By Beth Lueders
Many elders are too afraid to speak up about the missing medication, or the yelling, or the unexplained bank withdrawals. It’s hard to come to terms with the fact that a close relative or loved one is actually a conniving bully instead of a dutiful caregiver.
Countless elders in America face inadequate support for their well-being and do not know where to turn for help. Nearly 45 million people age 65 or older live in the United States—a number that increased almost 25 percent between 2003 and 2013. Not only do these older adults now comprise 23 percent of the total U.S. population, but they are also living longer. As their numbers are projected to more than double to 98 million by 2060, will they receive the appropriate daily care that they need?
Ethical Principles in Caregiving
Whether an aging person receives assistance in a care facility or at home, four practical ethical approaches called Principlism are central to holistic senior care:
- Autonomy is the right of a person to determine his or her own destiny.
- Beneficence is to do good on behalf of the patient rather than healthcare professionals.
- Nonmaleficence aim is to protect the patient’s safety and not cause harm.
- Justice seeks the sharing of benefits and burdens based on fairness and equality.
When any of these ethical principles are overlooked, a person may be at risk for neglect or abuse.
Preventing Elder Neglect and Abuse
Elder neglect is the failure to carry out caregiving obligations. There are several types of neglect to consider. Active neglect of an elder can present when a caregiver pursues selfish motives or causes personal harm or conflict such as withholding food and water for the care recipient. Passive neglect can arise when a caregiver unintentionally cannot fulfill care responsibilities typically because of illness, stress, ignorance or lack of resources. Self-neglect occurs when an older person fails to meet his or her own care needs.
Elder abuse by both family and professional caregivers along with clinicians and those entrusted to care for older adults can range from physical and sexual assault to emotional and financial exploitation. Examples of abuse of older adults include over- and under-medicating to forging the elder’s signature on legal documents.
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Healthcare Advocacy: Fundamentals of Ethical Caregiving
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In response to underreported cases of elder abuse, the Elder Justice Act (EJA) was signed into law in 2010 as part of the Patient Protection and Affordable Care Act. The core of the national legislation is to “prevent, detect, treat, intervene in, and prosecute elder abuse, neglect and exploitation [and] protect elders with diminished capacity while maximizing their autonomy.”
Essential provisions of the EJA includes creating grant programs for adult protective services and requiring the reporting of neglect and abuse at long-term care facilities. Widespread support for preventing elder abuse also focuses on caregiver support, mental health care and legal assistance.
Support for An Elder’s Care Decisions
Ensuring that elders receive a full measure of consistent care extends beyond preventing abuse and neglect. Regarding and protecting a person’s choice of ongoing care and end-of-life decisions is also imperative in ethical caregiving.
To look out for the everyday and long-term needs of the aging care recipient, it is beneficial to have an elder care team on board—from physicians and home care professionals to elder attorneys and financial planners. This care team can advise the senior and family members on possible medical treatments and allow the patient to make personal preferences on care.
The John A. Hartford Foundation conducted focus groups among patients and clinicians and 82 percent of the patients surveyed said if they were seriously ill, they would want to talk about end-of-life decisions with their doctor. But only 7 percent of these survey participants have discussed advanced healthcare directives with their physician. Many people nearing the end of life are not physically or mentally capable of making their own care decisions, so having a signed durable power of attorney for healthcare protects the patient’s care choices and prevents family members and medical staff from guessing what the patient would want.
An elder law attorney who specialists in the complicated legal issues confronting seniors, can guide the elder through advanced healthcare directives, Medicare and Medicaid issues, estate planning, family caregiver agreements and other documents that safeguard the current and future care of older adults. In addition to a durable power of attorney for healthcare and financial assets, priority legal documents for elders include a will, living will declaration and a living trust.
When choosing the best advocate team for an aging individual’s care, the ethical principles of justly protecting the safety and the personal decisions of the elderly matter.
For additional educational resources on ethical elder care, visit the National Center on Elder Abuse, or the U.S. government services available through the Administration on Aging. For help with home care therapies and caregiver assistance, visit Right at Home or call them at (402) 697-7537.
Beth Lueders is a journalist, author and speaker who frequently reports on health, aging and caregiving issues in the United States and globally.