Long-term-care Facility Ethical Code

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ethical code

Long-term-care facilities offer healthcare, social, and residential services to chronically disabled persons, aged individuals, or terminally ill patients. Such institutions include nursing homes, rehabilitation, and long-term chronic care facilities. However, the dominant role in this sphere belongs to nursing homes that provide rehabilitation and other health-related services to their clients. These services are available to patients of all ages, although the majority of them belong to the elderly population. In the United States, nursing home facilities host approximately 1.5 million residents (Degenholtz, Resnick, Bulger, & Chia, 2014). For many aging adults, enrolling in a nursing home is almost inevitable, so these institutions act as their homes when they reach this stage of their lives. Medicaid and Medicare fund about 60% of all expenditures in these facilities (Mody, Bradley, & Huang, 2013). Such a level of funding shows the importance and regard, with which nursing homes are held. Therefore, their staff and management should be ethical in their daily operations since the application of ethics ensures that the environment in the facility is favorable for everyone involved. The establishment of a proper code of conduct in a long-term care facility is the first step towards a healthy and healthful environment since it leads to respect and dignity among the concerned parties.

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Background of the Facility

Due to the dominant role of nursing homes in the long-term-care sector, one should know how they operate. These facilities provide skilled nursing services that include 24-hour skilled medical care for acute and chronic conditions (Bollig, Rosland, & Heller, 2016). Moreover, complementary help in daily activities is also available for the aged population. patients in nursing homes are always under the surveillance of a registered nurse who is overseen by a doctor. The latter usually serves as the director. These facilities are either privately or publicly owned, and, as mentioned earlier, they receive Medicaid and Medicare funds (Bollig et al., 2016). Nursing homes also have the option of providing private and semi-private rooms. Therefore, it takes solid teamwork to run such a facility, which requires an equally solid structure in the organization.

Organizational Structure

The nursing home has a top-down organizational structure. The Director of Operations ensures that the goals of the institution are met. This professional is also directly responsible for and in charge of the administrative staff. Essentially, the director acts as the face of the nursing home. Specifically, they are responsible for dealing with negotiations that might lead to funding from investors and donations, when needed. Furthermore, the administrative staff constitutes the smallest department in the nursing home. However, this department has the widest range of tasks. Thus, its staff is responsible for dealing with all financial matters such as payroll, taxes, utilities, and accounts receivable (Siegel, Bakerjian, & Zysberg, 2017). The administrative staff also has other duties such as assisting in the ordering of office supplies, answering phone calls, and replying to emails. Finally, they also deal with human resource matters for other departments.

Another employee group in the facility is the support staff. These professionals are responsible for the basic upkeep of the facility as well as for meeting the basic needs of their residents (Siegel et al., 2017). The duties of the support staff include landscaping and taking care of the lawns, disposing of garbage, and maintaining cleanliness in the facility’s public areas as well as cleaning the resident and office areas. These employees also act as the kitchen managers since their role lies in cooking meals for residents and other staff members. The support staff reports to supervisors that act as kitchen and custodial managers. In turn, the latter report to the director of operations.

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The Chief Nursing Officer (CNO) is an important member of the facility faculty. This professional acts as the head of all employees who are directly related to the care-giving of patients. The Chief Nursing Officer works in the conjunction with the director of operations to ensure that all needs and wants in the facility are met (Siegel et al., 2017). The CNO also works with the nurses and nurse managers to make sure that the care-giving standards in the facility are upheld according to all requirements. The nursing managers are responsible for a smaller group of nurses. Typically, one nursing manager is assigned the responsibility over one floor of the building. They make sure that all nurses in the assigned floor of the building work cohesively to provide the best care for their residents. These professionals report to the Chief Nursing Officer.

Finally, the direct support staffs in the facility are responsible for providing direct care to all clients of this nursing home. Their care entails providing medical needs and comfort for all residents. This department consists of both registered and licensed practical nurses. Their duties involve making sure that the residents are clean, congenial and they take their medication as prescribed. These nurses are usually the first responders in case of an emergency as they monitor the residents of the facility round the clock. Finally, these professionals report to the nursing manager assigned the floor.

