Support Planning for Geriatric Health Conditions
- Adrian Capalad
1. Actual and potential conflict of interest between family members, professional caregivers and the elderly.
There are several actual and potential conflicts of interest that are continuously happening between family members, professional caregivers and the elderly. To prevent issues and conflict with regard to elderly abuse and neglect in the Kindly residential care and rest home, there are a number of key principles that the institution shall adhere to:
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Autonomy is mainly adhering to the wishes of the patient; Medical health practitioners in the Kindly residential care and rest home are reminded and are taught that the patients are the primary decision makers for their care. Hence, following this principle can create both actual and potential conflicts for the institution when clients with dementia do not have full decision-making capabilities or if they just simply wish to cease from their family members’ directives. Conflict within the family and the time-consuming processes of interceding and establishing what their patients truly want, can become frustrating for physicians whenever the situation arises.
In addition, using restraints on patients without their consent or the knowledge of family members is an actual conflict that may occur in the institution. It may aid the health providers during the time when a client with dementia becomes confuse and combative but, it should only be an option and implemented only when their confusion may harm themselves.
Moreover, placing client in their room without their personal opinion is still considered as false imprisonment. Client and family directives are sometimes bypassed because clients may become uncooperative and from illness constraints, which should not be the case since elderly patients with or without dementia should have the right for independence, choice and respected. Even the patient has a history of being noisy and unruly in the common area, it is not recommended to transfer the patient to a private room or isolating them. It is more therapeutic to manage their discomfort as well as assess the reason for their actions and not merely because the health team has several scheduled tasks to be accomplished. Furthermore, by allowing the client to perform simple activities like picking-up their clothes or straighten out their bed sheets will help them to feel independent and have a sense of achievement. However, health care assistants tend not to solicit the client’s opinion and decide whatever is convenient for them.
Respect should be given with utmost consideration to elderly people even when suffering from dementia. It is another avenue where conflicts between stakeholders begin because of certain issues that encompasses equality and diversity. For instance, health care assistant would be caught looking at the elderly diapers even in a public place like the common lounge. Not to mention, certain incidents that a health care assistant would raise their voice and threaten clients to deliver an authoritative command when the patient is not cooperative. Hence, healthcare providers not following the directives or the wishes of the client, even not mentally handicapped is constantly happening because the health provider fails to recognize and assess the client properly. There are incidences when the health providers would use excessive force that may injure and hurt clients with dementia and other elderly diseases (stroke, physically handicapped, paralyzed and mentally ill) during transfers from chair to bed and vice versa.
Dignity refers to the manner of esteem or respect that is given to the elderly. Certain cultures and ethnic background have a nature to eavesdrop and gossip among themselves the status of their clients. Thus, helping out patients to have a phone call just to collect information about personal matters is an actual conflict with regard to privacy. However, in most instances allowing the patient merely to make a phone call is usually ignored because the health provider would reason out that the time used for this action can be a deterrent to the other pressing duties and responsibilities of the health team.
Health providers should continuously be a patient advocate, by not allowing them to leave their rooms half-naked or probably missing a sock or foot wear which will be a potential conflict with the family when they would happen to see their family member in such a predicament and embarrassing situation. There are simple gestures that can impact a lot to the overall well being of the elderly, like putting on dentures when eating is important to maintain the client’s dignity. Apparently, health workers intentionally forget to put on this when they already cleansed it, as a matter of fact, they feel it can be too troublesome to brush the dentures again. It is a sign of poor morale in the part of the caregiver and can be seen merely as an excuse for being lazy and ignorance.
Rights and choice should be advocated especially with the advance directives. This can be done by encouraging the patient to secure and accomplish all necessary forms, as well as ensuring that the patient understands the document being asked to be filled out with regard to their health like informed consent.
What you need to know about Kindly Residential Care and Rest Home:
How are the elderly treated in Kindly Residential Care and Rest Home?
The institution believes that our residents have rights and shall be treated with utmost respect, according to their socio-cultural belief. Maintaining dignity, independence and autonomy while taking into consideration their personal choice and upholding their individuality.
How can the client and family be assured that their safety and security is highly regarded in the Kindly Residential Care and Rest Home
- The facility shall issue each client technological devices that is found appropriate to their condition (ex. Wanderer tracker bracelets or necklace, room sensors, cameras, etc.).
- Utilizing safety provisions in the rest of the facilities for instance; railings, night lights, rubber mats, physical presence of nurses and caregivers to name a few.
- Yearly quality assurance and accreditations from government regulatory commission to acquire an A+ standard of facility.
- Acquiring a reliable security agency to safeguard the facility 24/7.
What we ensure as an elderly care provider with regard to adequate treatment and services are rendered accordingly?
- An in-house physician that will be available for consultation.
- The desired number of caregivers as required by the district board.
- The desired number of nurses as required by the district board
- Monthly quality assurance of the facility and a continuous monitoring and evaluation of the status of patient with regard to their whole well-being.
- Communicating and reporting to the family the condition and progress of the individual during their stay in the facility.
How does Kindly residential care and rest home keep its confidentiality?
