Page 25 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
for the resident to be able to iron as she wished than to take it away from her under the guise of keeping her safe. She irons every day – has not burned herself or anything around her – I think we could make money by selling her services! We see examples of our “overly protective” nature all of the time – we are continually questioning those decisions. “Risk taking” needs to be accepted as a normal part of life. (Oelfke, 2009)
I feel fortunate that we have not experienced some of the difficult situations other facilities have as they moved to households. We pay attention to the regs but interpret them from the resident’s perspective. We have become “okay” with deficiencies as long as they don’t affect what we are trying to do in creating our home...We have never had a deficiency that in any way challenged what or how we are doing things. Maybe that means we “haven’t pushed” far enough? (Oelfke, 2009)
THE RIGHT TO REFUSE TREATMENT
Similarly, the right to refuse treatment is a clearly defined personal right, yet so often challenged for residents of a traditional nursing home. It seems logical that, as citizens with rights living in their home (albeit a skilled nursing home), residents be offered choices of treatment options and encouraged to make a positive choice within the boundaries of their personal goals identical to the best practice process of health education for community-living elders. Health professionals do not expect universal compliance with their recommendations to community-living elders; we respect a person’s right to make a choice deemed inappropriate from our professional perspective. Our residents deserve the same respect.
Yet in long-term care, we traditionally expect compliance, and our care-giving systems default to compliance rather than to free choice. We label those making what we judge to be poor choices as “non-compliant,” continue to re-educate, re-educate, re-educate, (could this be harassment?) and sometimes even attempt to manipulate or trick residents into compliance. Do you serve decaffeinated coffee to all residents, sugar-free lemonade to all residents? Do you serve only “lite” fruits to all? If so, are your residents aware of the choices you have made for them? Free choice should be the same in an elder’s home, whether it be in the community or in your nursing
home. rights.
Honor the dignity of choice. Ban the label of non-compliance. Honor your residents’
My latest issue is the constant pressure we are under in the nursing home industry between the battle for human dignity and quality of life versus safety at all costs. There is enormous pressure both from the survey teams and the insurance industry due to wrongful death lawsuits that cause many to fear any injury to residents, sometimes compromising quality of life. My latest example is with thickened liquids. I completely understand the rationale... I have had residents and family members complain about this, and I think to myself if I was really thirsty would I want to drink a glass of glue? There is the Frazier water protocol that allows un-thickened water to be given in small sips since we have water in our bodies anyway. But I know some facilities won’t “allow” that because there is still some aspiration risk and concern over resident safety. I have seen many examples of safety over resident dignity, and I vote for dignity most of the time... (One administrator’s view)
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