Ethical aspects of assisted physical care at the end of life in care homes

Populations throughout the world are ageing. In a society where an increasing number of people live for so long that they become both frail and have multiple illnesses, the need to move into a care home at the end of life also increases. However, due to efforts to encourage people to remain in their own homes with the support of home care services, the number of places in care homes has decreased. In fact, since the turn of the millennium, the decrease has been by as much as 25%. This means that it is usually the most frail, with extensive needs for assisted physical care during all hours of the day, who are granted a place in a care home. Consequently, many older people have already entered the palliative phase of life when they move into these homes. Data from the Swedish Register of Palliative Care also show that survival is short, with almost half of those who move to care homes dying within a year. This makes assisted physical care an important area to study.

The project includes two sub-studies which make new analyses of observation material that was collected in connection with a doctoral project Kroppslig omvårdnad för äldre personer på vård- och omsorgsboende (Physical care of older people in care homes). The observation material concerns situations where assistant nurses and older people interact in connection with the performance of assisted physical care, for example, during mealtimes, dressing and undressing, transfers and personal hygiene.

In the analyses that are included in the current project, ethical aspects will be examined in more detail and described. The first sub-study aims to elucidate different types of ethical problems in the interaction between assistant nurses and older people in connection with the implementation of assisted physical care at the end of life in care homes. The analysis is deductive and is based on a template that describes different types of ethical problems.

The second study aims to deductively analyse the implementation of assisted physical care at the end of life in a care home based on a theoretical framework that focuses on the dignity and independent life choices of individuals.