves takes funding away from those who have no way to afford healthcare on their own. So the important question I have yet to find an answer to is, how do we decide if they should spend their assets on their own healthcare or provide them funding so they can pass down their assets?

We all demand autonomy when it comes to our healthcare. We all want to be active and involved in making decisions regarding treatment that will affect our lives. However, the elderly is a population that faces limitations to this autonomy. They don’t always have a say or a choice in where their care is provided or who provides this care. Away that we as healthcare providers could maintain the patient’s autonomy is to include them in making certain decisions. For example, when I was in high school and apart of the medical academy, we spent a clinical rotation in a nursing home. I worked in the Alzheimer’s unit. We were taught to always include the resident in the decision making process. For example, asking the resident what they’d like to wear today and allowing them to choose their own clothing allows them to have a say in what goes on. Other ways to include them in their own autonomy is to ask if they’d like a bath before or after breakfast, if they’d like to partake in certain activities, and other simple decision making questions.

Informed consent is an issue that affects every person receiving and providing any type of care. The problem related to LTC is that although you may give your resident all the information they may need, they may not have comprehended all the information you gave.  It is important to give your patients all the information they need to consent to treatments and make informed decisions about their own care. I want to use myself as an example of what happens when you make decisions that you’re not fully informed about. This past year, I found that I had some personal problems with my own health and after undergoing surgery, the next step was to try an experimental drug. Unfortunately, when discussing the drug, I was not made aware of all the possible side effects that I may experience. Had I known what all the risks against benefits were, I most certainly would not have agreed to take the drug. It was in the form of an injection that lasted 3 months. Almost immediately I had terrible side effects that affected how I was able to go about my daily functions. The drug made me feel sicker than I had ever felt and there was no way I would have agreed to it if I had known. Because the drug lasted 3 months, I had no choice but to suck it up and deal with it until the effects wore off. I wish that I was given all the information so that I could have made a decision that was right for me. After that experience, I now know how important informed consent really is.

Another ethical issue is end of life issues. At the end of life, it’s hard to determine the decision-making capacity of the person and if they need to allow family members to make decisions for them.  One way to help with this problem is advanced directives or a living will that states what actions they want to be taken in certain end of life situations (Pratt, 336).  As health care providers, we are all going to face end of life issues that will be very hard on us. It is important to make decisions based on the benefit of the individual patient and what the patient wants for them, not what we feel is right for them. I watched a show the other night about a 13 year old girl with a terminal heart decision who made the decision herself to not have a heart transplant. Although her parents and her healthcare providers all thought that she was making the wrong decision, she was making the right decision for herself based on her own cost-benefit analysis. Although we may not always agree with people’s decisions, as providers, we have to understand that they’re making that decision for themselves and what they feel is right for them.

The last ethical issue I want to touch on is the everyday issues that will be faced in the LTC setting.  Privacy and confidentiality are two main issues that are constantly faced in the LTC setting. I wrote my LTC memo this week based on these two main issues. I feel that it’s extremely important to respect the privacy of every person that we care for. Once again, when approaching these issues, we need to put ourselves in this position and understand how important privacy would be to us. Sometimes, residents are put in somewhat degrading positions such as when being assisted with bathing and toileting. To ensure that residents and patients maintain their dignity, we have to support them mentally and emotionally for them to feel comfortable allowing us to assist them in very vulnerable situations. Handling the patient’s privacy with the utmost respect and professionalism will allow them to understand that we are not here to degrade them, but to provide help and comfort in any situation.

Every ethical issue mentioned in chapter 12 are both important and issues that will frequently be addressed in the LTC setting. To handle them in appropriate manners, we have to put ourselves in their shoes and provide care based on who we’d want to be treated in those situations. Always providing support and care with the utmost respect will help residents for the better in these ethical situations.

Pratt, John R. Long-Term Care Managing Across the Continuum. Third. Sudbury, MA: Jones and Bartlett Publishers, 2010. 321-351. Print.

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