Medicare’s homebound regulation continues to present ethical dilemmas for clinicians faced with the limitations it imposes for clients in need of health care services. This article applies ethical theory and the principles of veracity, beneficence, nonmaleficence, justice, autonomy, and fidelity to the issue. A variety of strategies home care agencies can use to address ethicalissues are discussed. The use of an ethicaldecision-making modelto assist clinicians in reaching appropriate decisions is described and applied to a case study. The importance of addressing deficits in the home care system, as opposed to manipulation of the regulation to meet individual patient need, is recommended.
Health care managers today are being challenged to structure their organizations so that they can respond quickly and effectively to rapid changes in the health care arena. One way to do this is to empower staff through a shared governance model. Although hospital organizations have been the pioneers in establishing shared governance for professional staff, home care agen cies may also benefit from applying the lessons learned. Because home care organizations de pend on a full spectrum of employees, clinical and nonclinical, for their success, a case study demonstrates the advantage of including all agency personnel in home care shared governance models. Key words: home health care, management, shared governance
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