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1 Ethical & Legal Issues In Homecare AHHC is committed, in provision of care, to recognizing and respecting each client’s fundamental human, civil, constitutional and statutory rights. In order to make ethical decisions, you must first understand ethical principles. AHHC services are designed to create an environment of client-oriented values and to promote ethical sensitivity. AHHC seeks to establish and maintain high standards of conduct, recognizing that this is only achievable with a strong personal commitment from management and all staff. All personnel are expected to recognize and implement the ethical dimensions of agency policy. Every employee is expected to maintain the confidentiality of all professional relationships and to cooperate with all health professionals in meeting the needs of AHHC’s clients. Every employee is expected to adhere to this code of ethics. The setting for AHHC services is generally the private home of the client, and AHHC expects its employees to respect the client’s property and treat him/her with respect and dignity, regardless of the client’s race, color, creed, national origin, religion, age, sex, sexual preference, disability, socioeconomic status or diagnosis. Every employee must recognize and observe the client’s rights. Every client has the right to participate in the planning of his/her own care. Care rendered from the home differs from care provided in an institution, but this must not result in any compromise in the quality of care, safety or welfare of the client. AHHC’S ETHICS COMMITTEE Committee Chairperson: Beth Albert (618) 659-2273 [email protected] The Ethics Committee provides a forum for sharing ideas and discussing key ethical issues. The committee considers many complex issues. The Ethics Committee will function essentially in an advisory manner. It will not have the authority to make treatment decisions or to overrule physician’s orders. Its activities include tasks such as: education of staff and review/recommend revision of policies related to ethical issues as well as address any current ethical dilemmas which AHHC staff may be facing while providing care in the home. Any AHHC employee may request consultation with the ethics committee or for a situation to be reviewed by the ethics committee as needed. An ethical dilemma is any situation that may be identified by the following: There are reasons to do two (2) or more opposing activities There are conflicting values, wishes or beliefs among several involved persons Ethical principles are at stake There are no right or wrong answers The essence of ethical decision-making is the application of moral values. Such values may be derived from a number of sources, including family upbringing, religious training, education and social interaction; they may also be influenced by societal norms, such as those embodied in state and federal legislation. Health care organizations have become increasingly concerned, in recent years with ethical issues. Among the factors that have contributed to this concern are: a realization that financial resources are finite; pressures to contain costs; the phenomenal increase in technologic capabilities, with subsequent cost increases; and increased client expectations and demands for self-determination. Many of these factors are of particular significance in the provision of home health services, because this is so often seen as an alternative to inclient care, and potentially less costly. Increasingly, AHHC’s personnel will have to confront complex and sensitive ethical dilemmas concerning both professional and business matters involved in the delivery of health services. This information is intended to assist in illuminating the kinds of issues that may arise and in making sound decisions. The pages that follow are designed to provide a framework for your thinking and to encourage you to reflect upon the ethical issues that arise whenever health services are provided. The ethical challenges that may arise in the home setting differ in some respects from those in the institutional setting and are highlighted in these pages. Although ethics can and should permeate our daily activities, the various agency policies are the key guidelines for all activities; there is no conflict between policy as set forth in the manual and the ethical principles at AHHC.

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Page 1: Ethical & Legal Issues In Homecare - Anchor Home Health Careanchorhomehealthcare.com/download/i/mark_dl/u/2345134/1492933… · Ethical & Legal Issues In Homecare AHHC is committed,

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Ethical & Legal Issues In HomecareAHHC is committed, in provision of care, to recognizing and respecting each client’s fundamental

human, civil, constitutional and statutory rights. In order to make ethical decisions, you must firstunderstand ethical principles.

AHHC services are designed to create an environment of client-oriented values and to promoteethical sensitivity. AHHC seeks to establish and maintain high standards of conduct, recognizing that this isonly achievable with a strong personal commitment from management and all staff. All personnel areexpected to recognize and implement the ethical dimensions of agency policy. Every employee is expectedto maintain the confidentiality of all professional relationships and to cooperate with all health professionalsin meeting the needs of AHHC’s clients. Every employee is expected to adhere to this code of ethics. Thesetting for AHHC services is generally the private home of the client, and AHHC expects its employees torespect the client’s property and treat him/her with respect and dignity, regardless of the client’s race, color,creed, national origin, religion, age, sex, sexual preference, disability, socioeconomic status or diagnosis.Every employee must recognize and observe the client’s rights. Every client has the right to participate inthe planning of his/her own care. Care rendered from the home differs from care provided in an institution,but this must not result in any compromise in the quality of care, safety or welfare of the client.

AHHC’S ETHICS COMMITTEE Committee Chairperson: Beth Albert (618) [email protected]

The Ethics Committee provides a forum for sharing ideas and discussing key ethical issues. Thecommittee considers many complex issues. The Ethics Committee will functionessentially in an advisory manner. It will not have the authority to maketreatment decisions or to overrule physician’s orders. Its activities include taskssuch as: education of staff and review/recommend revision of policies relatedto ethical issues as well as address any current ethical dilemmas which AHHCstaff may be facing while providing care in the home. Any AHHC employee mayrequest consultation with the ethics committee or for a situation to be reviewedby the ethics committee as needed.

