Academic journal article Generations

Case Managers Meeting to Discuss Ethics

Academic journal article Generations

Case Managers Meeting to Discuss Ethics

Article excerpt

Several years ago a few case managers at the Milwaukee County Department on Aging became concerned-by the lack of any forum in which they could discuss stories oftheir day-today work in providing services to elders living in the community. Workers particularly wanted to share with each other the narratives ofthose cases that raised questions about the clients right to self-determination, and about safety, confidentiality, cost of service given limits of financial resources, termination of services, the clients use of drugs or alcohol, or mental health problems.

Several workers believed it was important to come together to critically examine the content and purpose of their work. Supervisory staff agreed that we could meet in order to pursue this goal. At the most rudimentary level, our "ethics discussion group" connoted a level of consciousness or conscientiousness in doing our work as well as a commitment to pursue further education in ethics as it relates to our work.

Within a short time the group expanded. It now includes additional case managers, a unit supervisor, the department nurse, and, by invitation, a case manager in private practice with experience in geriatric ethics. This person offers a unique perspective given that she works outside the department.

The composition of the group provides varied perspectives and is nonhierarchical. Individuals rotate the responsibilities for chairing the meeting, acting as secretary, and providing public relations for each monthly meeting, which occurs at an established date and time in our office at the Department on Aging. The meeting is open to any worker having an ethical concern about a case and willing to discuss it with the group.

An abbreviated outline for case presentation that includes a brief description of the elder's medical, psychological, and social levels of functioning is available to enable the worker to discuss the case. The format is unstructured. The worker is asked to write a short summary of the case prior to presentation and to state the cause of moral concern or distress that has brought the case up for discussion. Workers are encouraged to invite the elder, the elder's family members and significant others, other agency professionals, and any other service providers.

In telling the story of the case and presenting the ethical problem, workers support, affirm, and encourage one another in their efforts to serve the elder and assure that every possible service and case management strategy has been utilized to provide all the services needed by the elder. …

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