Special Supplement: New Directions in Nursing Home Ethics

Collopy, Bart; Boyle, Philip; Jennings, Bruce

doi:10.2307/3562344

Cited by 42 publications

(2 citation statements)

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“…Family members play an important role in the moral problems that caregivers experience [6, 33]. A resident’s family is part of his or her life.…”

Section: Discussionmentioning

confidence: 99%

“…Instead of temporarily getting treatment and being cured older people in nursing or care homes are living in an institution until their last day, facing deterioration rather than cure [6, 17]. This calls for a different ethical framework in which the emphasis shifts from upholding individual rights to meeting the residents’ needs in congruence with their life story and sharing responsibilities between resident, family and staff [17].…”

Section: Introductionmentioning

confidence: 99%

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“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

Dam

Abma

Kardol³

et al. 2011

Health Care Anal

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Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’.

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“…Family members play an important role in the moral problems that caregivers experience [6, 33]. A resident’s family is part of his or her life.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

Dam

Abma

Kardol³

et al. 2011

Health Care Anal

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Nursing Home Residents' Preferences for Life-Sustaining Treatments

O’Brien

Grisso²,

Maislin³

et al. 1995

JAMA

166

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Access to Palliative Care and Hospice in Nursing Homes

Zerzan

Stearns²,

Hanson³

2000

JAMA

186

123

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Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.

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Special Supplement: New Directions in Nursing Home Ethics

Cited by 42 publications

References 0 publications

“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

Nursing Home Residents' Preferences for Life-Sustaining Treatments

Access to Palliative Care and Hospice in Nursing Homes

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