United Nations. (2016). The Growing Need for Long-Term Care. Excerpt from www.un.org/esa/socdev/ageing/documents/un-ageing_briefing-paper_Long-term-care.pdf decisions related to long-term care are made under public policy restrictions on public funding of long-term care services. These restrictions affect eligibility for funding for long-term care services, particularly those supported by local, state, and federal taxpayer funds. There is ongoing debate as to whether these limitations meet the ethical requirements of various concepts and theories of justice. Human beings are born equal in dignity and rights. These are moral claims that are inalienable and inherent in all human individuals solely because of their humanity. These demands are articulated and formulated in what we now call human rights and have been translated into legal rights established through the legislative processes of societies at the national and international levels.
The basis of these legal rights is the consent of the governed, that is, the consent of the subjects of rights (Levin 2012, page 19). As health organizations that accept state and federal funding, nursing homes that accept Medicare and Medicaid are agents of government and therefore also responsible for respecting, protecting, and fulfilling human rights. The following section shows how substance use by workers and family members in nursing homes does not respect and protect the human rights of people living in nursing homes. Although the percentage of older Americans living in a nursing home on any given day continues to decline, 1.4 million people lived in a nursing home in 2014. While the age structure of nursing home residents continues to be dominated by those over the age of 75, who make up 68% of all residents, the number of people under the age of 65 continues to increase slightly to 15.5%. People aged 95 and older accounted for 8% of all residents in 2014 (CMS 2015). Bern-Klug, M., Kramer, K. W. O., Chan, G., Kane, R., Dorfman, L. T., & Saunders, J. (2009). Characteristics of nursing home social service providers: How common is a social work degree? Journal of the American Medical Directors Association, 10, 36-44.
doi:10.1016/j.jamda.2008.06.011. Shinoda-Tagawa, T., Leonard, R., Pontikas, J., McDonough, J. E., Allen, D., & Dreyer, P. I. (2004). Resident-to-resident violent incidents in nursing homes. Journal of the American Medical Association, 291, 591-598. However, a mystery still exists. It is not always easy to identify the factors that trigger aggressive behaviour, and even when triggers are identified, it can take trial and error to determine which interventions are effective in preventing recurrence of the behaviour. Meanwhile, the safety of other residents is threatened. This raises the question of how long and how many interventions institutional staff should try before determining that a move is the best option.
If it is difficult to identify effective interventions, how can we be sure that it is really the severity of the resident`s underlying condition that leads to the physical assault, rather than the lack of knowledge of institutional staff about behavioural management? These questions illustrate the complex ethical dilemmas that can arise in protecting the human rights of all residents. Issues of neglect and abuse are important when it comes to nursing homes. Nursing home residents tend to be a more vulnerable population due to their age, illness and finances. At times, residents have been exploited, ignored and abused by nursing home staff. In addition, there is concern that neglect and abuse may be under-reported because residents fear that their care will be affected if they voice their complaints. Therefore, oversight of nursing homes is crucial. Alternatively, there have also been cases where residents have abused nursing home staff both physically and verbally. For example, depression, grief and confusion can lead a resident to abuse an employee. The national voice of consumers for high-quality long-term care. (undated) News in brief: A closer look at the revised regulation of the care facility: involuntary transfer and dismissal.
Retrieved 17.01.17 from theconsumervoice.org/uploads/files/issues/Revised_Nursing_Facility_Regulations_Involuntary_Transfer_and_Discharge.pdf. The quality of care in retirement homes raises several ethical questions. There may be conflicts between nursing home residents and staff about what constitutes adequate care. Sometimes nursing home staff may misperceive or misinterpret a resident`s wishes. This may be the case if the decision-making capacity of an elderly resident with a disability fluctuates, staff attempts to determine the resident`s wishes. Bereavement, confusion and/or taking certain medications, for example, can temporarily affect a resident`s decision-making ability. If staff do not pay sufficient attention to a resident`s condition, they may assume that the resident is incapable of making decisions even if they are actually able to do so. For example, a resident may have difficulty making a financial decision but retain the ability to make a decision about their health care.