Transcript NCOA Legal & Ethical Considerations for the Elderly

NCOA
Legal & Ethical
Considerations & End of
Life Issues for the Elderly
Chapters 4 & 9 (4th ed)
Pati Cox, RN, BSN, M.Ed.
Ethical Dilemma’s
• Study of moral actions & values
• Anything that impacts “Quality
of Life”
• Quantity versus Quality
• Spent much time discussing in
P&VC
Patient’s Bill of Rights
• AHA - 1992
• It ensures that each patient or resident
has the right to make his/her own
decisions regarding care and treatment
• Provided to each person
• Posted in facilities (acute and LTC)
The LAW
• Based on rules and regulations
• As a LPN, you are required to function
under the mandates of the state Nurse
Practice Act in which you practice. You
are NOT allowed to practice outside those
rules and regulations
Negligence
• Failure to exercise adequate care
• Prudent Nurse Theory
• Determination is based upon:
• Level of performance that is expected
• What is considered safe practice
• Will discuss more in Leadership &
Management
• Various types of negligence
Omission
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Straight forward concept
Simply omit or leave something out
May be on purpose or not
But it is expected of you to complete as
part of the care or treatment provided
• Example: Medications or treatments
Restraints
• Physical and Chemical
• If utilized, must be ordered; protocol
must be followed to assess and release
• Restraint Free Environment is Goal
• Use of the least restrictive devices
• Strategies of Care givers
Advanced Directives
• Living Will
• Many states require Advanced Directives
upon admittance to health care facility
• Primary Objective is to follow the wishes
of the patient/client/resident
• Discussed in great detail in P&VC
Right To Die
Factors Influencing Decision Include:
./ 'Patient's Suffering
./ 'Patient's Cognitive Impairment
./ 'Patient’s and Family’s Expressed
Wishes
./ QUALITY OF LIF£
./ Current Care Setting
Right TO DIE
Related Issues:
./ 'Patient's competency to make decision
./ Family's view of Patient’s decision
./ NO Code and No Treatment Situations
. -DO NOT Resuscitate (DNR)
. "DO NOT Hospitalize (DNH)
. "DO NOT Treat (DNT)
“DO NOT Intubate (DNI)
Doctor’s Signature Required for the orders
Right To Die
Possible Nursing Implications:
Support Patient and Family in
decisions
Support Nurses and Doctors who
implement policies
Ensure that supportive care is
maintained
Informed Consent
• Right to information before consent to
treatment or procedure
• Must be signature on consent form (or
mark)
• Guardian/Health care Power of Attorney
may sign if necessary
Informed Consent
• To Give Valid Consent:
• Fully informed of all risks and benefits of procedure
• Competent
• Nursing Implications:
• Assess and screen areas of client competency carefully
• Consent must be obtained first – if not – can’t do
• Follow legal requirements & facility specific
procedures/policy
PROTECTIVE SERVICES
GENERAL INFORMATION:
1. ADULT PROTECTIVE SERVICES:
GENERAL TERM FOR SERVICES PROVIDED TO PROTECT AN
INCOMPETENT PERSON FROM HARM ARISING FROM INABILITY TO
CARE FOR SELF OR MANAGE DAILY AFFAIRS
2. GOAL IS TO PROVIDE WITH MINIMAL- DISRUPTION OF LIFESTYLE & WITH LEAST RESTRICTIVE CARE ALTERNATIVES;
BALANCE FREEDOM WITH SAFETY
3. PROTECTIVE SERVICEDS NEEDED BY ELDERLY:
A. SOCIAL SUPPORT
B. HOUSING ASSISTANCE
C. SUPPORT WITH ACTIVITIES OF DAILY LIVING
D. LEGAL AID
E. FINANCIAL SUPPORT
F. MEDICAL AND PERSONAL CARE
G. EMERGENCY SERVICES
Protective Services
• Power of Attorney
• Joint Tenancy
• Intervious Trust
• Conservatorship
Power of Attorney
• LEGAL DEVICE WHEREBY OLDER
PERSON DESIGNATES ANOTHER
TO MANAGE AFFAIRS;
• PERSON MUST BE LEGALLY
COMPETENT TO INITIATE THIS
ACTION
• Durable or Designated area
(Health Care, Financial, etc.)
Joint Tenancy
• LEGAL DEVICE ALLOWING EITHER
ELDERLY PERSON OR PERSON
HAVING POWER OF ATTORNEY TO
MANAGE THE FORMER'S AFFAIRS
Intervious Trust
• TRUST CREATED BY ELDERLY
PERSON IN WHICH THAT PERSON
SERVES AS THE FIRST TRUSTEE
AND NAMES SUCCESSOR AS
SECOND TRUSTEE
Conservatorship
• DESIGNATION OF A PERSON OR INSTITUTION
TO TAKE OVER AND PROTECT INTERESTS OF
PERSON JUDGED INCOMPETENT;
• COURT APPOINTS CONSERVATOR AFTER
INVESTIGATION OF PERSON'S COMPETENCE;
• MOST RESTRICTIVE FORM OF PROTECTIVE
SERVICE; PERSON NO LONGER HAS THE
RIGHT TO VOTE, MANAGE MONEY, DETERMINE
RESIDENCE, OR MAKE OTHER MAJOR
DECISIONS
Informal Guardianship
• NONLEGAL ARRANGEMENT MADE
WITH NEIGHBORS, NURSING
HOMES, PRIVATE ATTORNEYS,
BANKS, TRUST COMPANIES, &
NONPROFIT CORPORATIONS
ELDER ABUSE
http://www.elderabusecenter.org/default.cfm
Statewide Elderly Abuse/Neglect
Hotline: 1-800-392-0210
DEPARTMENT OF SOCIAL
SERVICES MISSOURI DIVISION
OF AGING
P.O. BOX 1337
JEFFERSON CITY, MISSOURI
65102
elderly abuse/neglect
ABUSE
Abuse