This paper examines the growing ethical challenges facing long-term care services as an aging population drives demand for care. It identifies three core ethical issues—living arrangements and family obligations, financial costs, and the risk of abuse or isolation—and proposes leadership strategies nurses can adopt to address them. These strategies include cultivating compassion and setting a professional example, improving communication with patients and families, and adhering to regulatory standards. The paper analyzes how these approaches work in practice and explains their broader importance to the nursing profession's fundamental goal of reducing pain and suffering.
Over the last ten years, the demand for long-term care services has faced increasing pressure. Part of the reason for this is the large portion of the population that is growing older — the Baby Boomers — who have the potential to cause overall demand to increase dramatically. Evidence of this can be seen in data compiled by the Government Accountability Office, which found that the total number of people requiring long-term care services will double by the year 2050. The costs for this care are projected to reach $379 billion, up from $179 billion spent in 2000 (Walker, 2002). This is significant because it shows how long-term care is going to become a major part of all health care expenditures in the future.
As a result, there are a number of unique ethical challenges facing the industry. To fully understand the overall scope of these concerns — as well as how they can be addressed — requires identifying specific ethical issues and the leadership strategies that can be used to tackle them. This will be accomplished by examining key strategies pertinent to these ethical challenges, analyzing the evidence, and understanding its importance to nursing. Together, these elements will provide the greatest insight into the underlying challenges and solutions for the different issues facing long-term care.
There are a number of different ethical issues affecting long-term care services. These include: living arrangements and family obligations, financial costs, and possible abuse or isolation. The issue of living arrangements and family obligations arises when family members — such as adult children — are forced to determine what to do with an elderly relative. On one hand, they want to support these individuals, yet they may have competing obligations in their own lives that make it impossible to spend the necessary time with an elderly relative. The financial costs represent the total monetary impact of caring for a relative; in some cases, family members may be unable to stop working due to economic and family pressures ("Long-Term Care Ethics," 2011).
Possible isolation and abuse occur when an elderly relative faces various forms of neglect from a caregiver in a nursing home or assisted living facility ("Ethical and Legal Issues of Long-Term Care," 2008). These different elements are important because they highlight a host of ethical issues that must be confronted when placing a relative in a long-term care facility. This is troubling because these challenges can compound the burdens that family members are already wrestling with.
To effectively address these issues, leadership strategies must incorporate a number of different elements designed to tackle the ethical challenges being faced and provide workable solutions that can be adapted to various situations. The key factors that must be embraced to achieve these objectives include: cultivating a deep sense of compassion and setting the example, improving communication, and understanding how different regulations can be used to address these issues.
Having a deep sense of compassion and setting the example means that the individual health care professional has a genuine concern about the well-being of each patient. At the same time, that professional must set the tone for how ethical challenges will be tackled within the organization. These factors are important because they determine the overall quality of care provided to the patient. A trained health care professional who demonstrates compassion and consistent follow-through can set the standard for the entire organization. Once this is in place, family members can feel a sense of relief, knowing that ethical concerns will be addressed through the professional's underlying compassion and professionalism (Sullivan, 2006, pp. 907–914).
Improving communication means that the health care professional actively discusses the different ethical issues with the family and informs them of the options available to them. This is important because most people are unaware of the range of choices they have. When someone communicates clearly with them, it helps families decide what is best for their relative and for themselves, allowing them to make a well-informed decision about a particular facility. This strategy gives families the most complete information about the avenues available for addressing their underlying challenges (Kane, 2006, pp. 293–304).
Understanding and applying relevant regulations means that the health care professional consistently adheres to these standards as a foundation for their ethical practice. This is important because regulatory compliance helps protect elderly residents from abusive staff, since the regulations clearly prohibit such actions (Stoudemire, 1996, pp. 77–94).
"Evaluating how strategies reduce family burden"
"Strategies align with nursing's core mission"
"Ethical leadership reduces suffering in long-term care"
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