Page 21 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
OBRA 87 gives us the opportunity and obligation to reexamine our attitudes, our routines, and personal assumptions regarding resident rights. We have the chance to re-focus our efforts and in the process, social awareness and ethical practices that emphasize individuality will evolve.
When we reaffirm the dignity of each resident, we will also enrich the lives and values of our staff members. And, as we seek new ways of enhancing independence and offering new choices and opportunities to our residents, staff members will feel rewarded by those they empower.
Enriched lives means more productive lives for our staff. Pride and personal determination will improve the quality of life for our elders.
Busy care-givers are routinely required to make “on the spot” decisions. In the past, these decisions may have been made with the primary focus on efficiency and not on thoughtful consideration to individuality. To place appropriate emphasis on resident rights, we may need to sacrifice some efficiency for the sake of human pride.
Goals must be set that hold individual dignity in higher esteem than overall facility efficiency. It will not be easy. Years of caring practices and habits based on experience will need to be challenged. Ideas once believed to provide quality will need to be reexamined.
The following examples address areas in which quality care and resident rights should be examined.
Quality and the Dignity of Risk
The frail, elderly nursing home resident often must balance the dignity of risk, which enables pride and independence, with the need to be kept safe.
The dignity of risk, individual pride, and the need for adult mastery and independence are valuable human options.
Individual choice after full discussion of risk factors may be the most appropriate choice for many residents.
Quality and the Dignity of Privacy
Visitors, space and privacy are other important areas of concern.
The key to the development of an effective policy that provides dignity and privacy is to remember that residents should make the final decision. In the process, they can learn to lobby and to take into consideration the wishes of the majority when making a decision.
Providing quality in areas of privacy may also extend to cleaning rooms by appointment and respecting the privacy of a resident’s dresser drawers or closet space.
Privacy for families to meet must also be considered. Ideally, an administrator will foster family-like units that allow for readily available private space, without a great deal of cost or effort.
Quality and the Right to Participate in Care Decisions
Although residents and their families are routinely invited to attend care conferences, we may need to explore other avenues that allow residents to
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