The Ministry of Health in New Zealand issued laws regarding patient confidentiality to safeguard their rights. There are government agencies that continuously encourage stakeholders to report and file a complaint if they believe their rights have been breached. The government provides a health and disability advocates to help people in their situation whenever the stakeholder feels uncomfortable to discuss their predicament to the Kindly residential care and rest home manager.
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The privacy Act of 1993 and The Health Privacy Code of 1994 further encompasses the rights of the stakeholder’s confidentiality. According to the New Zealand privacy code of 1994, there are 12 rules that health institutions must follow when gather, utilizing and keeping the clients information as follows:
- The reason the health information collected should be for a valid reason.
- People who are authorized to provide the information.
- Valid reason why these information is collected from the client.
- The mode on collecting information. (sensitively and privately)
- How your information is kept and secured.
- The right of the client to have access and see their records.
- Knowledgeable about the corrections been done to prevent inaccuracies.
- Safeguarding the veracity of the information.
- Duration the information it is kept and what are the actions to be done with afterwards.
- How the data may and may not be utilized.
- Personnel’s that can access and utilize your data.
- The privacy of your National Health Index number.
The District Health Board staffs are all well informed with their obligation with regard to the confidentiality. It is their accountability to use the client’s information for their treatment or reasons that is directly related to the total well being of the client. The health providers are also keen in disclosing any information that they are not entitled to give. Health providers are also knowledgeable that utilizing the client’s information is for treatment purposes only and as guide on the duties they should perform as the client’s caregiver. It is the health provider’s duty to safeguard classified information from unauthorized personnel’s.
In addition, there are basic expectations for health providers working in the Kindly residential care and rest home:
- To respect the personal and physical privacy of all clients to the maximum degree available.
- Discussing confidential information is prohibited with regard to the clients well being in common areas like corridors and lifts. Being cautious on the possibility of other unconcerned individuals hearing the care of a client during handover or ward rounds.
- Avoid from spreading rumors or discussing information that you may have heard during the duration of work. It is only important to know about patients that are under your care.
- Securing patient details are not left in view for the public. Computer screens, files and other documents should safeguard at all times when transported.
- Reporting immediately to the manager or supervisor if the health provider becomes aware of incidents that may breach the privacy of the client.
3. Decision-making capacity of the elderly
Health care managers and medical practitioners engage in a highly complex system. There are numerous economic, legal, ethical, organizational and technical changes that are taking place continuously in the institution. Each decision that the manager makes will directly impact with the performance of the organization since it will influence multiple facets that will result in financial success, customer satisfaction, and long-term viability of the organization (Guo, K.,2008).
The decision-making capacity of the elderly can be a huge factor on how policies and procedures are being implemented by the institution. In light of this, it can be viewed as a positive and as a negative effect, since the elderly has a say and can affect what are the objectives viewed by the institution has set.
How does the Kindly residential care and rest home implement their policies and procedures with regard to the decision making capacity of the elderly? In terms of:
Kindly residential care and rest home advocates autonomy as one of the foundations of professional ethics when working with older people. However, it is rather difficult to manage their care and at the same time putting in to consideration their autonomy. Thus, clients with dementia should be regularly assessed to determine their mental status like comprehension, cognition and competency to function on day to day activities.
Moreover, stakeholders those are able to decide and function for themselves, should be allowed to exercise their moral and legal rights to refuse any medical treatment. The health providers should respect the client’s rights to decide for their well-being regardless if it is beyond the policies of the institution as long it does not cause harm to others and to the individual.
Kindly residential rest care home encourages clients to complete several forms that would be the basis for the client’s directives which will be implemented after experiencing the loss of independence:
- Health Care Proxy Form – clients are encouraged to complete this form to identify someone who can act on their behalf if the client can no longer make or communicate health care decisions.
- Advance Directive Form/ DNR Directives – clients are encouraged to complete this form to document their end-of-life wishes in the event when the client that you are terminally ill and unable to communicate.
- Privacy Requirements – clients are encouraged to complete this form to protect the privacy and confidentiality of personal medication information.
- Enduring power of attorney – (Under the Protection of Personal and Property Rights Act 1988). The Act was instituted to provide better protection for people in order the attorney can act accordingly in their behalf (Ministry of Social Development, 2014).
There are two types of EPAs:
- A Personal Care and Welfare EPA designates one person as your counsel to make arrangements regarding your personal care and interest on your behalf if you become mentally unfit (Ministry of Social Development, 2014).
- A Property EPA appoints one or more counsels to handle and prepare agreements about your property affairs. The client can, if they wish, can give your counsel authority to manage your property affairs while you still have capacity (Ministry of Social Development, 2014).
Guo, K. (2008). DECIDE: A Decision-Making Model for More Effective Decision Making by Health Care Managers. April/June 2008Volume 27Number 2Pages118–127.
Ministry of Social Development. (2014). Enduring Power of Attorney – Keeping you protected. Retrieved from https://www.msd.govt.nz/what-we-can-do/seniorcitizens/your-rights/enduring-power-of-attorney.html.
Parliamentary Counsel Office.(2014). New Zealand Legislation: Privacy Act 1993. No 28. Retrieved from http://www.legislation.govt.nz/act/public/1993/0028/latest/DLM296639.html.
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