Ethical guidelines are the foundation to our profession and maximizes client welfare.

Hello everyone.

This is dr carol and today I'll be talking about

ethical competencies and considerations from working with older adults.

This is week one of gerontology.

And today we'll be talking about the hallmark features of

the A.

C. Code of Ethics and what that looks like when

you're dealing with older adults.

Yeah. First of all the A.

C. A code of Ethics is the foundation of what

we used to be able to gauge how we're treating

their clients and that involves adolescents and Children as well

as adults and older adults.

The very first ethical principle is non malfeasance.

So basically you want to do no harm.

There's someone would say well why would anyone even considered

doing harm to someone a lot of times harm is

done unintentionally.

Okay so you want to avoid any kind of actions

or reactions that may cause any kind of difficulty any

kind of suffering any um any issues with your client

that may not be positive.

And what we talk about is sometimes subtle actions or

comments or even though missions that could cause harm.

For example, when you're talking to someone and they tell

you that when they were younger, they didn't have an

indoor bathroom and there's like a look on your face

like, oh my gosh, I can't imagine not having an

indoor bathroom or the fact that they had a party

line and they had to talk on the phone with

other people that could been privy to their conversations, listening

unconditionally as a way to do no harm, to be

able to hear their story, to be able to accept

that and not pass judgment in any regard or fashion.

Also, you want to make sure by doing no harm.

You're gaining multiple methods of inquiry from multiple sources.

So talk to the caregivers if their caregivers involved, if

you can form a collaborative treatment team, you want to

do that as well to make sure that you're getting

information from other folks to see how you're doing with

your counseling services, whether it be in office counseling, tele

behavioral health counseling or whether it's through some kind of

in home counseling process.

But above all else, you want to make sure that

you're not doing harm to your client and sometimes that

is undetectable and you need to gather different sources to

be able to determine that.

Yeah. So doing no harm is the first thing, but

you can't just sit back and play it safe.

You have to make sure that you're doing good.

So doing no harm.

Not enough essence is one thing.

But also how do you know when you're doing well?

How do you know when the person that you're seeing,

the person that you're treating the older adult, it's benefiting

from your time together?

Um Well you can use a number of things.

You can do qualitative analysis in terms of asking the

person how they're doing if they're feeling better, if they're

having less depression, less anxiety.

Maybe some of the mindful techniques that you've done with

them have helped with bringing down some of the anxiety.

Sometimes you want to do quantitative measures.

Okay? So you can do a pre and post test

symptom checklist, 90, some kind of a big anxiety depressive

inventory when you first start out and then later on

again to see if their anxiety or depression has decreased.

You can also just do some scaling questions and have

them scale various aspects of their life That they have

been able to kind of put a number one when

they started with you.

And then at this point now later on in therapy

and then sometimes you have to measure what you don't

see. And what I mean by that is that you

don't see the person isolated as much.

They're actually getting out more.

You don't see the person um uh being negative or

pessimistic. You don't hear them making these kind of comments.

You see them being positive, you see them taking better

care of themselves.

You see them showering every other day or daily.

You don't see them sometimes giving away personal possessions or

being taken advantage of being more are assertive.

So whatever it is still working on in therapy with

you, you have to measure quantitatively qualitatively through pre and

post test measures, but sometimes by getting information from others

as well.

So Lady Justice here is Lady Justice and she's blind

and everything is equitable in terms of how you treat

others. Let's talk a little bit about what justice looks

like when you're dealing with older adults.

It means being able to treat people in a fair

and equitable manner.

So what this means is avoiding any kind of micro

aggressions or any slides that may have happened.

Uh for example, if you're doing in home counseling and

you're going to someone's home, making sure that when you

go in and you see things or smell things that

may be off putting.

I've had people tell me that doing in home services

with older adults, sometimes they smell things, they see things

um that sometimes is all putting and they have reactions

to those, so monitoring your reactions, making sure that you're

prepared to these potential, such as having a urinal in

the bathroom with an open door on it because doors

are hard to navigate with people sometimes that have walkers

or canes or wheelchairs.

Uh Sometimes the smell in there, maybe someone is not

bathed in a while, um that there's a difference between

someone lacking hygiene and it being intentional because they don't

have the ability to do so versus it being somewhat

inflicted upon if there are caretakers there and that's a

whole different issue we're gonna talk about in just a

second with elderly abuse.

But justice means just making sure that you're treating fairly,

making sure that you check any kind of transference that

comes to you and make sure that you deal with

that. For example, um you'll have an age differential when

you're dealing with older adults.

Most times therapists who are seeing older adults aren't 75

or 80 like the client, they're gonna be like younger.

So there will be some transferred.

Sometimes you'll have people that are older that you're dealing

with. Ask you, what do you know about life?

You're only 30 years of age, You know, what do

you know about what I've been through?

And sometimes you just got to kind of move through

that and be able to say you're right, I haven't

had the lived experiences you have.

So why don't you tell me about what it was

like when you were growing up?

Um sometimes you have it going the opposite way and

you have to counter transparent.

So this person may remind you of the grandfather that

you lost the grandmother that was lovingly bringing you up

during your childhood.

