Physical, mental, or social change in the life of an elderly person may result in a loss of self-sufficiency. Deciding how to compensate for the change -- a process that often involves family members, friends, or health professionals -- frequently leads to consideration of long-term care. Most of the existing literature on ethics and decision making, however, focuses on acute care and does not necessarily apply to issues involved in choosing long-term care.

This book offers the first conceptual and ethical framework for thinking about long-term care decision making in gerontologic and geriatric practice. It is also the first to examine these issues at the level of decision-making by elders, family members, and professionals and to consider the broad range of options -- from receiving care at home to entering a nursing home. The discussion ranges from the philosophical, historical, and societal to the sometimes painfully specific and personal. Topics include the current system of long-term care in the United States and how it evolved; value considerations facing professionals involved with home care and care plans; the basic concepts of autonomy and independence; the affect on long-term-care of changing intrafamilial relationships and responsibilities; and a preventive ethics approach to long-term care decision making. The chapters make effective use of case histories and offer a strong sense of how individual human lives are affected by these issues.

"This collection of essays is a forum for clinicians, ethicists, and policy specialists to address the social and ethical implications of both the basic and the high-technology aspects of caring for very ill or very dependent patients in their homes... It should also be brought to the attention of the health policy analysts and politicians who believe cheaper care at home will solve our health care crisis." -- The New England Journal of Medicine