to remain true
to the agency's mission.
Can a nonprofit, community-service organization become more focused on the "bottom line" and still remain true to its ethical values? In I997, staff of the Council for Jewish Elderly in Chicago met to express concerns about the lack of an approach to integrate the agency's values into all organizational practices. Prompted by significant change over the past several years in the way CE operates, the staff had two main ethicsrelated concerns: first, that CJE not lose sight of our mission as we change and, second, that as we establish new services and business practices, they embody the values of the organization.
The Council for Jewish Elderly in Chicago provides services to Iz,ooo older people and their families yearly in the northern metropolitan Chicago area. We serve many needs (related to transportation, independent housing, assisted living, home health, adult daycare, in-home services, mental health services, and nursing home care) with a substantial budget from a number of funding sources (private fees, Medicare, Medicaid and Title III, foundation grants, private donors, the Jewish Federation, and others). We are accountable not only to the consumer of our services, the older person, but also to our funding sources, to our board of directors, and especially since we are a sectarian organization, to our community.
In recent years, we have undergone major organizational change as we respond to the marketplace. We have relied on the quality expert Edwards Demming's concepts of continuous quality improvement, process thinking, strategic planning, and market-driven programs as we shift from a social welfare model to a more market-driven model. A philosophy that focuses on the "bottom line" has been introduced, to coexist with our long-standing commitment to provide quality services, as we anticipate a growing need for services to the aging and in order to position ourselves to provide more services to more people.
CJE has had an ethics program since i984. Two ethics committees were established, one dealing with nursing home issues and one dealing with community issues. Within a couple of years, the committees developed ethics guidelines for community-based practice and for the long-termcare facility. These guidelines are now used to orient new clinical staff and as a guide for practice and for the work of the ethics committees.
The CJE ethics program has been providing a number of services, including ethics training for our practitioners and occasional seminars on selected topics for clients, families, and other staff. In the community, where the clinicians seldom have "ethics emergencies, we created monthly ethics brown bag lunches to discuss cases. Over lunch, an ethicist joins our homecare staff to discuss topics that could range from a moral conflict about their role in a case to questions about distribution of resources when atrisk clients refuse services to, most common, questions about a client's self-determination when the person's judgment is perceived to be impaired. These clinically focused mechanisms have served the needs of the agency and the professional to work out the often complex issues that arise in day-to-day service delivery to older people.
The recent changes in the CJE operations have been of real concern to the clinical practitioners. And, because of their sensitivity to ethical issues, they have framed some of their concerns in ethical terms, expressing worries about creation of a "two-tiered system" and "not throwing the baby out with the bath water" At a particularly heated ethics brown bag last year, one social worker raised her concern about an ad CTE was running in local papers for our new assisted living program. The ad cleverly made reference to forgetfulness in a way that could be taken in more than one way. The clinicians harshly challenged CJE's commitment to organizational values, stating that their colleagues outside of CJE expressed surprise at what could be interpreted as CJE's insensitivity and use of stereotypes. …