Long-Term Care: Ethical Issues and Exam Review

Practice flashcards covering unit exam logistics, core healthcare ethics principles, advance directives, elder abuse, ombudsman functions, and ethical leadership in long-term care.

In healthcare ethics, what is the core meaning of the principle of autonomy?

The right of individuals to self-determination, which includes making their own informed medical decisions, giving informed consent, and having their wishes respected.

What does the ethical principle of beneficence require of healthcare professionals?

It requires medical professionals to act in the best interest of their patients and actively promote their health and well-being.

How does the principle of nonmaleficence guide clinical practice?

It aligns with the Hippocratic oath to 'do no harm' by requiring professionals to avoid actions that cause harm and ensure treatments are safe and effective.

What is the primary focus of the ethical principle of justice in healthcare?

Fairness and equality, ensuring medical resources are distributed equitably and patients receive fair treatment regardless of personal characteristics.

What ethical controversy surrounds the Medicaid 'spend-down' phenomenon?

Some individuals hide or transfer assets to appear impoverished and qualify for Medicaid, conflicting with the view that Medicaid is a needs-based program designed strictly for those without personal resources.

Why do autonomy and beneficence often conflict in long-term care facilities?

A resident's personal desires or exercise of independence (autonomy) may directly conflict with the provider's duty to protect their safety and avoid negligence (beneficence).

Under what circumstance may long-term care providers legally disregard a resident's stated wishes?

Only when the resident has undergone a legal court process and been officially declared incompetent.

Whose wishes must a long-term care provider follow if family members disagree with the resident?

The provider is required to follow the resident's wishes rather than the family's wishes.

How many U.S. states have enacted 'death with dignity' laws permitting physician-assisted suicide, and what is its status in Virginia?

14 states permit it under specific circumstances, while it remains illegal in Virginia.

What mandate does the Patient Self-Determination Act of 1990 impose on healthcare providers?

It requires all healthcare providers to inform consumers of their rights to determine their medical care, give informed consent, and create advance directives.

What distinguishes a living will from a last will and testament?

A living will specifies medical treatments a person would or would not want if incapacitated, whereas a last will and testament specifies the distribution of assets after death.

What specific care directive does a Do Not Resuscitate (DNR) order convey?

It directs that medical staff should not administer CPR or any form of resuscitation if the individual enters cardiopulmonary arrest.

What authority does designating a healthcare surrogate or proxy grant to an individual?

It legally authorizes that person to make medical decisions on the patient's behalf if the patient becomes unconscious, comatose, or otherwise incapacitated.

What does the acronym POLST stand for, and what is its main advantage?

Physician Orders for Life-Sustaining Treatment; it converts a patient's preferences directly into an immediate medical order without requiring a lengthy legal process with an attorney.

Why does using physical or chemical restraints represent an ethical dilemma?

It involves a subjective gray area between preserving resident freedom and autonomy versus imposing restrictions when medically necessary for resident safety.

What form of elder abuse occurs most frequently inside long-term care facilities?

Resident-to-resident abuse (verbal or physical), which is far more common than staff-on-resident abuse.

What is the primary role of a long-term care ombudsman?

To serve as an independent resident advocate and mediator, helping resolve complaints and quality-of-care issues internally within facilities without adopting an adversarial stance.

What are the major roles and limitations of an institutional ethics committee?

They are interdisciplinary teams that clarify complex issues, improve communication, propose policies, and educate staff, but their recommendations are non-binding rather than final legal determinations.

Which professional organizations govern the codes of ethics for long-term care administrators versus hospital executives?

ACHCA (American College of Health Care Administrators) governs long-term care leaders, while ACHE (American College of Healthcare Executives) governs hospital administrators.

Why does the reimbursement-driven nature of the U.S. long-term care system create an ethical challenge regarding access?

Access to care is often determined by a resident's payer source (such as Medicare or Medicaid coverage limits) rather than their actual clinical or personal care needs.

