Read the following case study and submit a 1500 – 2000 word paper that addresses the case study and the questions at the end of the case study.
Mr. B. is an 83 year old male referred to home health services following a hospital admission for congestive heart failure. His payor source is Medicare (traditional). He lives alone and indicates he does not have sufficient financial resources to afford private-pay in home supportive care. His daughter, who lives in the neighboring county about 30 miles away, has offered her father to move in with her – he has refused and she is not “forcing the issue”. Mr. B. is also not open to discussing moving to an assisted living environment.
This is his third hospital admission for the same problem over the last 12 months and his second admission to a home health agency. He was discharged from the previous home health agency 6 weeks ago. Physician orders are for the home health agency to provide skilled nursing for assessment of his cardiac condition and to teach him about his care and medication regime. Physical therapy has been ordered to establish a home exercise program. Home health aide services have been ordered 3 times a week to assist Mr. B. with his personal care needs.
By the end of the third week of service, it is clear to the RN Case Manager that Mr. B. is not making progress to the established goals. She reports during case conference that he is not a good candidate for teaching because of intermittent confusion and forgetfulness. According to the nurse, no matter what she has tried to teach him and regardless of the aids she has used, Mr. B. continues to take is medication incorrectly. She states, “I know he needs services, but I am not sure that he is in the right environment. I am concerned about Mr. B. – I am not sure why his daughter won’t just step up and put her foot down.”
The physical therapist reports at case conference that the “client lacks motivation”. The home exercise program has been established with Mr. B.; however, he does not complete the exercises between therapy visits.
An improvement in his personal hygiene has been noted with the Home Health Aide (HHA) services. The HHA has also been successful in decluttering his living space. The HHA reports that she is concerned that he is not eating regular meals.
This situation offers an ethical challenge to the professional caregivers and to the agency for which they work.
Discuss how you would handle this ethical dilemma. Address the following questions as a part of your response:
- What are your concerns about this case?
- How does the RN Case Manager meet her ethical responsibilities to the patient and to the organization?
- What is the best plan of action to ensure the client’s safety and well-being?
- What are realistic outcomes and goals for this client?
- Who will provide the ongoing care needs required by this client?