Posted: September 20th, 2022

Discussion Topic After reading this week’s chapter 13, in this forum, do you feel that health care is over-regulated or under-regulated? Explain, using examples where appropriate. At least 275 words Course Materials: Pratt. J. Long-Term Care- Mana

Chapter13lecturenotes-week11 Chapter13-week11PPT
 

Discussion Topic

After reading this week’s chapter 13, in this forum, do you feel that health care is over-regulated or under-regulated? Explain, using examples where appropriate.

At least 275 words 

Course Materials: Pratt. J. Long-Term Care- Managing Across the Continuum. 4th edition. Jones and Bartlett ISBN: 978-1-284-05459-0. 

Long-Term Care: Managing Across the Continuum, Fourth Edition
John R. Pratt

  • CHAPTER THIRTEEN: ETHICAL ISSUES IN LONG-TERM CARE
  • CHAPTER HIGHLIGHTS
  • Introduction – there are many ethical issues relating to long-term care.
  • Emotional Impact on Consumers – it is important to understand and recognize the emotional

    impact on someone needing long-term care. It is a huge lifestyle change.

  • Access to Long-Term Care – the first ethical issue addressed deals with access to care.
  • It is far from universal or equitable.
  •  Consumers do not always have a choice of services.

    Ethics of Rationing – an ongoing debate

     Should health care services be rationed?

     Should everyone get all services they desire?

     Who pays?

    Transfer of Assets: “Spending Down” – The Medicaid requirement that consumers must

    spend other resources before qualifying for Medicaid raises ethical issues.

     They do not want to lose all that they have saved over the years.

     Medicaid is intended as a safety net for those who have no other assets.

     Lawyers and estate planners find ways to circumvent the rule.

     Who is right?

    Autonomy – Virtually all other ethical issues in long-term care seem to revolve around the

    question of how much autonomy a person has in deciding how he or she will live and be treated.

  • Autonomy can be defined simply as self-determination.
  • © 2015 Jones and Bartlett Publishers, LLC 1

    Long-Term Care: Managing Across the Continuum, Fourth Edition
    John R. Pratt

     Long-term care consumers want more choice in their care.

     How to grant autonomy and still maintain clinical safety is an ongoing issue.

    Culture Change – a national movement based on person-directed values and practices where

    the voices of elders and those working with them are considered and respected.

    Autonomy–Beneficence Conflict – autonomy in long-term care may conflict with the more

    traditional concept of beneficence: the responsibility of the provider to act in the best

    interests of the patient.

    Other Autonomy-Related Conflicts

     Meeting the wishes (demands) of the consumer within the resources of the provider.

     Balancing the rights or wishes of one consume with others.

     Conflict between consumer desires and provider values.

    Informed Consent

     Means that consumers have the right to have enough information to make intelligent

    decisions about the care they receive.

     Is a legal right.

     Requires making sure consumers understand their options.

    End of Life Treatment Issues – many long-term care ethical issues involve end-of-life care and

    all of the complications that attend it.

     Competency and Decision-Making Capacity – if consumer cannot make own

    decisions, someone else must do so for them.

    © 2015 Jones and Bartlett Publishers, LLC 2

    Long-Term Care: Managing Across the Continuum, Fourth Edition
    John R. Pratt

     Protecting the Interests of the Consumer – defining competency is a subjective process

    at best and all involved need to protect the interests of consumers who cannot protect

    themselves.

     Advance Directives – the general term for a variety of documents designed to enable

    competent adults to make healthcare decision-making plans in advance of possible future

    incapacity, including:

     Living Wills – documents that spell out treatments that one wants or does not

    want ic case of future inability to make decisions.

     Durable Power of Attorney – designates someone to make such future decisions

    on one’s behalf.

     Patient Self-Determination Act – Requires providers to make consumers aware of their

    right to create advance directives and have them honored.

     Ethics Committees – in-house committees that assist in ensuring that life and death

    decisions are made properly and in accordance with the wishes of the resident.

    Futile Care – having to provide life-extending care regardless of the previously stated wishes

    of the resident when there is no hope of recovery or improvement in the patient’s condition.

    Autonomy: How Far to Go? – This promises to be an ongoing debate with no easy answers.

    Everyday Life Issues – Although end of life issues are of critical importance, everyday life

    issues are much more on the minds of long-term care consumers, including:

     Privacy – a critical component of a feeling of self-worth and independence, but not

    always easy to provide.

    © 2015 Jones and Bartlett Publishers, LLC 3

    Long-Term Care: Managing Across the Continuum, Fourth Edition
    John R. Pratt

     Shared Space – residents in an institutional setting must sacrifice some of their privacy

    in sharing space with others.

     Confidentiality – respecting privacy also means respecting confidentiality and all

    consumers deserve it to the degree possible in a care situation.

     Food – different people have different tastes and preferences in the type of food they eat,

    sometimes based on ethnic or religious background. Complying with all of their wishes in

    an institutional setting can be very difficult

     Activities – group and individual activities are important for the physical and mental

    health of consumers in institutions, and can reinforce individualism if planned carefully.

    Restraints – physical and chemical restraints may be necessary to protect the consumer’s safety

    and well-being.

     They must not be used for the convenience of staff or to control difficult residents.

