NCOA Legal & Ethical Considerations & End of Life Issues for the Elderly Chapters 4 & 9 (4 th ed) Pati Cox, RN, BSN, M.Ed.

Ethical Dilemma’s Study of moral actions & values Anything that impacts “Quality of Life” Quantity versus Quality Spent much time discussing in P&VC

Patient’s Bill of Rights AHA It ensures that each patient or resident has the right to make his/her own decisions regarding care and treatment Provided to each person Posted in facilities (acute and LTC)

The LAW Based on rules and regulations As a LPN, you are required to function under the mandates of the state Nurse Practice Act in which you practice. You are NOT allowed to practice outside those rules and regulations

Negligence Failure to exercise adequate care Prudent Nurse Theory Determination is based upon: Level of performance that is expected What is considered safe practice Will discuss more in Leadership & Management Various types of negligence

Omission Straight forward concept Simply omit or leave something out May be on purpose or not But it is expected of you to complete as part of the care or treatment provided Example: Medications or treatments

Restraints Physical and Chemical If utilized, must be ordered; protocol must be followed to assess and release Restraint Free Environment is Goal Use of the least restrictive devices Strategies of Care givers

Advanced Directives Living Will Many states require Advanced Directives upon admittance to health care facility Primary Objective is to follow the wishes of the patient/client/resident Discussed in great detail in P&VC

Right To Die Factors Influencing Decision Include:./ 'Patient's Suffering./ 'Patient's Cognitive Impairment./ 'Patient’s and Family’s Expressed Wishes./ QUALITY OF LIF£./ Current Care Setting

Right TO DIE Related Issues:./ 'Patient's competency to make decision./ Family's view of Patient’s decision./ NO Code and No Treatment Situations. -DO NOT Resuscitate (DNR). "DO NOT Hospitalize (DNH). "DO NOT Treat (DNT) “DO NOT Intubate (DNI) Doctor’s Signature Required for the orders

Right To Die Possible Nursing Implications: Support Patient and Family in decisions Support Nurses and Doctors who implement policies Ensure that supportive care is maintained

Informed Consent Right to information before consent to treatment or procedure Must be signature on consent form (or mark) Guardian/Health care Power of Attorney may sign if necessary

Informed Consent To Give Valid Consent: Fully informed of all risks and benefits of procedure Competent Nursing Implications: Assess and screen areas of client competency carefully Consent must be obtained first – if not – can’t do Follow legal requirements & facility specific procedures/policy

PROTECTIVE SERVICES GENERAL INFORMATION: 1. ADULT PROTECTIVE SERVICES: GENERAL TERM FOR SERVICES PROVIDED TO PROTECT AN INCOMPETENT PERSON FROM HARM ARISING FROM INABILITY TO CARE FOR SELF OR MANAGE DAILY AFFAIRS 2. GOAL IS TO PROVIDE WITH MINIMAL- DISRUPTION OF LIFE- STYLE & WITH LEAST RESTRICTIVE CARE ALTERNATIVES; BALANCE FREEDOM WITH SAFETY 3. PROTECTIVE SERVICEDS NEEDED BY ELDERLY: A. SOCIAL SUPPORT B. HOUSING ASSISTANCE C. SUPPORT WITH ACTIVITIES OF DAILY LIVING D. LEGAL AID E. FINANCIAL SUPPORT F. MEDICAL AND PERSONAL CARE G. EMERGENCY SERVICES

Protective Services Power of Attorney Joint Tenancy Intervious Trust Conservatorship

Power of Attorney LEGAL DEVICE WHEREBY OLDER PERSON DESIGNATES ANOTHER TO MANAGE AFFAIRS; PERSON MUST BE LEGALLY COMPETENT TO INITIATE THIS ACTION Durable or Designated area (Health Care, Financial, etc.)

Joint Tenancy LEGAL DEVICE ALLOWING EITHER ELDERLY PERSON OR PERSON HAVING POWER OF ATTORNEY TO MANAGE THE FORMER'S AFFAIRS

Intervious Trust TRUST CREATED BY ELDERLY PERSON IN WHICH THAT PERSON SERVES AS THE FIRST TRUSTEE AND NAMES SUCCESSOR AS SECOND TRUSTEE

Conservatorship DESIGNATION OF A PERSON OR INSTITUTION TO TAKE OVER AND PROTECT INTERESTS OF PERSON JUDGED INCOMPETENT; COURT APPOINTS CONSERVATOR AFTER INVESTIGATION OF PERSON'S COMPETENCE; MOST RESTRICTIVE FORM OF PROTECTIVE SERVICE; PERSON NO LONGER HAS THE RIGHT TO VOTE, MANAGE MONEY, DETERMINE RESIDENCE, OR MAKE OTHER MAJOR DECISIONS

Informal Guardianship NONLEGAL ARRANGEMENT MADE WITH NEIGHBORS, NURSING HOMES, PRIVATE ATTORNEYS, BANKS, TRUST COMPANIES, & NONPROFIT CORPORATIONS

ELDER ABUSE

Statewide Elderly Abuse/Neglect Hotline: DEPARTMENT OF SOCIAL SERVICES MISSOURI DIVISION OF AGING P.O. BOX 1337 JEFFERSON CITY, MISSOURI elderly abuse/neglect

ABUSE

Abuse