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Diverse committee, communication are key
Set up process that doesn't intimidate staff
An ethics service or ethics committee will look different in each hospice and home health agency, because the program should be geared to meet the specific needs of the agency, says Sigrid Fry-Revere, PhD, JD, medical ethicist and president of the Center for Ethical Solutions in Lovettsville, VA.
"You do have to make sure the committee meets [The] Joint Commission or other accreditation requirements, but be sure it will also address home health specific needs," Fry-Revere says.
Make sure that your committee includes representation from all service delivery areas and includes diverse professional representation in order to bring the variety of perspectives necessary for rich ethical deliberation, suggests Leslie Kuhnel, MPA, clinical ethics officer for Alegent Health in Omaha, NE.
"I think a home health agency could start educating staff members about the role of an ethics service by offering regular lunchtime discussions with a local ethicist," she suggests. The conversation should be run by a seasoned home health employee along with the ethicist, and it should be a free- flowing conversation about issues that might arise.
"Talk about the social worker who wants to do a favor for a longtime patient by taking her to a hair appointment for her 80th birthday," says Fry-Revere. "This action creates a liability risk for the agency, because transporting a patient is outside the social worker's normal job parameters," she says. In the conversation with staff members, ask them how they draw the line between professional and personal tasks without offending the patient or family members, Fry-Revere suggests.
Less formality, more education
A successful home health ethics program is less formal, focuses on education, involves peer mentoring, and channels questions to people who are open to discussing the issues with staff members, says Fry-Revere. "Although information about the options for discussing ethical concerns should be covered in orientation, there is only so much you can do in an orientation program," she says. A better way to educate staff is to develop an ongoing, informal educational program that gives staff members a chance to attend even if they don't have an issue to discuss, she says. "This increases the likelihood that the staff member will contact a member of the ethics committee when he or she does have an issue," she adds.
Home health agencies are stretched thin when it comes to resources and time for education, but Fry-Revere likes to describe ethics programs as a risk management tool. "Educate staff on situations that might arise and how they might handle them before they become a problem," she says. "By addressing ethical concerns proactively, you help employees learn to cope with difficult situations."