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Ethical Dilemmas in Home Healthcare

Ethical Dilemmas in Home Healthcare

Jennifer LeClaire | Monster Contributing Writer

Confidentiality Conundrum

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.”

This article was originally published on

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  • Photo_user_blank_big


    over 3 years ago


    This is interesting, I didn't know that there's such a big emphasis on the ethical dilemmas, working in health care is indeed challenging but these jobs come with strict tasks, there shouldn't be any room for dilemmas but that's of course in an ideal world. I recently found this dental website design resource, it will help me understand more about this type of dilemmas.

  • Photo_user_blank_big


    almost 6 years ago


    This is a common challenge because of the nature of nursing(humanitarian). It's expected that will go all way "legally" to satisfy or make them(client/patient) comfortable. Therefore it is a challenge to individual's perspective and value system and a matter of how long you can endure or alter your schedule to optimise clien's satisfaction.

  • Photo_user_blank_big


    almost 6 years ago


    In Home Health there is no 'time clock'. If, in spite of good time management, one has a situation that requires them to stay longer with a pt. we make it happen. As a rule most nurses will not leave their pt in a compromising position whether it be a safety or a comfort issue. To me this is not a dilemma it is common sense and the nursing way.

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