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					Long-Term Care
Vol. 15, No. 3

Abstracts

"Hospice in the Nursing Home — A Valuable Collaboration."
by Ann Allegre, Barbara Frank, and Elaine McIntosh

Long-term care facilities have one of the most difficult tasks in health care: to maximize the health
of frail elderly people. However, our society's resistance to the natural process of dying
commands the assistance of hospice services in helping patients and their families cope with
illness and death. The presence of such hospice services in long-term care facilities is relatively
recent, and the two teams are still negotiating an optimal collaboration.

Allegre, Ann, Barbara Frank and Elaine McIntosh. 1999. "Hospice in the Nursing Home — A
Valuable Collaboration." Bioethics Forum 15(3): 7-12.

"Educational Initiatives in Long-Term Care — Midwest Bioethics Center's Kansas Nursing
Home Project."
by Jeremy Kenner

Most Americans would doubtless agree that positive change is a critical need in facilities
providing long-term care. This article describes a project currently underway in which Midwest
Bioethics Center (MBC) staff and Kansas City area experts in long-term care are doing their part
to create meaningful change in the way residents of nursing homes are cared for in the last
chapter of their lives.

Kenner, Jeremy. 1999. "Educational Initiatives in Long-Term Care — Midwest Bioethics Center's
Kansas Nursing Home Project." Bioethics Forum 15(3): 13-17.

"End-of-Life Care in the Nursing Home — Is a Good Death Compatible with Regulatory
Compliance?"
by Larry W. Lawhorne

By using relevant clinical practice guidelines for end-of-life care and by incorporating meaningful
quality indicators into an effective continuous quality improvement program, nursing facilities can
provide quality end-of-life care for their residents while complying with state and federal
regulations.

Lawhorne, Larry W. 1999. "End-of-Life Care in the Nursing Home — Is a Good Death Compatible
with Regulatory Compliance?" Bioethics Forum 15(3): 23-28.
"The Real Caregivers in the Nursing Home - Certified Nursing Assistants."
by David Oliver

Certified nursing assistants are integral to maintaining the quality of nursing homes because they
have the most extensive contact with residents. Low wages, stressful work, demanding residents,
and little recognition often lead to high turnover rates. With these premises, this article asserts
that to ensure high quality care in nursing homes, we must develop job satisfaction among CNAs.

Oliver, David B. 1999. "The Real Caregivers in the Nursing Home - Certified Nursing Assistants."
Bioethics Forum 15(3): 18-22.

"Long-Term Care — Institution, Residence, Hospital, or Home?"
by Rachel Reeder

Finding quality long-term nursing care is a growing concern for millions of Americans and their
families, especially as the baby-boom generation reaches retirement age. The issue is not
money, but the way long-term care is delivered to those who need it. The following story depicts
one family’s education in the field of long-term care; and is a call to action for everybody facing
these tough decisions.

Reeder, Rachel. 1999. "Long-Term Care — Institution, Residence, Hospital, or Home?" Bioethics
Forum 15(3): 35-40.

"Medicare Prospective Payment — The Ethical Implications of Converging Clinical and
Financial Decisions in Long-Term Care."
by Don F. Reynolds

The principles of bioethics indicate that Prospective Payment has a moral dimension. Because
Prospective Payment unifies clinical and financial decisions, it poses problems for long-term care
facilities, especially those motivated by a humanitarian mission rather than financial
considerations. This article outlines how Prospective Payment conflicts with the ethical principles
of respect for persons, autonomy, justice, promise keeping, and fidelity.

Reynolds, Don F. 1999. "Medicare Prospective Payment — The Ethical Implications of
Converging Clinical and Financial Decisions in Long-Term Care." Bioethics Forum 15(3): 29-34.

"Hospice in the Nursing Home"
by Fred and Carol Isaacs

In the past century, American culture has changed the face of the dying process. One hundred
years ago, nearly everyone died at home. Now, 80 percent of us will die in an institution. To
ensure optimal quality of life at the end of life, we must further develop hospice care in nursing
homes.

Isaacs, Fred and Carol Isaacs. 1999. "Hospice in the Nursing Home." Bioethics Forum Web
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