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Ethical dilemmas in home care case management
Elaine Gallagher1, Denise Alcock, Elizabeth Diem
1School of Nursing, University of Victoria. egallagh@uvic.ca
Summary
Case managers face significant ethical challenges due to inadequate support and resources. Addressing systemic issues like funding and waitlist management is crucial for improving elder care and supporting these vital healthcare professionals.
Area of Science:
- Healthcare Management
- Gerontology
- Ethics in Healthcare
Background:
- The healthcare landscape is increasingly complex, with an aging population, deinstitutionalization of seniors, and cost containment pressures.
- Case managers play a critical role in navigating these challenges, yet often operate with limited support.
- Understanding the ethical dilemmas faced by case managers is essential for improving healthcare delivery.
Purpose of the Study:
- To identify and analyze the ethical dilemmas and issues encountered by case managers in Canada.
- To explore the experiences of case managers regarding support, resources, and agency policies.
Main Methods:
- Qualitative study involving focus groups with 89 case managers.
- Data collected from participants across five urban and five rural regions in Canada.
- Thematic analysis of focus group discussions to identify key ethical concerns.
Main Results:
- Case managers reported significant frustration stemming from a lack of adequate resources and agency policies.
- Four primary themes emerged regarding ethical concerns: equity, beneficence, non-maleficence, and autonomy/power imbalances.
- Inadequate support systems and resource limitations exacerbate ethical conflicts for case managers.
Conclusions:
- Case managers experience substantial ethical conflicts due to systemic issues and insufficient support.
- Recommendations include enhanced training, ongoing support, and increased resources for case managers.
- Systemic changes, such as improved long-term care funding, waitlist management, supportive housing, health promotion, and interdisciplinary teamwork, are needed to mitigate ethical conflicts.