Page 20 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
WHO OWNS THE CARE PLAN? WHO ARE WE TO DECIDE FOR PEOPLE WHAT IS BEST FOR THEM?
The deep-seated issues of resident self-determination were clearly identified in the IOM report previously reviewed. Further, the initial surveyor/provider trainings introducing the revolutionary concepts of OBRA ‘87 to the long-term care world clearly defined the concept of autonomy in surveyor guidelines as a framework for resident rights, and introduced a new perspective on resident rights for survey focus, excerpted below. (See additional excerpts, Appendix B and C.)
Autonomy: A Framework for Assessing Resident Rights and Quality of Life
All persons have autonomy, regardless of the range of their functional abilities. The concept of autonomy – the degree to which a person expresses his or her individuality – is useful to thinking about assessing a facility’s compliance with resident rights and quality of life requirements. The new nursing facility requirements recognize that autonomy is a basic human need. Autonomy has three dimensions:
-Independence -Self-control -Competence
Autonomy and the Nursing Facility Environment
Your review of resident rights and quality of life reduces to one basic question – how much control over their lives do residents living in a nursing facility have? The new nursing facility requirements challenge the assumption that institutionalization limits personal autonomy more or less by definition. Rather, assume that the nursing facility and environment is neutral with respect to residents’ autonomy. Everything depends on the way the facility sets up its institutionalized practices. Set up in one way, the facility is receptive to autonomy; set up in another way, it limits autonomy.
In surveying resident rights and quality of life, you are evaluating the extent to which the nursing facility’s social and physical environments advance resident autonomy. Think of your job as searching for organizational traits that assist residents’ autonomous behavior – exercising independence, self-control, and competence. Assessing two characteristics are critical:
-Flexibility -Controllability
Flexibility means that the facility provides opportunities for residents’ autonomous participation.
Controllability means that to some degree that facility allows residents to have an on-going role in shaping the institution – to have a say in how the facility functions.
Insofar as it is flexible and controllable, the nursing facility becomes an environment with opportunities for residents to live autonomously.
A New Perspective on Resident Rights Dignity means more than door-knocking.
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