Unique Features of Adult Day Care: Ethics of Everyday Living

1. Unique Features of Adult Day Care:Ethics of Everyday Living Philip Boyle, PhD Vice President. Mission & Ethics Catholic Health East

2. What I am going to do today? • Identify unique moral ecology of adult day care • Ethics of caring • Caring practices not dilemmas • Flourishing even in decline • Propose a method to identify • Suggest guideposts • Identify best practices

3. The Moral Ecology The clients • Impaired sensory, cognitive, & functional • Limit autonomy • Subtle clotting and vulnerability • Stigma: • Attendance =Less than capacitated • Adult day care = baby sitting

4. The Moral Ecology The staff—different professional training • Professional boundaries unclear • Becoming intimate with the client • Self disclosure, identifying with client, accepting or giving gifts • Coercion— behavioral limits • Provider no longer the “expert”--power

5. The Moral Ecology The setting • Community care setting • Less health care, more social services • Not thought as social obligations • Institutional configurations vary • Quasi-intitutional • Clients voluntarily purchasing service • Relief for informal caregivers

6. Focus of concern • Caring • Dignity • Flourishing

7. Ethics of Care • Pull of responsibility, not demand of obligation • Attention to particulars, not rules & principles • Focus on who gives care/power differential • Alleviate pain of aloneness, of vulnerability, of fear, of abandonment, of illness, of dying

8. Agitated Mary • Attends 1 yr • Dementia 4 yrs • Generally cooperative • 1 day last week became upset • Upset escalated • Clients notice • Called family for early pick up

9. Adult day care • What is the ethical problem? • Would it be framed differently if told from the perspectives of each party involved?

10. Adult day care • What values are important to preserve?

11. Adult day care • What facts are needed before discharging Mary?

12. Adult day care • What actions might respect each person involved in caring for Mary?

13. Adult day care • What kind of care plan ought to be developed? • Think of aims that go beyond the immediate need of her confusion

14. Angela • Stroke, blind unable to carry out directions • Capacitated • Disagrees about everything • Escort often has problem returning her home • Staff has given up going the extra mile

15. Kate, Ralph, & Manager • Kate has dementia • Increasing loud activity • Talking out loud • Pulling at clothing and in their faces • Manger worried about clients could strike out at Kate • Husband told they would have to look to alternatives & he responds in anger

16. Meeting Miss Jones • 74 yr old progressive Alzheimer • Sister brings Jones to center because she feels confined at home • Jones become agitated when sister leaves • What are the most important behaviors to welcome Jones? • How can you build trust?

17. Guidelines for Caring Practices • Greet with surname • Introduce your self with a story • Create a sense of equality • Put yourself in their position • Honor privacy • Create opportunity to find out what actions they value • Understand client’s habits • Talk normally

18. Guidelines for Caring Practices • Discover that they want you to let others know • Promote adult choices • Learn about past & hopes • Be aware of invasive elements of care • What supports client’s self-worth • What is you way of understanding a problem?

19. What amount of harm should warrant action? • Serious harm • Likely to happen • Alternatives have been exhausted • Intervention will stop the harm

20. Conclusions • Ethics of everyday living • Attention to particularities • Focus: caring, listening, respecting… • Need separate mechanisms

21. WWW.CHE.ORG/ETHICS