New Ethical Perspectives on Long-Term Care Emphasize Quality and Patient Safety

The American College of Physicians (ACP) has released a comprehensive new paper highlighting the critical ethical issues surrounding long-term care systems. The publication calls for increased research and scrutiny into current practices to better serve vulnerable populations, ensuring that quality, safety, and ethical principles remain central. Entitled "Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports," the paper underscores the complex challenges faced by the long-term care sector in the United States.

Long-term care includes a broad spectrum of services and facilities for individuals who can no longer independently manage their daily activities due to cognitive decline, physical disabilities, chronic illnesses, or a combination of these factors. These services are delivered across various settings such as nursing homes, assisted living facilities, home-based programs, and hospice care. Despite serving approximately eight million individuals, the sector faces significant systemic challenges, which have only become more apparent during the COVID-19 pandemic.

The pandemic laid bare the shortcomings in the U.S. long-term care infrastructure, exposing issues related to inadequate staffing, fragmented regulation, and financial instability. A 2022 report from the National Academies of Sciences, Engineering, and Medicine characterized the current system as "ineffective, inefficient, and unsustainable." Notably, the pandemic resulted in a 13% decrease in nursing home residents nationwide due to inadequate infection control and the undervaluing of resident life. Furthermore, quality of care varies significantly depending on the business model—whether profit-driven, nonprofit, or government-operated—with for-profit facilities often linked to higher hospitalization rates and staffing shortages.

The ACP’s new position paper provides four key ethical stances. First, it advocates for policies that promote evidence-based, resource-efficient long-term care practices that enhance not only safety but also respect patient preferences and autonomy. Second, it emphasizes respecting the dignity and individuality of each patient, advocating for personalized, patient-centered care rather than organizational efficiency or profit motives.

Third, the paper urges a focus on health equity, urging healthcare professionals and policymakers to improve access and combat stereotypes rooted in race, ethnicity, age, and socioeconomic status. Ageism remains a prevalent issue, underscoring the importance of valuing older adults and recognizing their contributions to society.

Finally, the paper stresses transparency and accountability, making sure that families and patients have access to clear information about the quality and standards of care at long-term facilities. This transparency is essential for fostering trust and ensuring that care providers uphold ethical standards.

The authors argue that ethical, collaborative approaches involving healthcare systems, policymakers, facility operators, and caregivers are vital for creating a more equitable and person-centered long-term care system. As Dr. Jason M. Goldman, President of the ACP, states, "An ethical approach throughout the patient's lifetime is critical, especially for older adults dependent on long-term care."

This publication aims to stimulate critical discussions and reforms in long-term care, striving to align practices with core ethical principles to improve outcomes and dignity for all residents.

Source: https://medicalxpress.com/news/2025-05-paper-ethical-implications-term-prioritizing.html