1. JANUARY 21, 2014 Ethics and the LTCO Program NSLTCO Orientation Please call 1-866-740-1260 and use access code 3322275 to join the audio portion of today’s webinar

2. Overview of Webinar Ethics for LTCO, Sara Hunt Ethics and Program Management, Bev Laubert, OH SLTCO Discussion: Ethical Dilemmas Question and Answer Closing  Review of available resources

3. Sara Hunt NORC Consultant

4. What is ethics? A set of moral principles  a theory or system of moral values  the principles of conduct governing an individual or a group  a guiding philosophy Merriam-Webster online dictionary

5. Code of Ethics for LTCO LTCO work is filled with ambiguity  Client/resident characteristics  Right or Wrong courses of action unclear  Need to maintain credibility and work with integrity Code of Ethics guides actions

6. Doing Ethics Ethics is about the process as well as what you do. It is about how you get there. Good ethics begins with good facts. There is always a range of morally acceptable actions. Glover, 2001 presentation to LTCO

7. Principles for Decision-Making Informed consent and autonomy Substituted judgment Best interest

8. Substituted Judgment Factual information about the person Information about the person’s preferences based upon your knowledge Information about the person’s values based upon your knowledge What you think the person would choose

9. Tips for LTCO Practice Conflicts usually arise over the application of values, instead of over the values themselves. Values emerge from relationships. Values may evolve and change depending upon who’s involved in the conversation.

10. LTCO Action Identify individuals to be involved in the conversation with the resident when conflicts arise. Be able to tolerate ambiguity. The key is the process used to sort out the options and arrive at a choice. Gibson, 1991 presentation to LTCO

11. Teaching Ethics Code of Ethics Applying ethical concept Identify situations for self-check  What internal conflict am I feeling? Why?  Whose interests am I representing?  What if resident cannot express wishes? Provide guidance and support Periodic training and dialogue

12. Bev Laubert Ohio SLTCO

13. Scenario #1 A local LTCO contacts your office for a consultation regarding a resident named Mr. Jones. Mr. Jones lives in Baywater Nursing Home and has occasional memory loss, but does not have dementia or significant cognitive impairment. Mr. Jones is married and his wife still lives in the community in their family home; however, Mr. Jones has been involved in a romantic relationship with another woman who lives in Baywater for the last few weeks. The LLTCO tells you that the facility staff contacted her regarding this situation as they want to restrict his visits with the other resident to public areas of the nursing home and inform his wife of this new relationship. The LLTCO is unsure of how to proceed and shares her personal discomfort with this situation as she does not agree with this relationship.

14. Scenario #1- Questions What are the ethical considerations in this situation? What needs to be considered regarding Mr. Jones’ rights, the responsibilities of the facility and the role of the LLTCO? How would you advise the LLTCO to proceed in this situation? How could you use this situation as a training opportunity for your program?

15. Scenario #2 During an annual monitoring visit of a local LTCOP housed in an Aging & Disability Resource Center (ADRC) you find that several of the Staff Ombudsmen are responsible for work outside of the LTCOP. Two of the Staff Ombudsmen spend 25% of their time as Options Counselors, another Staff Ombudsman spends 50% of her time providing short- term case management and one Staff Ombudsman spends 50% of his time as a Benefits Counselor.

16. Scenario #2- Questions What are the ethical considerations in this situation? What needs to be considered regarding the role of the LTCOP and the other responsibilities the Staff Ombudsmen were given? How would you proceed? What should you consider in contracts between your office and the host agencies for LLTCO?

17. Scenario #3 After analyzing your program’s data and learning from the experiences of your program representatives, you develop a systems advocacy plan that includes participating in a statewide elder abuse coalition. You expect participation will create more awareness of abuse in long-term care facilities, coordinate efforts with other statewide entities and inform the participants of the role of the LTCOP. The coalition has several goals, including, increasing public awareness regarding elder abuse, improving interagency coordination and case review. As a coalition member, you want to share cases for review in order to identify individual and systems issues related to the prevention, detection, reporting and investigating of allegations of abuse.

18. Scenario #3- Questions What are the ethical considerations in this situation? How much information do you share if you do not have resident consent to reveal their identity? How do you explain your role and the responsibilities of the LTCOP to the rest of the coalition? In order to take advantage of this opportunity to collaborate with other entities, how can you share information and participate in the coalition while ensuring you protect the resident rights and promote the interests of residents?

19. Resources and Training Resources to Review  Program Management- Ethics http://www.ltcombudsman.org/ombudsman-support/program-management#Ethics  Advocacy in Ethical Issues: A Multi-Disciplinary Approach- A Guide for Ombudsmen  Conflict of Interest and the Long-Term Care Ombudsman Program  Ethical Issues in Ombudsman Advocacy  In-Service Training Guide for Ombudsmen: Ethical Issues in Case Advocacy  Quick Reference Guide for Ombudsmen: Ethical Guide for Long-Term Care Ombudsmen  NASOP and NALLTCO Code of Ethics  Self-Evaluation and Continuous Quality Improvement Tool In-Person Orientation  Wednesday, April 9, 8:00-10:00 (San Diego)

20. The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) http://www.theconsumervoice.org/ This presentation was supported, in part, by a grant from the Administration on Aging, Administration for Community Living, U.S. Department of Health and Human Services.