Page 31 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
here is that individual preferences need to be honored and there is no regulatory barrier to doing so.
We have been fortunate to have a “forward thinking” group of surveyors – they value what we are doing and are willing to look at things from the perspective of the resident outcomes. We have worked closely with them throughout the transition of the facility, keeping them informed about changes and “educating” them on our perspective. When they enter the facility, they find happy residents, families, and even staff!! It sets a whole different tone for the survey. Several have commented about how happy everyone is – they specifically noted that the residents seem to enjoy each other – they have “real” conversations around the tables at meal time. Apparently the surveyors don’t see that often. (Oelfke, 2009)
Clearly the care team must relentlessly balance the often conflicting accountabilities between quality of life and quality of care. Only a high functioning, self-led team with highly involved members working and thinking creatively can anticipate success. As noted in Pursuit of the Sunbeam, “Self-led teams in long-term care are unique because they include the consumer. Elders are involved in their own care. They drive and direct the team.” (Shields and Norton, 2006) They have expressed the ultimate goal of the interdisciplinary care team in long-term care. But what must we do to empower our elders to drive and direct the care plan team?
Know the resident. Nancy Fox comments in The Journey of a Lifetime that culture change organizations understand the concept of “becoming well-known as the single most important strategy we have as caregivers. Under this paradigm, the care plan becomes a living story of the Elder and her needs...What is most important is that the Elder is now seen and known as the whole person she is.” (Fox, 2007, p 71)
Unfortunately, some well-intended facilities are simply rewriting their traditional care plans in the recommended “I” or “narrative” format; this is not the intent, and perhaps even counter to the intent, since the result would indicate that the resident actually chose the facility-generated care plan goals and approaches. Only when we begin with the residents -- their personal story, their personal goals and priorities -- can we generate a plan of care that is truly meaningful to them.
Advocate for the resident. Fox shares her personal story in The Journey of a Lifetime. She states, “I told my social worker she was first and foremost the Elder’s advocate. I know this is what social workers are suppose to be, but how many actually have the courage to stand up to the administrator? A better question is how many administrators are willing to listen when they do?” (Fox, 2007, p 59)
Too often, the care plan reflects the needs of the staff by limiting approaches to those already successfully implemented in the facility and advocated for by department leaders out of necessity by the realities of limited time and money. Only when the resident and nursing assistant can say that the care plan simply details what they really want to do together every day have we generated a resident-centered plan of care.
Care plan with flexibility to honor resident self-determination. The care plan controls the care given and must reflect the individuality and flexibility of resident choice. It must reflect the
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