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

Explore the ethical frameworks and personal perspectives involved in discharge planning for people with dementia. Case study examines the challenges and solutions in facilitating a patient's wish to return home.

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

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  1. Home is where the heart is…the challenges of discharge planning with people who have dementia. Zoe Ellis Rachel Wilson

  2. Background • Physiotherapist and Occupational Therapist • Secure GEM ward • Multidisciplinary team

  3. Aim • Ethical frameworks • Case study • Personal perspectives • Positive solutions

  4. Case Study – ‘Noel’ • 68 yr old male • Fall - fractured hip • Past medical history • Life history

  5. Discharge planning • Early planning • Home • Residential care • Guardianship

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

  7. Case Manager • Identified risks • Residential care • Guardianship

  8. Daughter • ‘he would die in residential care’ • Discharge home • Community services • Independent spirit

  9. General Practitioner • Decision making • Guardianship • Residential care

  10. Noel’s Perspective • Home • No services • Independent life

  11. Team perspective NURSES DOCTOR OCCUPATIONAL THERAPIST PHYSIO SOCIAL WORK NEUROPSYCHOLOGIST

  12. Where to from here? • Will it be possible to respect Noel’s wish to return home? • Ethical concepts

  13. 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)

  14. Autonomy • ‘Individual choice or freedom to follow one’s own will’ (Beauchamp & Childress 1995)

  15. 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)

  16. 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)

  17. Competence • Complex issue • Application to Noel’s case • Guardian

  18. Assessment process • Hospital and community based assessments • Strengths and weaknesses • Risk versus safety

  19. Noel’s Journey • Discharge home • Support services

  20. Personal perspectives

  21. Positive solutions • ‘What does safety mean to this person in the context of their life?’ • Compromise • Patient autonomy • Team work

  22. Conclusion

  23. References • Beauchamp, T. & Childress, J. (1994). Principles of biomedical ethics (4th edition). New York:Oxford 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 Alzheimer’s 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

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