You just got to make sure that you understand that

there are different dynamics of the relationship that take place.

They may be stronger when you're dealing with older adults.

But also you need to remember where you in and

the person begins and to be able to show that

I want to uh but get this synaptic cliff right

here. So what this is is a two synapses meeting

together. To communicate.

You have one that's the firing some naps and one

that is the receiving synapse.

So this is a lot like counseling.

You come to the point of contact but you get

no closer, okay if you're six inches apart, these synapses

won't be able to communicate with each other.

If you're touching one another and embed it within each

other and then meshed so to speak, then they die.

They can't communicate.

You gotta have that that space, that small space right

there where you come and the client comes to the

session into that meeting into that conversation.

And that's where you hold it and that's where all

the good communication happens and that's where you're able to

do the best work.

But you don't get so far away that you can't

connect with that client and empathize with them.

But you don't get overly involved, that person and lose

yourself within that that client, let's talk a little bit

about fidelity.

Fidelity basically.

It's just committing to a person to that relationship with

that person.

When you have a client that um, that you commit

to on the front end, you've got to make sure

that you move forward with your your commitment and honoring

responsibilities to that client.

And that includes working with all age groups.

But when we're talking about working with older adults, sometimes,

uh, it gets complicated because you also have caretakers that

are responsible for their care.

Uh family members who may be a part of that

family. That client situation to where you have to balance

your fidelity to your client and to the caretaker.

And sometimes they're at odds.

Sometimes, uh, caretaker wants something different than the decline.

For example, if the client is 81 years of age

and they started to lose some of their faculties and

their eyesight is going down.

Uh, and the caretaker wants to restrict their license or

take their car away and their means of transportation in

that regard, then you may have to consider where your

loyalties lie.

Is it with the client or is it with the

caretaker? And using discretion is always important.

But making sure that you understand the boundaries and who

you're responsible too, and your fidelity towards that something is

gonna be very important.

Okay. Another thing I want to talk about is this

death with dignity right here.

Let me see.

I'll go back for a second.

The death with dignity website.

You need to look at that and see in your

state would it says regarding um assisted suicide is what

it is or death with dignity.

And some states have various laws that are different from

other states in regards to how that can occur and

what that looks like.

So I would encourage you to go to this website

right here and look at specific laws pertaining to someone

who is wanting to hasten their their death.

The last principle that was just added in the 2014

edition of the ACA code of ethics is veracity.

So making sure that you're dealing truthfully and honestly with

all individuals who you come in contact with and that

includes your clients, your caretakers, any kind of a team

approach that you're dealing with this client on in regards

to collaboration.

It could be medical staff, it could be nurses, it

could be caseworkers, it could be hospice, it could be

a variety of folks.

But making sure that you're honest and that you're up

front. Now if someone does not have the capacity to

be able to exercise their best interest, how much are

you able to in an honesty and in truthfulness, be

able to overcome that and to be able to supersede

that. Sometimes for example if someone is wanting to drive

and you feel like and the caretakers that are working

with you feel like that that's not a good idea.

How do you how do you do you become truthful

and honest with someone with giving them that news?

Uh let you know, being honest with them in terms

of their abilities to maybe do things that may be

dangerous. Um Those things are important to consider when you're

talking about being honest and truthful with with your clients.

And a lot of times clients handle information very well.

It's the presentation of it.

So the A.

C. A Code of ethics has a link right here

and you use this in this field anyway.

But you may want to go and look in terms

of uh fewer mandated reporter for elderly abuse.

I know that in Virginia we are mandated reporters of

elder abuse, but that's not the case in every state.

So some states may have that.

You don't have to report when someone tells you that

they're being abused at home.

Maybe physically abused.

It doesn't necessarily have to be reported if you live

in a certain state, but there's different kinds of elderly

abuse. You have a financial abuse where the caretaker maybe

spending the money on themselves taking their check and cash,

their check of their guardians or if they got power

of attorneys and they're not getting the person the resources

that they need at that time.

Maybe, for example, they need a hand rail in the

bathroom or maybe they need some extra support during the

evenings before they go to bed or when they're asleep

and they're not paying for that, they're taking their check

and they're using it on different things for themselves.

Their sexual abuse of all different sorts, um, incapacitate adults

who are on medications and they're out and sexual abuse

happens. Physical abuse, there's verbal abuse and harassment and mental

abuse, putting people down, harassing them verbally, um, belittling them

things of that nature.

So there's different kinds of abuse that happened.

And if you detect that if the person reports that

to you, such as a child, if a five year

old child comes in your office and tells you that

their mom's boyfriend has been um playing with their kitty

cat or their vagina, then you have to report that

if someone comes into your office or if you're in

a tele behavioral health session with them or you're in

the home and you pick up on signs of elderly

abuse. If you're a mandated reporter in your state requires

you to report that, then that's something that you have

to, you have to disclose.

And here is the website right here in regards to

the different states and what they require for elderly abuse.

Well, I hope you've enjoyed this brief video and hope

it's been meaningful to you.

Thank you so much for participating.

Ethical guidelines are the foundation to our profession and maximizes client welfare.

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