An ethical dilemma is any situation that may be identified by the following: There are reasons to do two (2) or more opposing activities There are conflicting values, wishes or beliefs among several involved persons Ethical principles are at stake There are no right or wrong answers

The essence of ethical decision-making is the application of moral values. Such values may be derivedfrom a number of sources, including family upbringing, religious training, education and social interaction;they may also be influenced by societal norms, such as those embodied in state and federal legislation.

Health care organizations have become increasingly concerned, in recent years with ethical issues.Among the factors that have contributed to this concern are: a realization that financial resources are finite;pressures to contain costs; the phenomenal increase in technologic capabilities, with subsequent costincreases; and increased client expectations and demands for self-determination.

Many of these factors are of particular significance in the provision of home health services, becausethis is so often seen as an alternative to inclient care, and potentially less costly. Increasingly, AHHC’spersonnel will have to confront complex and sensitive ethical dilemmas concerning both professional andbusiness matters involved in the delivery of health services. This information is intended to assist inilluminating the kinds of issues that may arise and in making sound decisions.

The pages that follow are designed to provide a framework for your thinking and to encourage you toreflect upon the ethical issues that arise whenever health services are provided. The ethical challenges thatmay arise in the home setting differ in some respects from those in the institutional setting and arehighlighted in these pages. Although ethics can and should permeate our daily activities, the variousagency policies are the key guidelines for all activities; there is no conflict between policy as set forth in themanual and the ethical principles at AHHC.

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The following are all principles that are used to build a strong foundation for all of Anchor’s policies andservices we provide to our clients and their families.

Client autonomy means that each client is unique and has the right to make decisions affecting his/herown life. The client can revise these decisions at any time. As an autonomous person, a client is entitled tohave his/her privacy respected. At AHHC, we start with the assumption that the client is competent to giveauthorization and consent for care. If the client is not competent, she/he has a right to have a familymember or guardian exercise his/her rights.

To give “informed consent” for home health care:The client receives appropriate information.The client understands the information given.The client is able to voluntarily give the consent.

Beneficence & non-maleficence states a prevention of harm, a removal of harmful conditions; doingwell for the benefit of others and not harming others either intentionally or unintentionally. It also includesprotecting others from harm that are not able to protect themselves due to age, illness and/or other mentalstatus.

Fidelity reflects faithfulness in keeping the client’s reasonable expectations. The client has a right toexpect you to be: respectful, competent, professional and confidential.

Veracity means to tell the truth and not intentionally deceive or mislead.Justice states you can give others what they deserve or can legitimately claim.

CLIENT AUTONOMY & FAMILY OBLIGATIONThe delivery of care at home involves meeting the needs not only of the client, but also the family or

significant other; in some instances these are complimentary, but in others they may be in conflict. There isa constant need to see these various elements in perspective and to maintain a constructive balanceamong them – while maintaining respect for the autonomy of the client. How can we manage the family members or significant other who sees him/herself as a spokesperson or

negotiator for the client this effectively overriding client autonomy? What happens when family members/significant others intervene in care against professional judgment? What happens when a client is unable or unwilling to give the amount and quality of self-care that is

needed; or a family member or significant other is unwilling or unable to participate as needed? How should we deal with the competent client who insists on remaining at home despite a judgment by

our staff that his/her clinical needs have changed and care at home is no longer a practical option?

ABUSE & NEGLECTEvery home care client is potentially vulnerable to abuse or neglect. Dilemmas arise, not in cases that

are clear, but in those where evidence of abuse or neglect is ambiguous. In some situations, abuse may becovert and not readily observable. In other cases, differences in cultural norms may give rise to behaviorsthat may appear abusive. In these and other potentially ambiguous situations, discussions among staff areoften helpful in attaining resolution.

Home health care employees are often in the position to notice the first signs of abuse/neglect. Anyaccusations of abuse or neglect are very serious. If you believe there are risk factors for abuse or neglect,contact your supervisor immediately. As a health care employee you are a mandated reporter for actual orsuspected abuse and/or neglect. If you suspect abuse or neglect, immediately call the state hotline. Youmust also report to your nursing supervisor if a hotline report is made.

ADVANCE DIRECTIVES, LIVING WILLS, HEALTH CARE PROXIESEvery competent client has the right to participate in the decisions affecting his/her care.

