Applied Sciences

Chapter 13

Ethical Issues in
Long-Term Care

Learning Objectives

Understand the social and emotional impact of changes caused in the lives of individuals when long-term care is needed

Discuss the ethical aspects of access to care

Define autonomy and the relationship between independence and self-determination

Learning Objectives (continued)

4. Identify end-of-life issues and discuss their ethical and legal implications

5. Understand the magnitude of day-to-day needs of consumers and providers’ efforts to meet them

6. Discuss management ethics and its role in a long-term care organization

Emotional Impact on Consumers

Chronic illness or disability means:

Can no longer do things that were important, resulting in feeling of loss

Must rely on others for assistance with most intimate activities

Loss of privacy

May need to move, be separated
from family

Most important – loss of self-worth

Access to Long-Term Care

Access-related issues include:

A reimbursement-driven system

Cost-cutting efforts

Inequitable distribution of services

Institutional vs. non-institutional options

Balancing obligation to provide care with obligation to use resources wisely

The Ethics of Rationing

Explicit rationing:

Government allocation of limited funds

Insurance and managed care don’t cover certain conditions and procedures

Implicit rationing:

Favors one type of provider over another to influence service delivery

– e.g., home health care vs. nursing care facilities

Transfer of Assets

Is transferring assets to qualify for Medicaid ethical?

Right to leave assets to children?

Should the wealthy be subsidized?

Is it ethical to penalize frugal savers?


The concept of autonomy as the right to self-determination

  • Impact of cultural change

The autonomy-beneficence conflict

Other autonomy-related conflicts

Informed consent

End-of-Life Issues

Competency and decision-making capacity

Protecting the interests of the consumer

Advance directives

Patient Self-Determination Act

Ethics committees

Providing “futile care”

Everyday Life Issues


Shared space





Types of restraints

Regulatory requirements for their use

The ethics of using restraints


Types of abuse in long-term care:

Physical abuse

Sexual abuse

Fiduciary abuse

Emotional abuse

Preventing abuse

© 20 Jones and Bartlett Publishers, LLC

© 20 Jones and Bartlett Publishers, LLC

Other Settings

The level of dependence of nursing facility residents makes them more vulnerable, but the same ethical issues apply to other settings.

Management Ethics

Important for any management setting

Of particular importance where consumers are so vulnerable

Ethics Management Programs

Codes of ethics

Codes of conduct

Policies and procedures


Many ethical issues surround the provision of long-term care to vulnerable populations. These issues seldom have single right answers, but provider and consumer groups are working toward resolution.

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