Page 22 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
participate in care and treatment decisions. Residents are empowered by being given the choice about their method of involvement.
The areas in which we must address resident rights continue to grow. Consider:
-­‐ the right of the life –long smoker versus the right to a
smoke-free environment;
-­‐ the facility need to supply “optimal nutrition” versus the
individual need to satisfy lifestyle or fast food habits;
-­‐ the facility need to document perfection in grooming
versus the individual right to grooming habits;
-­‐ the right to refuse treatment versus the nursing
obligation to provide care;
-­‐ the right to refuse food versus the need to feed and offer
supplements. The list goes on.
This new perspective on approaching resident rights is appropriate as we enter a new decade of providing health care services. It is an opportunity to affirm that quality goes beyond hot meals and clean sheets. It is the chance to acknowledge that quality perhaps has more to do with meeting, to the best of our abilities, each resident’s right to maintain his or her dignity, pride, and self-esteem while in our care. (HCFA Training Manual, OBRA, 1987)
The origin of many of our current survey processes, and the foundation of Karen Schoeneman’s oft quoted statement that “OBRA mandates culture change” is clear. However, the intent of deep-seated choice so apparent in these early documents has been significantly diluted in the traditional institutional practices that have survived all these years. Facilities often continue to offer merely token choice, flexibility and control to residents. The dignity of risk is clear in these foundational documents, so how did we as an industry come to elevate safety over resident dignity and choice? How did the culture of traditional long-term care come to the expectation that we can, or should, prevent any risk? Over two decades later...many, perhaps most, of our elders are still waiting for meaningful life, increased choice and increased control assured through their real participation in planning their care and their life.
RESIDENT RIGHTS: Opportunities and Challenges
In their inspiring forward to In Pursuit of the Sunbeam, Norton and Shields challenge us all to a noble calling, quoting Alexander Hamilton: “The rights of mankind are not to be rummaged for among old parchments or musty records. They are written, as with sunbeam in the whole volume of human nature, by the hand of Divinity itself, and can never be erased or obscured by mortal power.” They challenge us all to “acknowledge the pursuit as central to who we are as human beings...assure choice in the daily lives of leaders and in our own future, and to act upon these rights to assure our humanity.” (Shields and Norton, 2006, ix)
These rights of mankind are guaranteed to nursing home residents in the federal law and regulations, OBRA ‘87, excerpted in shaded boxes below.
19