     How and how often they may be used are regulated.

    Abuse – Any form of abuse of long-term care residents or clients is unethical and illegal. Abuse

    may be:

     Physical – striking or otherwise harming the consumer (e.g., not providing needed

    medication or treatment).

     Sexual – taking sexual advantage of a vulnerable resident.

     Emotional – can range from the extremes of yelling and name-calling to subtle

    intimidation.

     Fiduciary – failure to demonstrate appropriate stewardship of the finances of consumers.

  • Management Ethics
  • © 2015 Jones and Bartlett Publishers, LLC 4

    Long-Term Care: Managing Across the Continuum, Fourth Edition
    John R. Pratt

     Focus on ethical issues concerning the management of the provider facilities and

    agencies.

     May not affect consumers as directly, but can have the same long-term impact.

    Ethics Management Programs – programs spell out an organization’s values, set guidelines

    for behavior, train employees, and provide guidance in difficult situations. They usually

    include:

     Codes of Ethics – a description of the organization’s values and the ethical rules by

    which it operates.

     Codes of Conduct – the code of ethics by identifying behaviors that are

    acceptable.

     Policies and Procedures – the code of ethics by identifying behaviors that are

    acceptable.

    © 2015 Jones and Bartlett Publishers, LLC 5

      CHAPTER THIRTEEN: ETHICAL ISSUES IN LONG-TERM CARE

      CHAPTER HIGHLIGHTS

      Introduction – there are many ethical issues relating to long-term care.

    • Emotional Impact on Consumers – it is important to understand and recognize the emotional impact on someone needing long-term care. It is a huge lifestyle change.
    • Access to Long-Term Care – the first ethical issue addressed deals with access to care.

      It is far from universal or equitable.

      Ethics of Rationing – an ongoing debate

      Should health care services be rationed?

      Transfer of Assets: “Spending Down” – The Medicaid requirement that consumers must spend other resources before qualifying for Medicaid raises ethical issues.

    • Autonomy – Virtually all other ethical issues in long-term care seem to revolve around the question of how much autonomy a person has in deciding how he or she will live and be treated.
    • Autonomy can be defined simply as self-determination.

      Culture Change – a national movement based on person-directed values and practices where the voices of elders and those working with them are considered and respected.

      Autonomy–Beneficence Conflict – autonomy in long-term care may conflict with the more traditional concept of beneficence: the responsibility of the provider to act in the best interests of the patient.

      Other Autonomy-Related Conflicts

      Informed Consent

      Means that consumers have the right to have enough information to make intelligent decisions about the care they receive.

      End of Life Treatment Issues – many long-term care ethical issues involve end-of-life care and all of the complications that attend it.

      Competency and Decision-Making Capacity – if consumer cannot make own decisions, someone else must do so for them.

      Protecting the Interests of the Consumer – defining competency is a subjective process at best and all involved need to protect the interests of consumers who cannot protect themselves.

      Advance Directives – the general term for a variety of documents designed to enable competent adults to make healthcare decision-making plans in advance of possible future incapacity, including:

      Patient Self-Determination Act – Requires providers to make consumers aware of their right to create advance directives and have them honored.

      Ethics Committees – in-house committees that assist in ensuring that life and death decisions are made properly and in accordance with the wishes of the resident.

      Futile Care – having to provide life-extending care regardless of the previously stated wishes of the resident when there is no hope of recovery or improvement in the patient’s condition.

      Autonomy: How Far to Go? – This promises to be an ongoing debate with no easy answers.

    • Everyday Life Issues – Although end of life issues are of critical importance, everyday life issues are much more on the minds of long-term care consumers, including:
    • Privacy – a critical component of a feeling of self-worth and independence, but not always easy to provide.

      Shared Space – residents in an institutional setting must sacrifice some of their privacy in sharing space with others.

      Confidentiality – respecting privacy also means respecting confidentiality and all consumers deserve it to the degree possible in a care situation.

      Food – different people have different tastes and preferences in the type of food they eat, sometimes based on ethnic or religious background. Complying with all of their wishes in an institutional setting can be very difficult

      Activities – group and individual activities are important for the physical and mental health of consumers in institutions, and can reinforce individualism if planned carefully.

    • Restraints – physical and chemical restraints may be necessary to protect the consumer’s safety and well-being.
    • Abuse – Any form of abuse of long-term care residents or clients is unethical and illegal. Abuse may be:
    • Management Ethics

    • Focus on ethical issues concerning the management of the provider facilities and agencies.
    • Ethics Management Programs – programs spell out an organization’s values, set guidelines for behavior, train employees, and provide guidance in difficult situations. They usually include:

      Codes of Ethics – a description of the organization’s values and the ethical rules by which it operates.

      Codes of Conduct – the code of ethics by identifying behaviors that are acceptable.

      Policies and Procedures – the code of ethics by identifying behaviors that are acceptable.

    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

    © 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.

    • Slide 1
    • Learning Objectives

      Learning Objectives (continued)

      Emotional Impact on Consumers

      Access to Long-Term Care

      The Ethics of Rationing

      Transfer of Assets

      Autonomy

      End-of-Life Issues

      Everyday Life Issues

      Restraints

      Abuse

      Other Settings

      Management Ethics

      Ethics Management Programs

      Summary

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