Ethics Resolution Assignment

Name of scenario: 3- Prioritization

Framework for ethical decision-making: Answer the following questions in your group. In each of the
scenarios, you are the manager and will need to think about how the approach you take will affect all
parties.

Scenario: You are the therapy services manager at a busy sub-acute rehabilitation facility. There has
been a recent shift in company philosophy, at a national level, as a response to significant changes in
reimbursement. Each OT on your staff is carrying a full caseload and needs to prioritize ADL treatment
sessions because each client can only be seen once a day. The company has stated that all patients will
receive OT services for ADL’s in the morning regardless of diagnosis, capability, discharge environment,
family support, etc. Your OT staff has also reported that in the past they have frequently found patients
in bed soiled and in need of bathing or other hygiene services.

List all of the involved parties: Make sure you consider the whole scope of the problem and list everyone
who may be affected by any decision you make.

- OT team, clients, the company, family, treatment team members (doctor, nursing staff, PT,
speech, case manager, social work, etc.) , the government/reimbursement agencies that have
implemented these changes

Consider the OT ethical standards: Review the ethical standards and create a bullet list the principles
that apply to the main parties (you do not need to write an explanation of your choices).

- Beneficence
- Fidelity
- Autonomy

Frame the problem: As the manager, you will need to explain the problem to the main involved parties
from the standpoint of their own involvement. Select the main 2-3 people involved and write a
paragraph framing the problem to each of them. Consider each of their unique perspectives and explain
the problem in factual and non-blaming terms.

Client - Will have to work on ADLs even if they’re fully independent in ADLs or if their diagnosis isn’t
necessarily relevant to working on ADLs. Also, if the client is soiled/in need of other hygiene needs at the
time of the OT treatment session it may be difficult to focus on ADLs. Would the OT be responsible for
these things or would nursing need to be called in to help before the treatment session started? The
client would be getting billed for skilled OT services - but they wouldn’t necessarily be receiving skilled
OT services if the OT doesn’t have time to actually work on ADLs due to addressing hygiene issues, or if
the client is already independent in ADLs. ADLs in the morning may not be the best fit for all clients, as
different clients may have different schedules and have varying routine needs.

OT - With a full caseload, it would not be possible to do ADLs for all clients in the morning -- there is just
not realistically enough time. Also, as OTs, we are looking at clients holistically. This includes considering
their goals, diagnosis, family support, d/c environment, capabilities, barriers, etc. By ignoring this and
just working on ADLs across the board, we would likely not be providing skilled OT services that are
efficient or client-centered. Additionally, because of the frail nature of the clients, the focus of therapy
would likely be less on completing ADLs and more on tolerance, which is an important step in the
therapeutic process.

Company- If clients are not receiving services for the areas of deficit that are truly needed (ex. activity
tolerance) this could increase their LOS, cost, and risk of rehospitalization. In time, the company may
have decreased funding or penalties due to higher percentages of rehospitalization. In addition, if the
OTs are unable to prioritize the needs of the client and provide client centered care, they are at risk for
burnout and decreased job satisfaction, which may lead them to relocate.

What do you know, what do you need to know, and what resources can you use to supplement your
understanding: It is important to make as informed a decision as possible. Make a bullet list of the facts
you know, then make a two-column table with a line item list of the information you need and a source
you could go reference to get the information.

Facts:

● Need to provide client centered treatment.

● Clients are in the sub-acute setting and may be too weak to begin working on ADLs,
regardless of diagnosis.
● Company is demanding each client work on ADL’s for treatment as a prioritization. ADLs
must be done in the morning.
● Clients are likely being neglected and soiling themselves.
● Changes were implemented as company policy due to national reimbursement
standards.
● Each OT is already carrying a full caseload.
● Clients will be limited to one treatment per day.

