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The prevalence, composition, and function of ethics committees in nursing facilities: results of a random, national survey of American Health Care Association members.

OBJECTIVES
To determine the prevalence, composition, and function of ethics committees in extended care facilities in the United States.


DESIGN
Descriptive survey by mail.


SETTING
A 5% random sample (n = 851) of nursing facility members of the American Health Care Association (n = 17,020). Most of these facilities (75%) are intermediate care facilities; the remainder include a varying number of skilled beds.


METHODS
An eight-item questionnaire was sent to the randomly selected 851 extended care facilities. The questionnaire inquired about the existence of an ethics committee, plans for formation when applicable, composition of the ethics committee, and its function. Survey data was coded and merged with information on facility characteristics that are part of the American Health Care Association's database.


RESULTS
Of the responding facilities (n = 394), 34% reported the presence of a functioning ethics committee, with an additional 19% indicating definite plans for ethic committee formation. Forty-three percent expressed no interest in establishing an ethics committee, and 4% reported having had an ethics committee sometime in the past. The greatest proportion of committee time was spent in case review (39%) with lesser amounts of time expended in areas of policy formation (27%) and education (27%). Forty percent of the ethics committees performed two or fewer case reviews per year. Nearly all committees included the following disciplines in the membership: nurses (96%), physicians (95%), and social workers (89%). Facility administrators (77%) and clergy (70%) were frequently represented. Very few facilities reported representation by residents (8%) and Certified Nursing Assistants (2%). The Medical Director served as a committee member on 75% of the ethics committees, and in more than one-half of those instances, he/she was the sole physician on the committee.


CONCLUSION
Ethics committees are currently active in or there are plans for their development in more than 50% of extended care facilities in the U.S. this represents a very significant increase in prevalence during the last decade. This tendency to form ethics committee's may slow considerably in the future. Ethics committees exhibit considerable variability in structure and function.