Ethical Dilemmas

Such institutions as nursing homes present sensitive issues that are similar in any other medical setting. One of the ethical issues that emerge in the facility is related to end-of-life care for residents (Bollig, Schmidt, Rosland, & Heller, 2015). Such an issue arises when some residents with untreatable conditions opt to end their own lives through various means such as sedation, physician-assisted suicide, and euthanasia. In these cases, the nurses at the nursing home encounter dilemmas that pertain to hydration and artificial nutrition (Fritch, Petronio, Helft, & Torke, 2013). This dilemma especially arises in the case of suicide through sedation. In this method, the patient is sedated and deprived of food and water, which is supposed to cause death. However, some nurses might feel the need to artificially hydrate and give food to the patient. In medicine, it would be ethically wrong for the nurse to violate the patient’s orders. Therefore, this requirement to respect the patient’s requests poses a dilemma to most nurses as they find it hard to watch a patient dying voluntarily.

Nursing homes often face more dilemmas that are related to interpersonal conflicts. One of them is the right way to resolve conflicts among residents or between residents and staff members. (Kusmaul, Bern-Klug, & Bonifas, 2017). Physical aggression is one of the forms of such aggression among residents. Although most their interactions are amicable, there still might be some hostile interactions. Some examples of this hostile behavior may include kicking, pinching, or unwarranted intimate touching (Kusmaul et al., 2017). These aggressive behaviors are mostly found in old residents who suffer from dementia (Lundberg, 2018). Such a hostile behavior might arise from certain frustrations. For instance, patients with dementia lack autonomy, and in the instances of research, people do not generally seek consent from them. Therefore, the consent process for such residents should be facilitated and improved (Beattie et al., 2018). These actions are consistent with peer bullying in long-term care. This aggressive behavior has a negative impact on the recipient. Physical aggression can result in injuries, anxiety, post-traumatic stress disorder, and depression in victims (Kusmaul et al., 2017). At the same time, aggressive behavior might also have negative outcomes for perpetrators. For instance, the perpetrator might not be allowed to stay at the facility, which might impact them negatively. Moreover, aggressive individuals might receive high dosages of psychotropic medications, which often leads to such negative effects as over-sedation (Kusmaul et al., 2017). Therefore, trying to maintain a fair balance for aggressors and victims often presents an ethical dilemma for nursing homes.

Ethical Standards for the Management and Staff

In order to deal with the numerous ethical challenges that arise in nursing homes, an ethical code of conduct needs to be developed. Thus, in the dilemma pertaining to end-of-life care, the staff should adhere to the resident’s wishes. The views and opinions of one’s relatives should also be considered. The staff should engage in timely and effective discussions regarding the planning of end-of-life activities. The management should ensure the continuation of ethical communications between the concerned parties (Bollig et al., 2016). The code of ethics for the nursing home should detail the fundamental principles and values of the facility. Although not an employment agreement, the code will act as a standard guide to the behavior and actions of the staff. Failure of the employees and management to comply with its principles will lead to disciplinary action or termination of contract. The code may be revised on occasion, but all revisions must be done to contribute to an ethical environment.


The ethical code prohibits retaliation. The facility will not tolerate any person who retaliates as the result of a report on violation of the law or the code of ethics. As such, all employees have the injunction to report any unethical behavior. The code also emphasizes the need for making the right choice. In some occasions, employees might be forced to violate the code. In such situations, the staff is advised to make the right choice, even though it might be difficult one. They should also remember that their fellow staff members encounter the same dilemmas.

Employees also have certain responsibilities that prompt them to act in a professional and ethical manner. They should also complete all required ethics and compliance training as well as apply their knowledge in their daily professional tasks. All employees who hold a job that requires certification should always maintain their certifications or licenses relevant and updated. In the case of an investigation into a case of ethical violations, staff members are required to respond truthfully. The employees should also report any ethical violations and misbehaviors to their relevant supervisor. As such, the employees should make sure they are familiar with the current ethical standards (Trilogy Health Services, n.d.). If an employee is accused of criminal and ethical misconduct, they should notify their immediate supervisor.

All staff members should protect the privacy of the nursing home’s residents to the best of their abilities. Therefore, staff members are expected to be careful when discussing a resident’s records. They should ensure that they are not overheard when discussing sensitive matters concerning their clients. Staff members should not use confidential information or the image of a resident for personal use. They should not allow such data to be used for the purposes of experimental research without the permission of the resident (Trilogy Health Services, n.d.). Any experimental research should be authorized by the Director of Operations. Moreover, the employees should only share residents’ records for the sole purposes of medical and business operations. Finally, they should not take any original documentation of clients from the facility without the consent of the Director of Operations.

