Ethics in Community-Based Elder Care

Article excerpt

Ethics in Community-Based Elder Care Martha B. Holstein and Phyllis B. Mitzen New York: Springer Publishing Company, 2001 ISBN 0-8261-2297-3, 336 PP., HARDCOVER, $48.95

"Caring for older people outside of institutions is the largest growing sector of the U.S. health care industry"-and thus it is necessary to examine the myriad issues that arise when examining community-based care for seniors. As the population of seniors continues to rise in the U.S., so do the options for long-term care. Ethics in Community-Based Elder Care discusses trends that show an increase in the number of seniors who are opting to remain in their communities for as long as possible. With this move towards non-institutional long-term care for seniors come the numerable problems that they, along with their caregivers, will encounter.

The book is a compilation of articles written by more than 30 contributors, providing many different perspectives on topics related to community-based elder care. The contributors attempt to give direction based on their collective experiences, united by the common goal of establishing ethically based services that will help the elderly and their caregivers make educated, sound, ethical decisions while maintaining healthy morale. The editors proudly claim they took no liberties in removing any one author's personal views, so that the book provides a range of views on how value conflicts and ethical dilemmas are to be handled. Comprised of five sections, the book introduces the topic, provides background to the ethical problems being faced by the industry, covers specifics regarding the organizations including both the providers of care and their receivers, treats the practice of ethics, and lastly, explores the policy involved in practicing ethics in community-based elder care.

The first section, written by the editors, outlines the problems that need to be addressed and a variety of aspects of community-based health care needs for seniors. They maintain that many of the ethical issues being discussed throughout the book are a result of the efforts of workers to help their clients spend the last years of their lives in a manner that is both dignified and allows them to maintain a level of self-respect. To accomplish this, the editors establish a case-based narrative approach to exploring ethical patient care from a perspective of both the giver and receiver of care.

The second section provides a detailed and necessary history of issues that have emerged in the field of bioethics and long-term care of the elderly. The first author, Brian F. Hofland, briefly outlines various methods of helping seniors and their caregivers deal with the ethical situations that develop in community-based care, specifically in the home. The main problem identified is that of maintaining the client's sense of dignity and privacy; one solution offered is to train all those involved in care giving on proper ethical behavior. Martha B. Holstein establishes the value of home-based as opposed to institutionally based care. She argues that seniors who remain in the home environment are able to maintain their sense of self-respect and self-worth. This is often absent once they are removed from the privacy of their own homes and the comfort and memories attached to their possessions. Mark Waymack discusses what is identified as the four phases of care: Caring About (individuals), Caring For, Care Giving, and Care Receiving. Included in this section is a set of questions that will allow workers to make caring judgments related to providing ethically based care. Joan C. Tronto evaluates the old framework under which long-term care was provided, and surmises that the previously established ethics are no longer sufficient for the current dilemmas faced today.

The third section examines organizations, care providers, and care receivers. The first author, David B. McCurdy, discusses the challenge of creating an ethical organization. …