Supporting patient autonomy: decision making in home care

Area of Science:

• Healthcare Policy
• Bioethics
• Home Health Care

Background:

• Home health care agencies face challenges in managing incapacitated patients.
• Life-sustaining treatment decisions require clear agency policies and procedures.

Purpose of the Study:

• To examine existing policies in home health care agencies regarding incapacitated patients.
• To assess policies related to life-sustaining treatment decisions and advance directives.
• To identify gaps and provide recommendations for policy development.

Main Methods:

• Survey of 154 home health care agency directors.
• Interviews with 92 agency staff (nurses, social workers).
• Interviews with 67 patients.

Main Results:

• Agreement among directors, staff, and patients that patients are informed of legal rights.
• Lower patient awareness and execution rates for advance directives.
• 67% of agencies had policies on advance directives; 41.5% had policies for questionable decision-making capacity.

Conclusions:

• Inconsistent policies exist for handling incapacitated patients and life-sustaining treatment decisions.
• There is a need for standardized policies to guide staff in ethical dilemmas.
• Recommendations are provided for improving agency policies on advance directives and patient capacity.