Nursing home placement and the demented patient. A case presentation and ethical analysis.

The decision to seek nursing home placement will be faced with increasing frequency as the population over age 65 continues to grow. Although this is a difficult juncture under any circumstances, the ethical issues accompanying such a move for persons of diminished competence are unusually complex and require involvement of many concerned parties. In a typical case presentation, the social context informing these decisions is described, including bias against the aged, perceptions of scarce resources in health care, and the problematic role of the courts. The perspectives and moral obligations of the patient, family, and health professionals are discussed and contrasted to clarify the sometimes conflicting roles and needs of those three parties. A stepwise process of decision making before nursing home placement is offered in an effort to choose the least restrictive alternative for the patient while respecting the needs of concerned persons.