Long term care decision arises for the individuals who are elderly and their families when these aged individuals are rendered unable to live independently and the loss of such capacity for independent living is often attributed to the changes in health resulting to a decreased ability to care for oneself especially as it regards to daily activities like cooking, bathing, eating and toileting. Such changes in the health status may include dementia, paralysis emanating from stroke or even blindness. The leading set of health acre authorities on long term care, Rosalie Kane and Robert Kane defines this situation as a set of health ,social services and personal care that are delivered over a sustained periods of time to individuals with lost or those who have never acquired some degree of functional capacity (Agich, 1993).
Over the recent years systematic restructuring and policy development have shifted its focus concerning health care from being given from the hospital set up as well as from other institutionalized settings to a home set up and this has resulted to care being given by several care givers that include the health h care professional, unpaid care givers, less killed an paid care givers including friends and family members. Such shift in the provision of health care into home set up has significant impacts both to the patient and the individuals who are both paid as well a the unpaid and these group of individuals bear the increasingly heavy burden characterized with providing care in the home setting. Home care has led to emergence of several ethical and practical issues that include the roles and the identity of the health care providers, meaning and significance o f a home, the complex relations involved, the potential for depersonalization, the complex issues associated with home care with children and finally the issues as it pertains to the broad policy considerations regarding the home care context (Kane & Caplan 1990).
Even as early as time before the 20th century caring for the sick was mostly done at home with physicians carrying out their assessment in the home while the subsequent was often provided by family members and relatives with the ones with sufficient finance being able to employ a nurse or any professional care giver. Those unable to care at home were looked after in variety of other institutions which gave way to the increased care giving in hospital in the late 20th century. This tern d has seen institutional care giving dominate. This paper will serve primarily as a research paper that will provide a background data on the details pertaining to the ethical issues that regards to the provision of long term home care. The research will be conducted through detailed analysis of relevant literature to yield an in depth information on the ethical issues in home care. The research will play a great role in designing of the long term care systems which are accessible, responsible, accountable and efficient able to help in addressing the wide variety of human needs with both dignity and respect.
In the context of providing long term home care the term ethics is mainly used to refer to the moral aspects of the human conducts as well as the personal character and often ethical dilemmas that arise relate to personal freedoms, rights, responsibilities and obligations. Some of the areas that show some ethical concerns when it comes to long-term home care include: in advance care planning in preparation for life un expected emergencies, health care ethics, family and friends, rights of privacy and finally on issues relating to religion and health care.
Care in the home setup is becoming an increasing area fro the members of the public both as patient, relatives and friends, family members, politicians, health care administrators, health care professionals and the media. Home care is presents a new direction in the health care provision thus can be regarded as a rediscovery of order paradigm of the health care. Providers of home healthcare ail from diverse back grounds with much less in uniformity as the one witnessed in hospitals. More over the funds available to be used by the home care providers as well as the sources of such funds serve to determine the actual care providers. The process of heath home care entails a physician visiting homes and making their assessment after which they report or communicate with a nurse mangers or a supervisor. In this case the nurse also makes make occasional visit to these homes where direct care is usually provided by wide variety of individuals who include licensed practical nurses who are the most qualified.
The main providers of health home care are commonly aides who have great variation in their background as well as in training. Therefore with one considering the previous back ground of the individual some specific preparations are required before one become effective in any new setting for instance home care. The preparation supplements the existing skills and may as well be far more extensive for aides and informal care givers as compared to the registered nurses. Regarding the level of education of the home care givers further preparations like information on technology that is applied in the home set up ethics, communication issues and special situations all intended to help in addressing areas pertaining to responsibility as well as the risks and the joys of operating independently. In addition to that consideration should also be given when identifying the sources of funding for the training (Pratt, 2010).
The long term care for individual with chronic illnesses and disabilities presents urgent challenges around the globe and this is attributed to the act that the existing systems of care have faced great strain thus becoming un able to meeting the ever increasing demands. This in turn has presented critical ethical issues which are related to long term care meaning that everybody is at risk of facing such state during their life times and this has attracted some attention from the health organizations like the world health organization.
