cupational therapy services based on medical necessity, yet the payer-source (Medicare) coverage criteria for services to be delivered at home was questionable. That is, should one continue to treat the client and uphold the principle of beneficence yet run afoul of the laws or should one discontinue treating the patient to uphold the law but possibly cause harm to the client?”
Nurses are hired to assist physicians. In the scenario described, the nurses can also be tapped to assist and/or complement the occupational and physical therapists. This will likely apply most to new nurses coming from developing country who can be hired at less expensive rates compared to US nurses as well as other nurses who have stayed long in the US. Thus, a nurse can be a potential party or direct participant to the situation described by Wells. In view of rising medical costs, tapping nurses from developing countries to either assist or substitute for occupational or physical therapists can emerge as a trend in the United States. Thus, an ethical dilemma for a nurse is whether he or she will allow himself or herself to be a party to the dilemma described by Wells (2007).
In the case described by Wells, the patient encountered difficulties in keeping up with appointments with the health providers. Medicare rules for client to receive home health require that the patients meet certain criteria (Wells, 2007, p. 31). Directly quoting Medicare sources, Wells said that a homebound patient situation exists when “there exists a normal inability to leave home, and, consequently, leaving home would require considerable and taxing effort” (2007, p. 31). Wells also said that although his case was definitely homebound, ethical principles were at risk because his moral duty to provide treatment was in conflict with institutional interpretations of the Medicare regulations or guidelines of what constitutes a homebound patient (2007, p. 31). In other words, the case described by Wells