Home Health Care Ethical Issues

Long-term care is becoming a main component of American health care. Long-term care takes place in hospitals, single-family or group homes, nursing homes, housing with linked services, and specialized day centers; patient populations include children with developmental disabilities, elderly people with physical disabilities and those with Alzheimer's disease, and adults with AIDS. Kasper cites Evashwick's definition of long-term care and home services to include intravenous administration of medicine, devices for mechanical ventilation, meal preparation, and bathing. Providers of health care include skilled nurses, technicians, therapists, family members, and others. Home health care legal and ethical issues pertain to all involved (Kasper, 1997, 274-276). This research paper will focus on ethical issues of privacy, terminal illness, human rights, living wills, making living wills mandatory for medicare, social worker's involvement, autonomy, the family role, termination of life support, and the right to die.

There exists an ethical and legal requirement to protect patient information and home care records, and home healthcare nurses have this responsibility along with health care institutions. Privacy and confidentiality are separate entities, and the protection of one does not necessarily mean the protection of the other. The right to privacy is embodied in the law. The First and Fourteenth Amendments to t

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for care provided in the last 30 days of a patient's life. In a survey of 1,400 doctors and nurses, it was found that 65 percent stated unnecessary treatment was provided to terminally ill patients. Living wills that block such unnecessary and unwanted last-minute procedures would result in substantial savings(Lindblom, 1997, 9). Polls and studies show that over two-thirds of Medicare patients would use a living will to reject heroic measures and standard forms of last-minute care; this would be nearly two-thirds of two million Medicare patients who die each year. In a study of five hospitals, the last-minute medical care costs for patients with near-death diagnoses who died in the hospital averaged about $10,400 per patient. It is estimated that in the final month of a patient's life the intensive care costs can surpass $100,000; total costs to Medicare for medical care to these patients in their last 30 days was approximately $20 billion in the fiscal year 1995 (Lindblom, 1995, 10-11). Congress could require all Medicare patients to have a living will that sets forth the kinds of treatments wanted when near death and unable to communicate clear instructions personally. Instead of being coerced into foregoing care, pati

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