NCOA Legal & Ethical Considerations & End of Life Issues for the Elderly Chapters 4 & 9 (4 th ed) Pati Cox, RN, BSN, M.Ed.

NCOALegal & 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

• 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 DIERelated 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

decisionsSupport Nurses and Doctors who

implement policiesEnsure 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 SERVICESGENERAL 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 AFFAIRS2. GOAL IS TO PROVIDE WITH MINIMAL- DISRUPTION OF LIFE-STYLE & WITH LEAST RESTRICTIVE CARE ALTERNATIVES; BALANCE FREEDOM WITH SAFETY3. PROTECTIVE SERVICEDS NEEDED BY ELDERLY:

A. SOCIAL SUPPORTB. HOUSING ASSISTANCEC. SUPPORT WITH ACTIVITIES OF DAILY LIVING D. LEGAL AIDE. FINANCIAL SUPPORTF. MEDICAL AND PERSONAL CAREG. 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 AGINGP.O. BOX 1337

JEFFERSON CITY, MISSOURI 65102

elderly abuse/neglect

ABUSE

Abuse