Ethical Dilemmas in Discharge Planning for Patients with Alzheimer's Disease

Abstract

Because of an increase in the older population in the United States, hospital social workers are faced with the task of developing discharge plans for patients with Alzheimer's disease. The nature of the disease creates the potential for complex situations that can complicate the discharge-planning process. This article explores the ethical dilemmas that arise in discharge planning for patients with Alzheimer's disease and examines how the nature of these dilemmas evolves as the illness progresses. A clinical model is proposed to help practitioners identify, organize, and evaluate information relevant to discharge planning and determine an appropriate course of action.

Abandonment or autonomy: How do social workers know the difference?

“…Wolf and Pillemer (1989) note that many older adults prefer abuse and neglect to the choice of the nursing home (as cited in Bergeron, 2006). Lack of funds may necessitate a choice between two unsatisfactory options for an older adult who requires care when the home environment is no longer appropriate (Cummings & Cockerham, 1997). When choices are limited or appear equally aversive, it is difficult to construe the choice to remain in an abusive situation as a free and conscious one.…”

“…This last idea leads to the need to recognize that the informal care provided by friends and family are an essential source of labour in our elder care system and must be recognized in care planning (Healy, 1999). The potential for conflict is great when the needs of the older adult and the caregiver are competing; mediation techniques are suggested as helpful, but the answers are not always clear (Cummings & Cockerham, 1997;Healy, 1999). The reality that the caregiver might need to be regarded as part of the equation also leads to the fact that planning support and assistance for an adult in abusive circumstances needs to take into consideration, not only the needs of the abused adult, but also the needs of the perpetrator (Beaulieu & Leclerc, 2006;Thompson & Priest, 2005).…”

“…Overall, the literature lacks substantial material to assist or provide direction to social workers when confronted with ethical dilemmas (Cummings & Cockerham, 1997). The principle of self-determination is emphasized as essential to the profession without guidelines for when directive intervention is appropriate (Rothman et al, 1996).…”

The impact of personal injury motor vehicle incidents: the development of adverse stress reactions

“…Social workers also provide discharge planning services that are designed to assist individuals and families in developing and implementing timely and appropriate service plans following release from primary health care services (Cummings & Cockerham, 1997;Morrow-Howell, Chadiha, Proctor, Hourd-Bryant, & Dore, 1996;Proctor, Morrow-Howell, & Kaplan, 1996;Ruster, 1995). Discharge plans can include the arrangement and organization of services or equipment that are needed in the individuals' home, placement in a long term care home, or any other service requirements that are needed at the time of discharge (Cummings & Cockerham, 1997;Morrow-Howell et al, 1996;Proctor, Morrow-Howell, & Kaplan, 1996;Ruster, 1995).…”

“…Discharge plans can include the arrangement and organization of services or equipment that are needed in the individuals' home, placement in a long term care home, or any other service requirements that are needed at the time of discharge (Cummings & Cockerham, 1997;Morrow-Howell et al, 1996;Proctor, Morrow-Howell, & Kaplan, 1996;Ruster, 1995). Discharge plans are determined based on the individual and family medical and social needs, taking into consideration the individuals' treatment needs, the preferences of the individual and family, the level of care needed, possible financial resources, and the services and facilities available in the community (Cummings & Cockerham, 1997).…”