Page 26 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
The needs and controls needed by elders living in the community do not always apply to elders in the long-term care setting. Control is given to scheduled medication administration and meals, and food is available but not in the LARGE quantities that would exacerbate someone’s glucose levels. Then the doctor chastises the elder for “poor food choices” and new orders return to the home with the elder for more strict controls on meals, food availability and more. The continuum needs to be educated on what makes “home” in long term care and we need to work with the professionals on “the other side.” (Madalone, 2009)
A regulator comments: The requirement to work out refusal issues with the resident cannot be waived.
An RD: I don’t believe we should treat pneumonia if the resident refused thickened liquids. Why should we treat it when they refused the treatment that would have avoided the negative consequence?
A regulator asks: How do you balance quality nutritional care and resident choice?
Is there a balance, or do resident choice and the right to refuse treatment after appropriate education and exploration of alternatives take precedence over the professional recommendations for quality care? They do for elders living in the community. Our elders deserve the same.
One of our favorite foods in Lancaster County is our potato chips, especially those made with lard. We had two gentlemen, both good Dutchmen, for whom swallowing problems made eating chips unsafe. Physician, family and residents made the choice to continue with their favorite food despite the risks. Garden Spot Village
COMPETING CHALLENGES TO SELF-DETERMINATION
The federal regulations or interpretive guidelines often seem to be competing with one another as it relates to application and/or enforcement, as indicated in the excerpted provisions below.
F 155
483.10(b)(4) – The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specific in
paragraph (8) of this section;
F279
483.20(k) Comprehensive Care Plans
Interpretive Guidelines
The requirements reflect the facility’s responsibilities to provide necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being in accordance with the comprehensive assessment and plan of care. However, in some cases, a resident may wish to refuse certain services or treatments that professional staff believe may be indicated to assist the resident in reaching his or her
highest practicable level of well-being. Desires of the resident should be documented in
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