Autonomy and Long-term Care


Book Description

The realities and misconceptions of long-term care and the challenges it presents for the ethics of autonomy are analyzed in this perceptive work. While defending the concept of autonomy, the author argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long-term care. He explains that autonomy should be understood as a comprehensiveness that defines the overall course of a person's life rather than as a way of responding to an isolated situation. Agich distinguishes actual and ideal autonomy and argues that actual autonomy is better revealed in the everyday experiences of long-term care than in dramatic, conflict-ridden paradigm situations such as decisions to institutionalize, to initiate aggressive treatments, or to withhold or to withdraw life-sustaining treatments. Through a phenomenological analysis of long-term care, he develops an ethical framework for it by showing how autonomy is actually manifest in certain structural features of the social world of long-term care. Throughout this timely work, the rich sociological and anthropological literature on aging and long-term care is referenced and the practical ethical questions of promoting and enhancing the exercise of autonomy are addressed.




Enhancing Autonomy in Long-term Care


Book Description

This volume assesses the importance of autonomy to quality of life in long-term care facilities. First addressing conceptual issues, the editors then pose such questions as: What is autonomy and what does it mean in the context of physically and/or cognitively impaired elders? What is the effect of nursing home financing and federal regulations? How does the traditional medical model, which casts residents as "patients", affect autonomy? How does the physical environment make a difference? The contributors then go on to describe six successful models of care that provide a more meaningful quality of life through promoting autonomy. Contributors include Robert and Rosalie Kane, Keren Brown Wilson, and Bart Collopy.




The Erosion of Autonomy in Long-term Care


Book Description

In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy. This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer detailed descriptions of the organizational patterns and routine practices that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in long-term care. The book concludes with suggestions on how the autonomy of elderly individuals in long-term care institutions might be promoted.




Dependence and Autonomy in Old Age


Book Description

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals.




Dependence and Autonomy in Old Age


Book Description

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals.




Improving the Quality of Long-Term Care


Book Description

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.




Long-Term Care in an Aging Society


Book Description

This comprehensive graduate textbook focuses on the full spectrum of long-term care settings ranging from family and community based care through supportive housing options to a variety of institutional long-term care alternatives. Integrating theory and practice, the book features the perspectives of diverse fields regarding current long-term care options and new directions for the future. Prominent scholars from history, environmental design, family caregiving, gerontology, social service delivery, clinical care, health service delivery, public policy, finance, law, and ethics explore such themes as: Relationships among independence, dependence, and interdependence Ethical considerations in the provision of long-term care Decision-making in long-term care Fluidity and transitions in long-term care The lived experience of long-term care A micro-macro perspective ranging from the individual to societal institutions The book examines future directions for long-term care, considering such factors as the interface of technology and long-term care, cultural diversity, and relationships between voluntary and paid services. Each chapter includes case examples, study questions, and exercises, additional resources, and website links. The appendices provide a glossary and a list of acronyms. Instructorís resources are also available. Key Features: Focuses on the full array of long-term care options Integrates theory and practice Incorporates the perspectives of diverse fields including history, environmental design, family caregiving, social services and public policy Includes numerous case examples, study questions, exercises, and additional resources Considers new approaches to long-term care incorporating technology and considering cultural diversity and the relationship between voluntary and paid services




Aging, Autonomy, and Architecture


Book Description

Examines various aspects of the design and function of aged care assisted living facilities. Includes the needs of people with dementia and people from culturally diverse backgrounds.




Dementia Care Training Manual for Staff Working in Nursing and Residential Settings


Book Description

This accessible, interactive resource book encourages front-line staff working with dementia sufferers in nursing and residential settings to examine their working practice and modify it to where appropriate to meet best practice guidelines. Packed with photocopiable training exercises, discussion points and questions to prompt care workers to reflect on their style of work, this practical training manual also provides a framework for care work in line with statutory requirements and national training standards. It can be used as a self-training guide by carers, who can work through it at their own pace or under the supervision of a colleague, or by trainers running structured courses on good practice in dementia care. It is also suitable for use as a quick reference in daily practice. This comprehensive resource will provide useful guidance for all staff working face-to-face with people with dementia, whether in nursing, day-care or residential settings.




Power and Autonomy in the Nursing Home


Book Description

As with all organizations, nursing homes have an internal hierarchy that guides decision-making practices and policies. Nursing assistants (NAs) are positioned at the bottom of the hierarchy. They are generally the last nursing home employees to be solicited for input regarding practices and the last to learn about mandated policies created by upper level management. Consequently, they have the most limited amount of power compared to other staff. The one group of people that is impacted by all levels of the hierarchy and generally positioned at the bottom of all power relations in long-term care is nursing home residents. Residents' daily life is directly influenced by nursing policies and practices, staff shortages, staff's ability to provide timely care, and staff's opinions about what type of care residents should receive. This dissertation is a compilation of three publishable manuscripts that describe the balance of power and hierarchy within the nursing home. Data were collected through observations and interviews with NAs in long-term care settings at one Veterans Affairs Medical Center (VAMC). All data were analyzed using grounded theory. Nursing homes are slowly shifting from a paternalistic medical model to a biopsychosocial model of care that promotes quality of life and autonomy. Unfortunately, the current conceptualizations of autonomy are not appropriate for long-term care settings. Without a cohesive framework for autonomy in long-term care, nursing home staff are apt to continue their approach to daily care consistent with a paternalistic, medical model of care. Therefore, the aim of the first paper is to present an applied conceptual framework for "everyday autonomy" in the nursing home. Additionally, a decisional framework is presented to assist NAs in determining what degree of resident autonomy to support. Within the framework of everyday autonomy, NAs are challenged to explore ways to support resident autonomy. The purpose of the second paper is to describe how NAs can support resident autonomy in long-term care. Through observations and interviews with NAs, ten autonomy-supportive approaches were identified. Suggestions for future research are presented. Several barriers to successful recruitment emerged during this study. The purposes of the final paper presented in this dissertation are to describe my recruitment process in detail, present challenges to recruitment, and reflect on the strengths and weaknesses of my recruitment strategies. Additionally, I summarize the characteristics of NAs in relation to power and hypothesize links between these characteristics and barriers to recruitment of the NA population. Finally, I propose possible strategies for effective recruitment of NAs for research in long-term care settings.