Page 28 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
to do the right thing for the right reasons. We need to acknowledge that one challenge is knowing what is the right thing to do. Furthermore we need to acknowledge that a second challenge is honoring residents’ rights as human beings. We have all been taught that the care plan actually belongs to the resident, but who really owns the care plan?
The issue was strongly addressed over a decade ago by Rosalie A. Kane, Robert L. Kane, and Richard C. Ladd in The Heart of Long Term Care as one Principle for Change:
Safety must give way as the number one quality indicator, because that is a recipe for oppression of the consumer. Without being foolhardy or encouraging negligent care, long-term care authorities must recognize that complete safety is an unrealistic goal for any population and that excellent health and elimination of injury, disease, and death are impossible goals for the disabled, often sick, often very old people who need long-term care. (Kane, Kane and Ladd, 1998)
Steve Shields spoke directly to the issue in Old Age in a New Age:
Risk is inherent to being alive. One of the mistakes we have made in long-term care is to eliminate risk...We’re so averse to risk that we’ll tie people up to avoid it. We will eliminate life’s enjoyment to avert it. But the fact is, getting up in the morning is a risk, from the moment we’re born to the day we die...So we all make choices. Life is full of risk. We make peace with that...We have made our decisions about where we fit into all that, relative to risk. And there’s no acceptable reason that any influence, whether it be regulation or attorneys-- nothing should interrupt a person’s sense of continuing that dynamic about life. (Baker, 2007)
In My Nursing Home Experience, Imogene Higbie, at the age of 87, expressed: “During my own experience, I was dismayed by the lack of personal autonomy and involvement by residents in making decisions about their personal lives and the pervasive assumption staff knew what was best for us better than we knew for ourselves.” (Shields and Norton, 2006, p 16)
But consider some of the complexities challenging the care team as expressed by providers and professionals working to honor resident-directed care and to create true home...
Challenge: Health care professionals are mandated in F279 and F281 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 and to assure that services being provided meet professional standards of quality and are provided by appropriate qualified persons.
Residents on dialysis are often challenges to nutrition care, both because they often do not follow their therapeutic diet, and because the standards of the dialysis centers for nutritional parameters are often difficult, if not impossible to achieve. The expectations of the dialysis centers are often based on financial incentives for outcomes rather than resident outcomes, and often fail to acknowledge the residents’ right to refuse dietary modifications in a long-term care facility. (A Registered Dietitian response)
I just feel that the emphasis on care planning, monitoring, re-evaluation and documentation processes besides the MDS protocol is out of hand. I find that with less competent dietary staff options out there and the turnover that occurs,
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