Ethics in LTC
The oversight of residents' healthcare needs, financial arrangements, and emotional wellbeing inevitably requires difficult decisions and ethical considerations. These are opportunities for open discussions, welcoming dialogue, and support of residents rights of autonomy and personal preference. PMDA supports open and structured discussions of ethical dilemmas in every LTC facility.
An Ethics Committee is a formalized way to encourage discussion of ethical issues in an interdepartmental forum. While not legally mandated, it indicates the facility's commitment to ethical behavioral, provides a structured format for processing ethical dilemmas, welcomes engagement of staff and residents/families, and can help formulate facility policies.
AMDA Tool Kit for Starting and Maintaining Ethics Committees in Long Term Care (lecture from 2012 national symposium - $24)
Ethics committee members may include: administrator, DON, nursing staff, direct care staff, chaplain, social work, medical director, maintenance, therapies, and residents or family representatives.
Frequency of meetings: Quarterly meetings are recommended, every 6 months at minimum. A "standing" committee that meets only on request will often be forgotten and have no meetings. A facility that has regularly scheduled and advertised meetings may be surprised how many "ethical" discussions are raised.
Format: Can vary based on facility and needs. An approach may include:
- An established leader who structures the meeting dates and topics, and leads the session
- Presentation of the particular issue or topic
- A brief didactic overview of literature, ethical principles, or pertinent factors
- Review of facility policy or previous management
- Group discussion related to the issue
- Summary via policy or facility understanding
Topics: Any topic may be appropriate based on the facility's needs. It may be a topic raised from a particular resident's issue or recent facility issue. It may be a broader facility issue that needs clarification. Staff or residents should be encouraged to submit topics for discussion. Possible topics may include:
- Ethical issues related to transitions between LTC levels of care. Discussion material.
- End of life care.
- Establishment of POLST program
- Intimacy related (sexual) behavior in dementia - supporting healthy sexuality and responding to inappropriate behavior. Discussion material.
- Pets in LTC - visiting or permanent
- Recognizing exploitative/abusive family behavior
- Responding to angry patients/family members
- Staff response to physically aggressive resident behavior
- Prevention of abusive behavior to residents by staff
- Identifying and supporting depression
- Resident rights of autonomy and decision making
- Effects of dementia on behavior and social interaction
- Maintaining resident personal dignity in LTC
- Facility approach to psychotropic medications
- Recognizing and treating pain
- Supporting the rights and dignity of GLBT residents
- Appropriate and smooth transition between different levels of care: hospital, skilled care, personal care, independent living
- Diversity of faith and religious perspective - supporting and meeting needs
- Staff member use of jewelry/tattoos/body piercings