Mr. Paul is a 67-year-old client with your home health care organization who suffers from moderate dementia. After providing the required personal health services to him, the attendant is asked by his substitute decision-maker (who just happens to be there that day) to walk Mr. Paul’s dog. It is a very cold and icy day and Mr. Paul does not feel comfortable going outside with his wheelchair. In the past, out of compassion and wanting to do a good deed, the attendant did walk Mr. Paul’s dog and engage in other activities that were outside of Mr. Paul’s care plan, and that put the attendant a little bit behind in their schedule. For example, the attendant cleaned the fridge and dishes and cooked a meal or two. Furthermore, Mr. Paul has heard about other clients receiving similar help with their pets and other special unusual requests. Today however the attendant feels uncomfortable to satisfy his request because they are concerned with slipping on the ice and frostbite. In addition, they are running late for their next client.

What are some of the ethical issues in this case?

What is the impact of the attendant’s past behavior on service delivery and expectations for this and all clients?

Should the attendant meet Mr. Paul’s / the SDM’s expectation to continue fulfilling special requests?

Is it the attendant’s responsibility to tell the client “no”?

Are there exceptions or exceptional circumstances to provide services outside the standard of care or scope of practice?

Mrs. Jones is an 83-year-old client that you have been attending to for 8 years now, and you have developed quite a friendly relationship with her. She lives alone and values your contribution to all aspects of her life. Around Christmas time, Mrs. Jones wants to show her appreciation for all that you do, and presents you with a $30 gift card to your favourite coffee shop.

What are some of the potential ethical issues in this case?

Should you accept the gift from Mrs. Jones? Why/why not?

What if she gave all of her attendants the same gift?

Does it matter if it was $5, or $100?

Is there the potential for a real or perceived conflict of interest?

Eva and Helen are 84- and 87-year-old unmarried sisters, recognized for their contributions to community social events after retiring from professional careers. They lived for 30 years in an inherited mansion preserving several generations of family heirlooms. Eva became increasingly incapacitated, following a stroke, unable to communicate and incontinent. Helen was the sole care-giver for eight months and her physical condition deteriorated. Family, friends, and medical providers became concerned as Eva’s care needs increased.

After six weeks of home care, aides reported hostility from Helen who was always in attendance during care, detailing “how to do it.” Additionally, Eva became increasingly hesitant to receive care, and cried when Helen was present. Helen also called the agency office frequently to complain about care, and to request services for her sister that were not included in the care plan. Despite their managers refusing to include some requested home-services, Helen convinces the PSWs that visit the home to provide them. Caregivers also soon observed bruises on Eva’s wrists.

What are some of the ethical issues in this case?

What is the impact of the PSW’s behavior on service delivery and expectations for this and all clients?

Should the PSW meet Helen’s expectation to continue fulfilling special requests?

Should the PSW pursue an investigation into the cause of bruises on Eva’s wrists?

Home care services were appropriately scheduled for Mr. Deere according to his assessed care needs and preferences for time/day. After several months of receiving services, Mr. Deere claimed that he wanted only certain staff to provide service. The reasons provided were simply that he preferred the company of certain staff over others. In an attempt to ensure client-centered care, Mr. Deere’s request was addressed such that all of his attendants were those that he agreed with. This caused significant adjustments to the service schedules of other staff.

What ethical issues might be present in this case?

Is the organization required to meet such client requests in the pursuit of client-centred care?

Does the client have the right to expect accommodation for preferences?

Is the organization able to meet such preferences for all of its other clients? If not, why is this client being treated differently? Is it fair?

As in any organization, there are often occasions when staff numbers are less than optimal due to sickness, vacation, etc. On those occasions, personal care for clients is the priority and homemaking/housekeeping tasks may be reduced/postponed. At your organization, you notice that it seems as though the homemaking tasks are most often cancelled are for those clients who staff know will not complain.

What are some of the ethical issues in this case?

While it seems that personal care services still get completed, do staff absences risk failing duties to colleagues or clients if they are not able to be filled?

How should you determine which tasks are not fulfilled, and for whom?

One of your clients recently returned home from hospital with increased care needs. She is unwilling to assist with self-management and expects staff to respond to the higher care needs as she requests. Currently there has been no reassessment for increased financial support to pay for additional hours of service.

What are some of the ethical issues in this case?

How can we balance the increasing needs of individual clients against zero financial increases?

Client care needs are decided following a formal assessment process and cannot/should not be adjusted without re-assessment. Can you appropriately meet this client’s needs, and ensure limited resources are used appropriately, without such an assessment?