Addressing Ethical Dilemmas in Provision of Care and Support for Clients and Carers

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1 Addressing Ethical Dilemmas in Provision of Care and Support for Clients and Carers

2 Ethical Practice Codes of Ethical Practice organisational and professional Core values empowerment, self determination and respect for human dignity Principles of individual wellbeing and social justice Standards of practice Guide reflective practice and ethical decision making

3 Ethical Decision Making BALANCING HACC Client -safety and quality of life Carers -needs and quality of life Services- resource management

4 Ethical Decision Making Supporting client self determination and choice Assessing and working with client s cognitive capacity Working collaboratively with Carers, family members and advocates Within service resources and HACC program parameters

5 Some Ethical Issues Not judging or blaming a person for their circumstances, eg, social isolation & relationship breakdown, health deterioration due to alcohol or substance abuse, while addressing the underlying causes & supporting the person to engage positively with services Counteracting negative stereotyping of older people and people with a disability in language, media representations, & service responses, Ethical practice in relation to duty of care, prevention & response to abuse including self neglect, balanced with dignity of risk & self determination Supporting individual rights & citizenship of the person & not reinforcing compliance & a passive clienthood status

6 Ethical Issues Addressing incapacity and cognitive decline in a manner that supports empowerment, self determination in lifestyle and accommodation choice Potential for HACC service based on maintaining people in their home, to foster social isolation, loneliness and depression. How do we effectively engage HACC services with family and community support networks, while balancing different perspectives and needs? How do we ensure supporting wellness & restorative care in HACC services doesn t increase stress and burden on families and community members?

7 Ethical Dilemma An ethical dilemma is when there is a choice between two equally conflicting moral principles and it is not clear which choice will be the right one for example: Client safety Client self determination and choice Client choice Carer stress and ill health

8 Case Study 90 yr old widow Lives alone. No family. Frail, restricted mobility Uterine cancer- palliative treatment Visual impairment Deteriorating health Needs support with ADLs and IADLs Assessed as having complex care needs

9 A strength based view Career as Concert Pianist and Piano teacher Maintained communication with ex-students Resourceful in arranging to have services and support Proud of independence and being a home owner A survivor Understood the use of power

10 HACC Service User Community Options case management Meals on Wheels delivered meals Domestic Assistance shopping, cleaning Personal Care -7 days a week Community Nursing when required Equipment commode, walker Home maintenance After hours monitoring Gardening and lawn mowing support

11 Issues Challenging Behaviours Blacklisted by most brokerage services Staff requesting transfer/roster rotation Refusal to consent to pay fees and increasing cost of care outstanding debt Secrecy, threats, verbal abuse Multiple complaints, misrepresentation Police involvement History of refusal of transfer to hospital when required

12 Issues Falls risk After hours support difficulties Living in one room, refusing to consider residential care Agitation, anger and anxiety Lack of trust in staff fearful? Service management and co-ordination very time consuming Constant crises and changing care arrangements Working with advocates/conflict

13 Reflective Practice Was she feeling safe and did she have the quality of life/lifestyle choice at end of life that she wished? What was her capacity to make informed decisions? Were we as service providers colluding with the abuse/using of her advocates, support staff/community volunteers? How to ensure medical and nursing care was provided to ameliorate physical pain and discomfort without heightening psychological pain?

14 Ethical decision making Being honest, open and non-judgmental Respecting privacy and confidentiality Assessment of cognitive capacity Teamwork based on trust Respecting her strengths/ honouring and valuing achievements Care planning & delivering services Addressing cost/fee payment Reduce gossip, conflict and blaming Contingency planning and monitoring

15 Conclusions No easy answers or short cuts Careful, considered reflective practice based on skilled assessment and interventions, a team work approach and grounded in ethical values Consult, communicate and review Takes time, energy and perseverance