Care Managers' Perceptions of Ethical Principles in Decision Making: Placing the Home and Community-based Individual with Dementia in a Nursing Facility

Document Type


Publication Date



The purpose of this study was to explore the perceptions of care managers faced with ethical dilemmas and conflicts that arise when contemplating nursing home placement of the client afflicted with dementia. It investigated care managers’ perceptions of their professional performance, levels of preparation regarding ethical principles in decision making, and their knowledge base dealing with the individual who has dementia. The research was comprised of qualitative data from initial interviews and follow-up interviews with care managers working in a home and community-based program for older adults. Data were coded to identify specific behaviors characteristics, and issues within each interview question, reflecting Kitchener’s (1984) moral principles framework of autonomy, nonmaleficence, beneficence, justice, and fidelity. The findings in the study are consistent with care managers’ perceptions of Kitchener’s five moral principles as they relate to respecting the client’s wishes, “doing no harm” by seeking a safe secure dementia unit, selecting a facility that promotes resident’s health and welfare, advocating for individual with dementia, and striving to maintain a trusting care manager/client relationship despite issues associated with dementia. Care managers also reported that although they had studied ethics in their respective disciplines, most did not have academic courses specific to dementia care. This study did, however, indicate that the home and community-based organization in which the care managers are employed conducts continuing educational workshops and in-services dealing with ethical issues, dementia care, and current trends in healthcare for the older adult. To identify best educational practices, further qualitative research should be conducted examining the curricula of college and universities social service and healthcare professions programs that address dealing with all aspects of the population afflicted with dementia. Similarly, the professional development activities provided by healthcare facilities should be examined. (Provided by author)

This document is currently not available here.