Page 30 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
see this far too often in overzealous parents with children with perceived allergies. Our challenges are to find the nutrients for that child around fears and obstacles. Apply the same thinking to the elder care industry and we need to find nutrients for ground we have lost by too much restriction. (Madalone, 2009)
We feel one of the biggest barriers to enhancing the dining of skilled nursing residents are those staff members – dietitians, dietary service managers, physicians and our professional staff -- who stand behind the restrictive dietary protocols they have embraced throughout the years. If we consider this the residents’ home, they should have the ability to choose whatever they want to eat, without answering to anyone. We discuss and document risks and benefits, but in the end, it should be the resident’s choice. (Weber, 2009)
Challenge: Residents’ right to self-determination, including the right to refuse care as residents often seek an acceptable balance between quality of care and quality of life.
I didn’t realize that this place is a prison. (Resident interview)
Challenge: Family concerns on occasion include hidden agendas counter to the residents’ right
to self-determination.
This is a health care facility, isn’t it? I brought my mother here because she was not following her diabetic, salt restricted diet at home and I expect that you will make sure she follows it here. That’s what I am paying you to do! (Family interview)
There is such a threat of liability that impacts this area. Who is to blame, or at fault if a bad outcome occurs? “We don’t want mom to have sweets because she has diabetes.” But mom is 95 and just wants to eat. Then because we follow the families’ wishes, mom’s intake declines, mom’s weight declines, mom “cheats,” mom steals food from other’s plates, mom uses petty cash to hit the vending machine daily, mom uses the outing to Wal-Mart to buy Ding Dongs and hides them in her room...you all know the scenario. (Madalone, 2009)
Challenge: Surveyors, the silent members of the care plan process, represent regulatory compliance concerns.
Our state surveyor said, “Let them cook, but then just throw away the food.”
I would replace all of the nurse surveyors with other disciplines. Having nurses audit nursing homes is like the wolf guarding the hen house.
A CMS regional dietitian said, “I’m very concerned when resident are given choice, staff fail to monitor their intake of the needed nutrients.”
As a surveyor, I am informing the homes that there is no regulatory barrier to the personalization of the dining experience in particular, and in promoting personal choice in general. We are encouraging the homes to be creative and to call us if they have concerns regarding the regulations.
As a surveyor, I want to see the process by which decisions were made and the education of staff, family and residents regarding safety. Otherwise, our position
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