Learning to pay attention. An ethics study group refocuses on issues affecting long-term care residents' daily lives

In 1991 the Sisters of Charity Healthcare Systems (SCHCS), Cincinnati, established an ethics study group for its long-term care facilities. The group was originally organized to address end-of-life treatment decisions, but it soon found that the daily lives of people by and for whom such decisions would be made were worthy of attention in their own right. Autonomy had been a topic of group discussions early on. Once reinterpreted in the context of long-term care, it became the pivotal value for the group. One key to the group's progress was identifying intrinsic and extrinsic factors that distract care givers' attention from issues of concern to residents. Members found that state and federal regulations, as well as constraints on medical treatment by payers such as Medicare and Medicaid, often ignore the human dimension in terms of which the elderly's needs and preferences can be framed. Rigidly defined roles and routines also blunt care givers' sensitivity to residents' concerns. The group is currently developing a program of in-service ethics education and training. Designed in four modules, the program will focus on the following topics: protecting and enhancing resident rights, staff issues and professionalism, talking about death and dying, and staff-physician issues.