Who's the boss? Ethical conflicts in home care

In 1987 a committee of the Home Health Assembly of New Jersey began a study of ethical issues in home care situations where the autonomy of the elderly patient is at risk. The study was based on four case histories describing actual situations of elderly patients, their families, and the professional practice of nursing and social work in the home. To determine concerns of home health agency administrators and their staffs, the committee did surveys, held round-table discussions, and conducted telephone interviews. As a result, it identified four key ethical concerns: 1. Maintaining agency solvency without denying care to patients who lack adequate financial resources. 2. Responding to the conflicting needs of patients and families. 3. Practicing healthcare in situations where patients may be abused or neglected. 4. Addressing decisions about candor and treatment in the care of the terminally ill. The committee identified five characteristics unique to the home care setting that create challenging situations which are rare in other healthcare settings: 1. Strongly asserted autonomy. 2. Limited definition of communal values. 3. Patient isolation. 4. Patient dependency on family care givers. 5. Inadequate long-term care policies.