Supporting Patient Autonomy: Decision Making in Home Health Care

Abstract

This study examines the policies and procedures that home health care agencies have developed to handle the incapacitated patient and life-sustaining treatment decisions. Data collected from a survey of 154 home health care agency directors and interviews with 92 local agency staff (including nurses and social workers) and 67 patients confirmed that directors, staff, and patients agree that patients are informed about their legal rights. When asked about specific rights, fewer patients were aware of their right to execute an advance directive, and even fewer patients had actually executed one. Only 67 percent of agencies reported having existing policies on advance directives and life-sustaining treatment decisions, whereas 41.5 percent had policies on how to handle the patient with questionable decision-making capacity. Consistent policies are needed for social workers, nurses, and other staff to handle such difficult ethical dilemmas. A review of specific agency policies is presented with recommendations for future policy changes and development.

Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden

“…In good clinical practice, when deciding on an appropriate level of treatment health care, providers should consider the wishes of the patient [1,2,3] and his or her family [4,5], the patient's prognosis [6,7], age and quality of life [8,9,10], the legal implications of providing or withholding care [11,12,13], the institution's policy, the availability and costs of health-care resources and the prevailing cultural and social norms.…”

Struggles Between the Body and Machine

“…Specifically, it means that patients will have an increased reliance on home-care (Egan & Kadushin,20 SOCIAL WORK IN HEALTH CARE 1999) and less face-to-face interaction with health care providers over the course of their treatment. This development has led social workers to study certain aspects of home care such as the policies and procedures developed by home care agencies (Kaye & Davitt;1996). Arguing that home care is the fastest growing sector in health care, Kaye and Davitt (1999) have produced a specialized study of home care and technology from a social work perspective.…”

Ethical Conflicts Over Access to Services

“…While the literature describes several ethical conflicts which characterize home health care including conflicts over patient autonomy (Callopy, 1988;Callopy, Dublar, & Zuckerman, 1990;Clemens, Wetle, Feltes, Crabtree, & Dubitzky, 1994;Galambos, 1997;Healy, 1998;Hofland, 1993); family autonomy (Arras & Dubler,1994;Callopy et al, 1990); the assessment of mental competence (Galambos, 1997;Healy, 1998;Kane & Caplan, 1993); and the implementation of advance directives (Davitt & Kaye, 1996), this discussion will focus on conflicts over access to services. Conflicts over access to services emerge from the duty of fidelity of the home care social worker to the client and to the agency.…”