Ethical Dilemmas in Home Healthcare
Jennifer LeClaire | Monster Contributing Writer
Yagoda touches on a dilemma that occupational therapists frequently encounter — that of patient confidentiality versus patient well-being.
“If you have concerns about a patient’s judgment, is your obligation solely to that client?” asks Janie Scott, director of practice and ethics for the American Occupational Therapy Association. “Or is the obligation to the family as well? Or to the referring authority? Do you breach confidentiality by sharing those concerns? Where does the client’s protection enter into the discussion?”
Occupational therapists should question a client’s judgment when, on a home visit, they see inadequate lighting, environmental hazards or bathrooms not equipped with proper safety features. Other signs that should call the client’s judgment into question include poor motor skills or poor short-term memory.
“If the client denies the opportunity to make remedies to dangerous situations, then you have a difficult decision to make,” Scott says. “It gets even more challenging when you understand that ethical issues can also turn into legal issues. Each practitioner needs to understand their scope of practice and their competency to intervene in a way that promotes well-being.”
Time vs. Money
For visiting nurses, dealing with all patient needs in the short time that managed-care providers and Medicare/Medicaid allot for a visit can lead to ethical challenges as well, says Lynda Van Dyke, a division manager for the Colorado office of the Visiting Nurse Associations of America.
“You have to be very creative in terms of time management,” Van Dyke says. “You have to identify additional resources in the community, like church and family members and volunteer workers, to assist the patient. Other disciplines, like social workers, can also be brought in to help.”
That’s all well and good until a situation occurs that requires immediate attention — just as the visiting nurse’s shift has ended. That’s when the real ethical dilemma hits. For example, what should the nurse do if a patient has a sanitary accident and needs help? Clock out or clean up?
“We often go above and beyond the call of duty on our own time,” Van Dyke says. “But that’s another issue, because then you are not covered in terms of liability. But we will not abandon our patients. I am going to stay until the patient is safe.”