Information Needed Source

1. What ethical standards OTs are expected
to comply with as professionals.
2. What expectations are OTs required to be
compliant with in terms of state
licensure/national certification.
3. How are the company’s
mission/vision/values relevant to this
scenario?
4. Does the company have the resources to
hire more employees?
5. Is management interpreting the national
reimbursement policy correctly?
6. Is there open communication in place
with the nursing staff to resolve problems
effectively?
1. AOTA Code of Ethics: Principles and
Standards of Conduct, Core Values,
Ethical Guidelines for professional
behaviors
2. Utah DOPL website/NBCOT website
3. Company website
4. Company reimbursement office (if that’s
a thing).
5. Consider talking to your immediate
supervisor or go up the line as needed, or
refer to policy documents
6. Guidelines to the Occupational Therapy
Code of Ethics, Company policy/standards
and procedure.
Make a decision: What course of action will you choose and why. Give details about how each of the
interested parties will be affected by your decision. This will not be a short answer. As the manager, you
will have to help all parties get “on board” with your decision to the extent that you can. This is the crux
of being a good manager. The ability to communicate difficult decisions to all parties and help them
understand the whole picture (at the appropriate level). Write up the course of action you will take and
then write a paragraph to each of the main interested parties, explaining your decision as it relates to
them.

Action: Team meeting -- This will provide an opportunity for all members of the interdisciplinary
healthcare team to come together and communicate any concerns about the new policy and make sure
everyone is on the same page. As a good therapy services manager, you will come into a meeting with
an idea of how this policy change can be addressed. Address to everyone that this meeting is open for
feedback and that everyone’s perspectives will be heard. To get the team on board, make sure everyone
is on the same page that we should be client-centered and focused on the client’s needs. There should
be a discussion of problems and impacts of this policy change. Then discuss how a different action can
provide benefits to not only the client, but to each party. Explain that from an OT perspective, clients
may already be independent in ADLs, or they may not be ready to participate in ADLs. Consider the fact
that it may not be realistic for OT to address ADLs for all clients in the morning due to not having enough
time, routine differences between clients, etc. Have a discussion on the importance of documentation in
terms of why or why not OT is addressing ADLs within the context of the policy.

Client: Clearly communicate with the client that OT will communicate with nursing staff to ensure that
hygiene needs are met prior to OT sessions. Make sure the client is aware of the policy that OT will be
focusing on ADLs in the morning unless the client is either unable to participate in ADLs yet or if they’re
already independent in ADLs. Explain to the client that if they’re not ready to work on ADLs yet, we will
be working toward being able to participate in ADLs. If the client is already independent in ADLs it will be
documented that they are, and provide opportunity to work on other client-centered interventions.
Communicate that we will still continue putting their therapeutic wants and needs at the forefront of
therapy, but will evaluate their needs for ADLs and then make a decision about whether or not only
addressing ADLs is appropriate.

OT: The OT will take on some responsibility to communicate their schedule with the nursing staff to help
ensure clients are properly cared for. They will administer ADL related assessments to document current
level of function to determine what steps need to be taken to get the client ready to work on ADLs or
what other areas may be of more concern. OT’s can advocate to follow established policies by AOTA.
OT’s can also help management understand they do more than just treat ADL’s. Broadening the scope
from ADL’s and taking a holistic approach will be better for the client and help with lessening the risk of
readmittance.

Company (Upper Management): Communicate that if clients are not receiving appropriate services,
such as if ADLs are not yet appropriate to work on with them, the clients would likely not optimally
benefit from OT services. As a result, they face greater risk of rehospitalization, which can impact the
company’s funding and reimbursement. This may also impact the image of the company and lead to
greater public distrust. Therefore, by discussing changes to the response to this national reimbursement
change, financial efficiency can be emphasized, as well as framing the concept of remaining a highly-
regarded organization within the community that people can trust their loved ones to go to.

Scenario 3 - Prioritization

You are the therapy services manager at a busy sub-acute rehabilitation facility. There has been a
recent shift in company philosophy, at a national level, as a response to significant changes in
reimbursement. Each OT on your staff is carrying a full caseload and needs to prioritize ADL treatment
sessions because each client can only be seen once a day. The company has stated that all patients will
receive OT services for ADL’s in the morning regardless of diagnosis, capability, discharge environment,
family support, etc. Your OT staff has also reported that in the past they have frequently found patients
in bed soiled and in need of bathing or other hygiene services.