Applying advanced directives regulations in home care agencies

As Dombi (1991) indicated, home healthcare agencies see people in their own settings and can be most influential in assisting clients and families to deal with important issues. Furthermore, in receiving care in their homes, clients and their families may be in a more amenable frame of mind to consider such issues. Agencies may find it helpful to identify special resource people who could be accessible to clients and families in enabling them to prepare appropriate documents. In a tape recording that reviews the state of life-sustaining therapy, Wolf (1993) highlighted the importance of seeing the regulations on advance directives as just the beginning of further work and discussion with clients and their families. Home healthcare agencies, in particular, need to do more than just comply with directives related to the Patient Self-Determination Act. Agencies can be in the forefront of identifying needs and concerns of clients and families related to critical life and death decisions and in exploring the ramifications of those decisions. The trend toward developing ethics committees in home healthcare agencies can be a vehicle for further exploration of such issues.