Home is where the heart is the challenges of discharge planning with people who have dementia'

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Home is where the heart isthe challenges of
discharge planning with people who have dementia.

• Zoe Ellis
• Rachel Wilson

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Background

• Physiotherapist and Occupational Therapist
• Secure GEM ward
• Multidisciplinary team

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Aim

• Ethical frameworks
• Case study
• Personal perspectives
• Positive solutions

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Case Study Noel

• 68 yr old male
• Fall - fractured hip
• Past medical history
• Life history

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Discharge planning

• Early planning
• Home
• Residential care
• Guardianship

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Discharge Planning
HOSPITAL TEAM
GP
DOCTOR.
NURSES
NOEL
OCCUPATIONAL THERAPIST
DAUGHTER
PHYSIO
SOCIAL WORK
CASE MANAGER
NEUROPSYCHOLOGIST
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Case Manager

• Identified risks
• Residential care
• Guardianship

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Daughter

• he would die in residential care
• Discharge home
• Community services
• Independent spirit

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General Practitioner

• Decision making
• Guardianship
• Residential care

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Noels Perspective

• Home
• No services
• Independent life

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Team perspective
DOCTOR
NURSES
OCCUPATIONAL THERAPIST
PHYSIO
SOCIAL WORK
NEUROPSYCHOLOGIST
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Where to from here?

• Will it be possible to respect Noels wish to
  return home?
• Ethical concepts

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Ethical dilemma

• (when) acting on one moral conviction means
  behaving contrary to another or when adhering to
  one value means abandoning another.
• (Bluemenfield Lowel 1987)

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Autonomy

• Individual choice or freedom to follow ones own
  will
• (Beauchamp Childress 1995)

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Beneficence

• Health care professionals do good in their
  decisions regarding actions towards patients
• (Beauchamp Childress, 1994)
• entails not only preventing harm but also
  actively promoting the health and welfare of the
  patient
• (Cummings Cockerham, 1997)

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Paternalism

• health care professionals assert their own
  risk-benefit analysis over that of the patient
  and families in the belief that they are
  protecting the best interests of the patient
• (Cummings Cockerham, 1997)

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Competence

• Complex issue
• Application to Noels case
• Guardian

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Assessment process

• Hospital and community based assessments
• Strengths and weaknesses
• Risk versus safety

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Noels Journey

• Discharge home
• Support services

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Personal perspectives
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Positive solutions

• What does safety mean to this person in the
  context of their life?
• Compromise
• Patient autonomy
• Team work

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Conclusion
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References

• Beauchamp, T. Childress, J. (1994). Principles
  of biomedical ethics (4th edition). New
  YorkOxford University Press.
• Bluemenfield, S. Lowel,J.I. (1987). A template
  for analysing ethical dilemmas in discharge
  planning. Health and Social Work, 12,47-56.
• Cummings, S. Cockerham, C. (1997). Ethical
  Dilemmas in discharge planning for patients with
  Alzheimers disease. Health Social work,
  22(2),101-108
• OT Australia (2001), Australian Association of
  Occupational Therapists, Code of Ethics.
• Reamer, F.G (1983). The concept of paternalism in
  social work. Social Service Review, 6,254-271