What essential elements must healthcare providers disclose to a patient to obtain valid informed consent?

The nature of the procedure, its potential risks and benefits, reasonable treatment alternatives, and the risks and benefits of foregoing or refusing the treatment.

Under the legal and ethical framework of informed consent, what reciprocal right do competent patients possess regarding recommended treatments?

The right to refuse medical care, procedures, or life-sustaining interventions, even if that refusal may lead to adverse health outcomes or death.

Why is a clinical diagnosis of dementia or cognitive impairment insufficient on its own to strip a resident of decision-making authority?

Competence is a legal determination made exclusively through a formal court process; cognitive impairment alone does not automatically declare a resident legally incompetent.

What procedural safeguards do states require before permitting physician-assisted suicide (medical aid in dying)?

Mandatory waiting periods, documented terminal illness with limited life expectancy, multiple independent requests over time, and confirmation of decision-making capacity free from coercion.

What does the general term 'advance directive' encompass in healthcare planning?

A broad category of legal documents (including living wills, healthcare proxies, and POLST forms) that state an individual's medical preferences should they lose decision-making capacity.

How does a healthcare power of attorney differ from a financial power of attorney?

A healthcare power of attorney authorizes an agent to make medical decisions during incapacity, while a financial power of attorney authorizes an agent to manage financial, business, and property affairs.

What do prominent legal cases like Nancy Cruzan and Terri Schiavo illustrate regarding end-of-life decision-making?

The severe ethical and legal disputes that arise when an incapacitated individual lacks advance directives, leading to prolonged family conflicts and court battles over life support.

What ethical conflict arises when a long-term care resident chooses to eat foods that violate their prescribed therapeutic diet?

A conflict between honoring the resident's autonomy and quality of life versus the provider's duty of beneficence and safety to prevent medical harm and liability.

What ethical and administrative challenge arises regarding consensual romantic relationships among long-term care residents?

Balancing residents' rights to autonomy, privacy, and personal happiness against family objections, roommate concerns, and ensuring both parties possess cognitive capacity to consent.

How is financial elder abuse defined, and who most commonly perpetrates it?

The unauthorized, illegal, or improper use of an older adult's funds, property, or assets, most frequently perpetrated by the individual's own family members or trusted caregivers.

What constitutes elder neglect in caregiving relationships?

A caregiver's failure to provide an older adult with essential necessities of life, including adequate food, hydration, shelter, clothing, hygiene, or necessary medical care.

What form of workplace abuse do long-term care staff frequently encounter from residents with advanced dementia?

Unfiltered verbal abuse (such as racial slurs and profanity) as well as physical aggression (such as hitting or pushing) resulting from cognitive loss and behavioral disinhibition.

What legal obligation do long-term care facilities have when elder abuse or neglect is suspected?

They are legally mandated by state and federal regulations to immediately report, thoroughly investigate, and notify appropriate law enforcement and regulatory authorities.

Which major federal statutory framework established the long-term care ombudsman program to advocate for resident rights?

The Older Americans Act and subsequent federal nursing home reforms under the Omnibus Budget Reconciliation Act of 1987 (OBRA '87).

What facility obligations and resident rights exist regarding the long-term care ombudsman?

Facilities must visibly post the ombudsman's contact information, and residents possess the protected right to contact and communicate with the ombudsman without fear of retaliation.

What diverse professional disciplines typically constitute an institutional ethics committee in healthcare?

Physicians, nurses, certified nursing assistants (CNAs), social workers, legal counsel, and clergy or chaplains.

What federal regulatory body requires long-term care facilities to maintain an ethics committee that meets regularly?

The Centers for Medicare & Medicaid Services (CMS).

How do healthcare leaders establish an ethical climate and lead with integrity across an organization?

By actively aligning staff conduct and operational practices with the organization's overarching mission, vision, and core shared values.