Transcript Home is where the heart is… the challenges of discharge

Home is where the heart is…
the challenges of discharge
planning with people who have
dementia.
Zoe Ellis
Rachel Wilson
Background
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Physiotherapist and Occupational Therapist
Secure GEM ward
Multidisciplinary team
Aim
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Ethical frameworks
Case study
Personal perspectives
Positive solutions
Case Study – ‘Noel’
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68 yr old male
Fall - fractured hip
Past medical history
Life history
Discharge planning
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Early planning
Home
Residential care
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Guardianship
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Discharge Planning
GP
HOSPITAL TEAM
NURSES
DAUGHTER
NOEL
OCCUPATIONAL
THERAPIST
PHYSIO
CASE MANAGER
DOCTOR.
SOCIAL
WORK
NEUROPSYCHOLOGIST
Case Manager
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Identified risks
Residential care
Guardianship
Daughter
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‘he would die in residential care’
Discharge home
Community services
Independent spirit
General Practitioner
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Decision making
Guardianship
Residential care
Noel’s Perspective
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Home
No services
Independent life
Team perspective
NURSES
PHYSIO
DOCTOR
OCCUPATIONAL
THERAPIST
NEUROPSYCHOLOGIST
SOCIAL
WORK
Where to from here?
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Will it be possible to respect Noel’s wish to
return home?
Ethical concepts
Ethical dilemma
‘…(when) acting on one moral conviction
means behaving contrary to another or when
adhering to one value means abandoning
another.’
(Bluemenfield & Lowel 1987)
Autonomy
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‘Individual choice or freedom to follow one’s
own will’
(Beauchamp & Childress 1995)
Beneficence
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‘Health care professionals ‘do good’ in their
decisions regarding actions towards patients’
(Beauchamp & Childress, 1994)
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‘…entails not only preventing harm but also
actively promoting the health and welfare of the
patient’
(Cummings & Cockerham, 1997)
Paternalism
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‘…health care professionals assert their own
risk-benefit analysis over that of the patient and
families in the belief that they are protecting the
best interests of the patient’
(Cummings & Cockerham, 1997)
Competence
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Complex issue
Application to Noel’s case
Guardian
Assessment process
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Hospital and community based assessments
Strengths and weaknesses
Risk versus safety
Noel’s Journey
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Discharge home
Support services
Personal perspectives
Positive solutions
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‘What does safety mean to this person in the
context of their life?’
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Compromise
Patient autonomy
Team work
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Conclusion
References
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Beauchamp, T. & Childress, J. (1994). Principles of biomedical
ethics (4th edition). New York:Oxford University Press.
Bluemenfield, S. & Lowel,J.I. (1987). A template for analysing
ethical dilemmas in discharge planning. Health and Social Work,
12,47-56.
Cummings, S. & Cockerham, C. (1997). Ethical Dilemmas in
discharge planning for patients with Alzheimer’s disease. Health &
Social work, 22(2),101-108
OT Australia (2001), Australian Association of Occupational
Therapists, Code of Ethics.
Reamer, F.G (1983). The concept of paternalism in social work.
Social Service Review, 6,254-271