Such rights vary from the simplest daily routines (for example: What time will meals beserved? When will the television set be on and what programs will be watched?) to the mostcomplex and sensitive issues such as those concerning “Do Not Resuscitate” (DNR) ordersand the type of care to be provided during terminal illness. The latter has becomeincreasingly important, as the provision of high-tech services in client’s homes (especially life-sustainingcare) has become more practical and widespread. As a result, laws have been enacted and designed toprotect the rights of dying clients regarding the withholding or withdrawal of life-sustaining treatment. Theseinclude:

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1) advance directive or “living will” laws providing for a person to specify in writing his/her wishes aboutartificial life support and other types of health care

2) laws providing for a person to designate a “health care agent” (proxy) or execute a durable power ofattorney for health care designating someone to make decisions if he/she is unable to make them forhim/herself

3) provisions spelling out who will have the authority to make surrogate decisions for incompetent clientswho have not executed the documents in 1 or 2

ENVIRONMENTDespite the search for perfect objectivity in client care, differences in judgment can result in ambiguous

situations that pose ethical problems for staff. What happens when the client, family members, professionalcaregivers, third party payers and regulatory surveyors define “appropriate environment” differently? Forexample: professional staff may find a setting unsatisfactory, but for the client, it is “home” and verysatisfactory; professional staff may favor a realistic compromise, while regulatory surveyors insist on “goingby the book”; dangerous environment may place staff in jeopardy and may require a decision not to accepta client despite significant clinical needs.

UNSAFEWhat are the ethics of refusing to accept or of discharging a client – or of looking the other way – when

client or family member are engaged in substance abuse or other types of inappropriate behavior.

INCOMPETENT OR ILLEGAL BEHAVIOR BY PERSONNELWhat is the appropriate course of action when a staff member observes that a co-worker (whether from

the same or a different agency) is behaving illegally in the client’s home, or has emotional problems or signsof substance abuse that interferes with job performance? How can such a staff member be offeredcounseling? When is termination appropriate? How can the staff member’s rights be protected and theindividual assured of due process?

INTOLERANCE & DISCRIMINATIONExpressions or actions on the part of staff which promote discrimination (against other staff, clients,

family members or significant other) on the basis of race, color, creed, national origin, religion, age, sex,sexual preference or disability are not compatible with good client care and are not permitted by AHHCpolicy and by law. Such behavior on the part of clients, family members or significant other is equallyunacceptable.

PRIVACY/CONFIDENTIALITYPreserving confidentiality of information obtained in connection with provision of health care and related

services is a primary obligation. Law does not only protect client/family information; confidentiality in suchmatters must be seen as an ethical imperative.

REFUSAL OF CAREA client, the parent/guardian of a client or the legal power of attorney for the client all have the right to

refuse any or all treatment or medication. You must respect the client’s decision if he/she refuses care.However, there are necessary steps to take if a client does refuse care:

1. Respectfully discuss this decision with the client in order to ensure they are aware of the physician’sreason for ordering the treatment/medication as well as educating them on the possiblecomplications or issues that may arise from not taking the medication or performing the treatment.

2. Document the client’s exact words and the reason it is not being done in your shift charting.3. Contact your Nursing Supervisor so he/she can determine if it is necessary to contact the physician.

NEGLIGENCE IN HOME HEALTH CARENegligence is when you fail to act or omit an important piece of information and that behavior causes

harm to another. Examples of negligence are: Failure to notify the physician of changes in a client’s condition Failure to follow the Plan of Care Failure to detect a client’s worsening condition Inadequately educating the client and family.

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MALPRACTICEMalpractice relates to professionals who must adhere to established standards of practice. This

automatically excludes aides and personal care attendants. It differs from negligence in that a duty owed tothe client is a professional one.

Four elements must be proved for any accused clinician to be found guilty of negligence or malpractice.1. DUTY: You have a duty to your client to provide reasonable and competent care. This is

defined externally through state practice act and legal standards of care. It isdefined internally through physician orders and AHHC policies.

2. BREACH: You deviate from the normal course of practice in one of twoways: Act - doing something you are not licensed to do or you do somethingincorrectly. Omission - failing to do something you are supposed to do.

3. INJURY OR DAMAGE: Your action or inaction must have caused injuryor damage to the client.

4. CAUSAITON: You failed to act, or acted incorrectly. Because of the action/inaction, the clientsuffers an injury.

State practice acts and regulations differ by state. Practice acts are shaped by many pieces oflegislation and federal public health laws. Below are general guidelines to practice in the field of homehealth care. Illinois regulations on nursing can be found at online at http://ilga.gov/legislation/ilcs/ilcs.asp (chooseCHAPTER 225, then choose 225 ILCS 65) or at http://www.ilga.gov/commission/jcar/admincode/068/06801300sections.html

CONFIDENTIALITYYou have a legal obligation to protect sensitive information and this information can only be revealed

with the client’s permission. In the client’s home, the medical records should be kept in an out of the wayarea not easily accessible to visitors and others in the home. Client privacy and confidentiality also appliesto voice mail, phone calls, cell phones, medical records and faxes.

STEPS TO REDUCE LIABILITY &RISK Follow AHHC policies. Document on time and accurately. Provide competent care.

Demonstrate respect for clients and families. Keep current clinically and professionally.

AHHC
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