Change in the social structure has partially led to the increased needs fro the long term care solutions and this is attributed to the fact that many families have fewer children and that more young individuals migrates from rural to urban areas, from developing to developed countries thus are not available to provide home care. More over women are considered traditional care givers have been pulled into the labor force by the prevailing economic necessity and personal desires hence barred from providing such services. Further more there has been much demand for long term home care arising from the aging population, increasing dependency, chronic heath challenges, HIV/AIDS epidemic, increased road injuries, dietary and lifestyle habits, and finally increased cases of diabetes, stroke and cardio vascular disease.
The increase demands for long terms home acre calls for a fundamental obligation to ensue that care for all especially the vulnerable and the weak and this call has been hampered in most societies which are often faced with resource limitations as well as difficult decision regarding the meeting of the competing needs. Therefore governments have crucial roles and this is because they must be in a position to anticipate needs, ensure that the required resources are available and that they are distributed equally and efficiently. Despite the severity of the situation many of these governments have low strategies for providing long term care meaning that government agendas have low or no at all in some countries hence the little effort in trying to addressing the current challenges much to preparing for the future.
The issues of long term care is intensifying around the world and thus presenting a an urgent challenge around the world and this is mainly because the existing systems of care are under great strain thus unable to meeting the growing demands and this presents a lot of ethical issues related to it especially due to the combination of the epidemiological and demographic forces. Moreover the social structure partially explains the increasing need for long term care solutions. Therefore doing a research on the ethical issues related to the long term care helps all the stakeholders involved in the process thus helping in designing of the long term care systems that are accountable, accessible, responsible, efficient and able to address the wider variety of human needs with respect and dignity.
This research utilizes an exploratory research strategy involving looking at the problem of ethical issues in long term care in both an descriptive and exploratory manner as well as exploring diverse relevant literature. Is technique integrates documentary analysis and survey to yield the required data to enable making of the expected conclusions and recommendations.
Considering the analysis of the relevant literature on ethical issue in providing long term home care a number of several issues arise especially regarding the long term care decision –making processes regardless of the policy constraints on the sated process. The complexities and the urgency of long term care decision making processes means that the acted issues arises in any undetermined and that the order of occurrence is often not subject to anyone’s control (Koren, 2010).
The second finding on the ethical issues when providing long term care concerns on whether an elderly person should continue living at home and for elders who are married the option raises serious questions reading the ability of the spouse to providing the essential informal long term care services. Such concerns may be attributed to the fact that the elders spouse may as well be ill or even have a significantly reduced functional status where he or she my be unable to help with care giving activities like moving the elderly to bathroom from the bed or even giving a hand the spouse in moving him or her to a sitting position. In addition to that the adult children of the elderly may be confronted with other major responsibilities within their own family set up e.g. taking care of their own children and providing them with financial security. Such circumstances then raises the issues for the informal care givers to set a ethically justified limits on their daily obligations of providing informal long term care services (Daniels, 1986).
Third ethical issues which is directly related to the second ethical issue is concerned with the obligation of the elderly to recognizing and respecting the limits that their family members justifiably sets regarding the care giving responsibilities. Such obligate is basically based on general obligation that dictates that all of us are faced with the option of having to avoid harming others without their approval and this obligation means that no one of us is entitled to unlimited claim as it pertains to time, energy, attention, or even resources of another individual and thus elders with long term needs are neither exempted.
Another ethical issues when it comes to provision of long term acre is the balance that is to be struck between independence and safety which in some cases be understood to one that is mutually exclusive in nature. The family members and the health care professionals tend to prioritizes on safety issues and this is evident after a serious health or even a life threatening events like wandering into a busy intersection. Unsurprisingly elders do tend to give priority to independence and the conflict between independence and safety forms one f the most defining ethical features when it comes to long term care decision making.
Based on the research the first ethical issue when it concerns to long term care decisions making process has to do with the nature and the significance of the elder’s diminished capacities for independent living and self care. For instance the family members of the older adults may fail to agree on the seriousness of an event like a fie a fire incident I the kitchen caused by a cooking pot left on the stove or even a fall from which the elder person takes a long time to get up and eventually call for some assistance. Considering the issue the elder person may interpret such events as being minor but when a care giver is called to an emergency room or even by afire department may interpret it to be a serious one. More over a disagreement on whether such events can lead signal the necessity for a change in the elders living arrangements like the level of support or even in location where as the elderly may think that they are still fit to live at home or even cook for themselves without any supervision (Kane & Kane, 1987).