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Governance and Management

The facility expects certain responsibilities and levels of accountability from supervisors and managers. Thus, they are expected to lead by example by setting high standards of ethical conduct. The management is also expected to explain to their employees how they can apply the code of ethics in their daily tasks. In possible delegation of responsibilities by supervisors, tasks should be given to law abiding and ethical employees. The supervisors should not pressure any staff member into doing something that they would not do themselves. Managers and supervisors are supposed to make sure that the facility has enough resources, including the workforce.

The code dictates that the staff members should not accept any gifts, loans, or tips from residents or their family members. If an employee wishes to purchase property from a resident, the former should consult and receive consent from the Director of Operations (Trilogy Health Services, n.d.). Employees are prohibited from acting as witnesses in the signing of legal documents that pertain to the wishes of patients. Such documents include those related to the termination of treatment for the patient. This provision should negate some of the ethical dilemmas that revolve around end-of-life care. However, employees may witness the signing of admission paperwork, routine consent that may involve the opening of mail and disbursements from a resident’s account.

Implementing the Ethical Code of Conduct

Constructing a code of ethics for any institution is only a part of upholding ethical behavior among employees. Implementing this code is as equally important. The ethics consultation organization should be clearly defined before the code of ethics is implemented in the facility (Bollig et al., 2016). The implementation process should give guidelines regarding the responsible sides in an ethics consultation and making decisions about which issue should be discussed in a consultation. Before the implementation of the ethical conduct, it is advisable to know the views of the staff as well as the nursing home’s residents and their relatives.

The inclusion of all parties involved should be at the center of implementing the code of ethics. An important factor in this process is the support of the management (Bollig et al., 2016). Thus, the facility’s management should be involved in the process from the early stages. The overall inclusion of employees and management is a favorable way to steer the implementation process. Moreover, the residents of the nursing home and their relatives should also be allowed to participate in the discussions pertaining to the proposed code of ethics. Most facilities tend to exclude patients in ethics meetings, but they should be included since the established ethical conduct tends to affect them the most. A successful implementation process should lead to decreased conflict between all the involved parties. Good and ethical decisions should be made during open discussions. The facility should perform an effective training and education on the code of ethics. Therefore, constant and open communication should act as a tool for ensuring compliance to the code of ethics. Finally, the fact that the staff members and management are involved in the implementation process should ensure that all parties are compliant to the same set of ethics they have assisted in formulating.


Lack of compliance to the code of ethics should bring various consequences to staff members. Employees who have been found violating this code by defrauding or deceiving the residents should be liable for disciplinary action that will be determined by the management. One of the possible consequences is the termination of employment contract in extreme cases. In criminal cases, the management has the right and power to prosecute offenders. Moreover, any staff member, who retaliates against a resident or a fellow staff member due to their implication in an ethics violation case, should be punished as well. Such tough repercussions should not instill fear in employees, but they should encourage them to make an effort in behaving in an ethically correct manner.


Ethical issues are bound to emerge in long-term care facilities, which is mostly the case in medical institutions. In such cases, staff members and the management face dilemmas that lie between doing the seemingly right thing and following certain regulations. Lack of behavior in an ethical way leads to the creation of unfriendly and hostile environments in long-term care facilities. Therefore, each organization should develop a code of ethical conduct for its staff members and supervisors. This code of conduct should act as a representation of the institution’s beliefs and standards. The implementation process should be include all involved parties such as the staff, the management, and the facility’s residents and their family members. As a result of implementing the code of ethics, an amicable environment will be created, which is most important for the residents of the nursing home. However, there should be grave consequences for members who do not comply with the set code of conduct. These consequences should be serious in order to act as an incentive for staff members to behave properly. Nursing homes provide unprecedented care for residents since this type of care can be barely achieved at home. Furthermore, most residents spend a significant time in these facilities. Therefore, their stay in should be as comfortable as possible. All mentioned measures should provide a pleasant experience for all residents in nursing homes as well as employees who provide care.

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