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Older adults: Adults 65+

Productive aging: “...continued participation of older adults in self-care, work, volunteering, informal caregiving, civic participation, and engagement in leisure and social activities as they grow older” (Scott, 2015, p. 134).

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Case Study 12.1: Balancing Ethical Obligations to Enable Aging in Place

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Case Study 12.1: Balancing Ethical Obligations to Enable Aging in Place

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Who

Marcie (61) is an occupational therapist in a community-based senior center.

Stephen (66) became disabled after he suffered a left-sided stroke.

Conflict

Stephen begins attending the center to be near his wife as well as participate in the center’s mealtimes and social activities.

Marcie becomes torn between meeting the duties of her position at the senior center and to her husband.

(Scott, 2015, p. 138)

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Discuss how your population is at risk for social injustice, occupational deprivation, and disparity in the receipt of services 

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Discuss how your population is at risk for social injustice, occupational deprivation, and disparity in the receipt of services 

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Ageism in workplace: more opportunities for the younger population; Older adults are seen as less valuable and unproductive

Social isolation: fewer opportunities for social engagement

Lack of inclusion within the community

Violation of human rights: autonomy is broken within making decisions on one’s life

Abuse: physical, emotional, & financial

Health status: Cognitive & physical impairments- older adults are often viewed as unhealthy or unaware

Financial insecurity: poverty rate within older adults is increasing, struggle with housing, healthcare, transportation, meal planning

Unsafe & inadequate living conditions: older adults are often placed in these types of conditions

Examples of health disparities include the following:

Lower quality of care

Misdiagnosis and overdiagnosis: causing improper treatment to diagnosis & can lead to serious side effects/consequences

Lack of access to affordable health insurance (inability to maintain their health)

Increase rate in disease & deaths

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How do contextual factors impact the delivery of OT services?

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How do contextual factors impact the delivery of OT services?

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Personal Context
Marcie's husband, Stephen, suffered from a left-sided stroke, so Marcie must assume the role of caretaker.
Marcie is now the sole breadwinner of the family and can't risk losing her job.

Social Context
Marcie works at a community-based senior center and is responsible for program evaluation and planning, group leadership, and client advocacy. Her employer and the senior center residents count on her to fulfill her duties.
Stephen now attends the senior center and expects Marcie to have lunch with him, go on center outings with him, and assist him in performing ADLs.

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Note. Reprinted from "Practical Applications for the Occupational Therapy Code of Ethics" by J. Scott and S. Reitz. 2015. AOTA Press. p. 139.  

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Which AOTA Ethical Principles relate to the scenario? How do these principles guide the decision-making process?

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Which AOTA Ethical Principles relate to the scenario? How do these principles guide the decision-making process?

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Nonmaleficence
Conflict of Commitment - the other residents will suffer if Marcie doesn't take the time to address her personal problems

Conflict of Interest - it's not appropriate for Marcie to treat Stephen due to the lack of a clear professional boundary; how would she bill for services provided to Stephen?

Fidelity
Marcie should collaborate with her co-workers and employer to solve the problem at hand.
By working as a team, the senior center staff can better serve their clients.

Final Course of Action
Marcie should collaborate with her supervisor and fellow employees to assign Stephen to a therapy group that doesn't involve Marcie. Marcie can work with her supervisor to rearrange her schedule to have lunch with Stephen too. This decision upholds the principles of Fidelity (by promoting teamwork) and Nonmaleficence (by preventing harm).

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Demonstrate an understanding of the ethical and practical considerations that affect the health and wellness needs of those in your assigned case study.

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Demonstrate an understanding of the ethical and practical considerations that affect the health and wellness needs of those in your assigned case study.

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Ethical Considerations

Marcie may be neglecting her duties as an occupational therapist if she is to devote so much time to Stephen’s personal care at the facility.

Should Stephen be included in the treatment groups led by Marcie? Is this a conflict of interest?

Practical Considerations

Marcie’s obligations at work.

Stephen’s extra care needs due to his disability.

Is Marcie becoming more of a center member than staff?

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Describe the systems and structures that create federal and state legislation, regulations, their implications, and if they affect the practice of occupational therapy with your given population

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Describe the systems and structures that create federal and state legislation, regulations, their implications, and if they affect the practice of occupational therapy with your given population

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1. Older Americans Act (1965)

Goal: Promote well-being of older adults by providing services & programs designed to help them live independently in their community and home

Family caregiver support, nutrition, health & wellness, transportation, protection from abuse, training for employment & volunteer opportunities, access to senior centers.

2.  Elder Justice Act (2010)

Goal: Address abuse, neglect, & exploitation

Forensic centers to identify abuse, reporting requirements in long-term care facilities, penalties upon retaliation against those who file a complaint

3. Medicare (1965)

Goal: Guarantees access to health insurance for all American 65 yrs. & older

Part A, B, & D

What does this program help cover? Hospital stays, hospice care, home health, outpatient care, doctors' visits, medical supplies, immunization, & prescription drugs.

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American Occupational Therapy Association. (2016b). Occupational therapy's distinct value: Productive aging. Retrieved from http://www.aota.org/-/media/Corporate/Files/Practice /Aging/Distinct-Value-Productive-Aging.pdf.

“Aging with Economic Insecurity: Resources for Older Americans.” MSW, University of Southern California.(2020). https://msw.usc.edu/mswusc-blog/the-aging-poor-how-social-workers-can-help.

Chen, C., Chlyoe, M., Harris, R.J., Hiroshi, H., Katsuhori, K., Tetsuji, Y., Toshiyuki, O.(2015). “Access Disparity and Health Inequality of the elderly: Unmet Needs and Delayed Healthcare.” National Library of Medicine. Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare - PMC (nih.gov) doi:10.3390/ijerph120201745

“Older Americans Act.” Administration for Community Living.(2021). https://acl.gov/about-acl/authorizing-statuses/older-americans-act

Scott, J. & Reitz, S. (2015). Practical Applications for the Occupational Therapy Code of Ethics. AOTA Press.

“What is the Justice Elder Act?” Siegal Law. (2020). https://www.neglectattorney.com/2020/03/25/what-is-the-elder-justice-act?

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Discuss ethics and the relationship to the occupational therapy profession.

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Discuss ethics and the relationship to the occupational therapy profession.

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Occupational therapists can uphold ethical standards in their treatment of older adults by practicing a client-centered approach, advocating for occupational justice, and upholding standards and principles of care.

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Occupational Therapy Role: Consider client factors and ability to maintain balance in occupations and facilitate productive participation of older adults.

Occupational therapy practice areas

Aging in place

Driving and community mobility

Primary care

Post-acute care and transitions to home

Palliative care (AOTA, 2016b, p.4).