The second ethical issue is very important because any family members consider only two alternatives which include doing everything which sometimes is beyond their abilities or doing nothing at all an alternative which sometimes makes them feel hard–hearted and selfish. Considering this finding a large middle ground with two ethical bases exist and the first ethical base is setting of limits that are based on the need to fulfilling obligations to others like owns children and the second base is setting limits that are based on the legitimate self-interest like avoiding the predictable and preventable loss of personal health resulting from the physical demands that arise from giving a long term care services (McCullough &Wilson, 1995).
Therefore these two ethical issues in long term care giving that is the setting of the limits by the family members and the obligation no the elders requires that it is negotiated both by the elders and their family members based on the context of long term care needs of the elderly as well as the available options essential in meeting such needs. Thus setting of such limits renders it a matter of careful reflectio9ns as well as a considered judgment hence no precise formula for identifying where to set such limits exists. Considering these ethical issues then a major responsibility of the health care as well as the social-service professional that are involved with the elderly and family members involved in the provision of long term acre decision making process are faced with the need to helping in negotiating the set limits in ways that are considered acceptable to all the involved parties.
Regarding the ethical issues concerning the compromise to made between independent and safety Bart Collopy (1995) suggest that a very useful of responding to the potential conflict that exists between these two is by not seeing them as being mutually exclusive but rather as the end points of a continuum. Safety entails both the physical and the psychological safety thus implying that by an elderly person staying at home means that they may risk their physical safety but on the other part protects and enhances their psychological safety. To a considerable degree independence depends on the health status of the elderly and thus unnecessary loss of health often leads to a loss of independent.
Both the independent and safety have psychological, health and social components thus making a conceptual and practice sense to perceive it in terms of ethically continuum concern rather than as a forced choice in which either of the two will be protected through the sacrifice of the other. The avid response to the potential conflict between the two issues should therefore to first recognize their complexity in nature as well as appreciate their level of overlap and secondly is by negotiating the compromise in which both issues are protected through an impartial fashion. I some cases it’s very important for the family members to appreciate the significance of making a sacrifice of the physical safety to allow for the protection of the psychological safety and sense of independence. it also equally important that the elderly also appreciates the need to preserve the physical safety and health as the sole way of ensuring that independent is protected from further loss.
In conclusion along term care decision making in ethical grounds should be comprehended in terms of a process entailing a mutual decision making both buy the elders and the family members with a support from the heath as well as the social-service professionals when they are involved. Considering the above ethical issues no algorithm can plug it to a simply cranked out answer thus the issue involving the long term decision making process encompass matters of negotiation which is often involve a complex compromises both by the elders and the family members. Therefore the health and the social factors shaping the long term care decision making are constantly changing jus as the elders condition keeps on changing wither fro the worst or for better and this thus calls for an ability or willingness often informal caregivers to continuously provide the informal long term acre services which are also subject to change likes wise to the policy constraints.
Consequentially elders, family members, health care and social service professionals should therefore appreciate the fact that any given long term care arrangement that is decide upon a trial of changes in both the lives of the elders as well as in the level of support provided thus circumstantial change is sometimes necessary to repeating the long term decisions making process to respond to the circumstance changed. The reality of the changes underwent becomes a source of frustration and distress both for the family members and the elders alike calling for a sustained support from the professionals and especially those who are involved in providing the formal long term care services (Collopy, 1995).
In case of an ethical issue of conflict arises in the course of a medical care, a home care or even a long term care the best way to resolving such conflict is by first discussing the issue of concern with all the people that are involved in the process and these includes the doctors, nurse, social workers and the family members after which one should request a meeting essential fro developing a plan on which every one of the involved agrees on. Thirdly one must ask for an ethics consult which is basically a meeting with the ethics committee o discuss the ethical issue at hand thus helping to clarifying issues as well as making of recommendations based on their greater understanding of both the hospital policies and the patient rights.