Vol. 21 •Issue 7 • Page 29
Ethics in Home Health
How Would You Handle These Scenarios?
Wouldn’t it be wonderful if all of your work dilemmas could be solved with clear-cut, no-doubt-about-it solutions? It probably will never happen.
Pollyanna dreams of a health care utopia were most likely squashed within your first few hours on the job. In the real world, a caregiver’s life is filled with questions that require the use of deductive reasoning and reliance on past experiences to come up with the best possible answers to problems.
This is especially true in home health care, where such issues go beyond patient treatment. When practicing in a person’s home, caregivers like respiratory therapists are likely to run into all types of ethical issues unique to their specialty.
Still, wouldn’t it be handy to have a “how-to” guide to deal with such ethical quandaries? That’s what ADVANCE had in mind when we asked a panel of home health managers to offer their input on ways to handle sticky situations.
Should You Do the Dishes?
When a caregiver is on the patient’s “turf,” patients and their family members can misunderstand the limits of the home health professional’s role. Many of our panelists said it is not unusual for a patient or a family member to casually ask for help with certain chores.
While some might acquiesce to such requests, Tara Della Polla, RN, a supervisor for Family Pediatric Homecare, Hicksville, N.Y., believes it is a bad precedent to set.
Caregivers shouldn’t do the dishes or clean the house, she explained. They should be taking care of the patient and the patient’s needs. They’re professionals and are there to carry out professional duties.
However, both Ann May, MS, BSN, RN, a regional vice president for Home Health Corporation of America, and Susan Sender, RN, vice president and chief nursing executive for Gentiva Health Services Inc., agree that in certain situations, it’s OK to lend a hand with certain chores.
It’s not required and not part of the job description, but there are times when caregivers may do things to help a patient, Sender explained. While she would not prohibit a professional from performing such tasks, it would be more likely that a home health aide would be assigned to the case to help the patient with these chores on a regular basis.
If needed, caregivers might ensure a patient’s personal space is clean in order to provide appropriate care, May added. “Such things could include changing the patient’s bed linens, cleaning up the area surrounding where they are most of the time, like the bedroom and bathroom.”
Consensus: Use your best judgment on chores that would help with patient care. But if doing such tasks interferes with that goal, then refrain.
Should You Run Errands?
In the same vein, caregivers are sometimes asked by patients and family members to run errands. Is this a no-no?
There are times it would be OK to run an errand if it affects the health and well-being of the patient, Sender said. It would be OK to pick up medications from a local pharmacy, transport medical supplies to the patient’s home or take a blood sample to a lab, she said.
However, Michelle Marrocco, MSHCA, BSN, RN, director of community outreach for Family Care Certified Services in New York, disagrees. “Errands are not the responsibility of the home care professional,” she said. “If patients need someone to run errands, I would place a home health aide in the house.”
For Della Polla, errand running interferes with the caregiver’s primary job.
Consensus: Just say no to errands.
Caregivers and Family Disputes
Arguments between family members are inevitable. Most home care staff members realize family disagreements can cause a lot of anxiety for the patient. In providing the best care for their patients, home health professionals may feel tempted to intercede. Should they?
“I do not feel it is appropriate for home care staff to attempt to settle family disputes,” May said. “Our staff members are basically guests in the patient’s home and are not familiar with family history and/or dynamics.”
However, that doesn’t mean staff should ignore family quarrels.
If a dispute could have a negative effect on a patient’s health, well-being or progress toward health goals, the caregiver would be expected to refer the patient for social work services, Sender said.
Consensus: Do not intercede.
Attending Family Events
Is it OK for a caregiver to attend events like a birthday party off the clock?
Due to the personal nature of home care, it is not unusual for a caregiver to be invited to family gatherings, Sender said. However, participating in such celebrations could cause problems down the road.
Home care staff should use professional discretion in accepting or politely declining such invitations, she explained. Staff members are discouraged from developing close personal relationships with the patient or family members.
Marrocco concurs. “Family events should not be attended by the professional,” she said. “Doing so could violate the professional relationship.”
Consensus: Graciously decline such invitations by explaining the importance of maintaining a professional caregiver-patient relationship.
Can caregivers accept gifts from clients or bring a gift to the patient?
Everyone likes to be rewarded for a job well-done; and it’s likely a patient will want to offer a token of his gratitude by offering a gift.
But ethically, should you accept it?
No, said Della Polla, explaining that accepting a gift could have a negative impact on the professional relationship. Marrocco, however, believes it is OK to take a gift from a patient, as long as it is not too expensive and it is not cash.
As for home care staff giving patients gifts for birthdays or special holidays, Della Polla considers it an acceptable practice.
With certain populations, gift-giving can actually be used as a reward for the patient, Marrocco added. “For instance, this is regularly done in pediatrics to help with compliance,” she explained. “Gift-giving can affect the professional relationship in a good way and show the patients you truly care for them.”
Consensus: Don’t accept money, but small gifts are usually OK. When giving a gift, state the purpose of why you’re giving the present so the patient doesn’t get any wrong ideas.
Working in Unhealthy Homes
Prior to each home care assignment, a safety assessment should be conducted to determine whether the conditions of the house are detrimental to patient care. However, if unsanitary conditions crop up after the initial assessment, what should you do?
If necessary, caregivers may report the conditions to social agencies, Sender explained. Caregivers are also responsible for educating the patient and the family on ways to avoid unsafe or unsanitary conditions. Things to look out for would be cockroaches, rats or other pests; moldy food; foul odors; or even excessive clutter that could cause a tripping hazard.
While patient care is a priority, staff and patient safety is also an important concern. If the care provider feels unsafe for any reason, the situation must be addressed, May said. “Staff are instructed to remove themselves from the situation.”
Depending on the conditions of the home, the patient may be referred for a social work evaluation or to a local non-profit organization designated to provide emergency funding assistance, May added.
Consensus: Make sure your patient is living in a healthy environment. If it is deemed unhealthy, speak with a supervisor or social services.
Verbal Abuse Issues
While most interactions with patients and families are pleasant, home health staff sometimes run into situations where household members take out their frustrations on staff. What’s the best way to handle these situations?
“The supervisor must be notified,” Marrocco said. “A family conference should be scheduled with the supervisor and medical social worker.”
However, if the verbal abuse is coming from the patient, Sender cautions staff members to consider that the behavior could be influenced by illness or medications.
“If a patient exhibits abusive behavior due to his medical condition, a specially trained clinician must be assigned to the case to work with the patient to address the problem,” she said. “In more serious situations, we would report any incidents to the appropriate authorities, including adult protective services or the police.”
Any way you look at it, verbal abuse isn’t acceptable, May said. “The patient and family should be aware that services could be discontinued if such behavior continues.”
Consensus: No matter the scenario, verbal abuse shouldn’t be tolerated. Rather than getting in a confrontation with the patient or family member, report the situation to your case manager to coordinate an appropriate plan of action.
Nick Schaefer is a former ADVANCE staff writer.
Michelle Marrocco, MSHCA, BSN, RN, director of community outreach for Family Care Certified Services, New York
Ann May, BSN, MS, RN, regional vice president for clinical operations for the Mid-Atlantic Region for Home Health Corporation of America, King of Prussia, Pa.
Susan Sender, RN, vice president and chief nursing executive for Gentiva Health Services Inc., which has locations in 37 states
Tara Della Polla, RN, nursing supervisor for Family Pediatric Homecare, Hicksville, N.Y.