Page 56 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
impossible task for most. Clearly, defining professional standards of quality for nutritional care of the elderly could eliminate the potential for less-than-optimal approaches for many of our elders, and reduce confusion among health professionals regarding outcomes and regulatory compliance. It is hoped that a national workgroup with representatives from all stakeholders and peer organizations can carry out the sacred work of developing best-practice guidelines for professional standards of quality for the nutritional care of the elderly.
But the challenges do not end with the identification of best practices in support of resident self- determination and professional standards of best practice for quality nutritional care. These best practices must then be widely disseminated to all stakeholder groups, communicating a consistent message with clear recommendations for consideration in individual decision making. It is critical that consistent messages be delivered in each state for purposes of education and advocacy and be respected as advisory to state decision makers, and that these functions also be coordinated nationwide. Regardless of the partnerships identified as the most appropriate for dissemination, a centralized focus will assist in reducing variability from state-to-state and will free scarce resources from duplication of effort wasted in developing related materials.
Recommendation: National workgroup with representatives from all stakeholders identify appropriate group (coalition, advisory council, QIO, etc.) to assume lead role in each state for dissemination of all individualized care practice guidelines for education, advocacy
and guidance to state decision makers, and to coordinate these functions nationwide.
Only when the expectations of residents, families, providers and advocates have a common base can the dignity of choice and dignity of risk be addressed and professional standards of practice be met with confidence in practice. A centralized approach to education would provide the strongest possible base, particularly in consideration of the development of advanced directives and by the interdisciplinary care plan team in the care planning process. Here again, the role (and the availability) of the ombudsman as a team member trusted by all involved should be expanded in both the educational process to residents and families, and in mediation of the care planning process as needed. It is hoped that by detailing specific questions and issues, the choices of the elderly as expressed in their advanced directives can truly direct the care plan, and can stand more strongly than the wishes of the Power of Attorney for health care after the resident is deemed unable to express rational choice, or of the staff fearing litigation if resident advanced directives are followed. Using the resident life history as a starting point, expressing the residents true wishes and choices even in difficult to attain goals and approaches, abandoning the medical problem-based model, communicating to all in a resident centered format that would guide all efforts in resident care... would be a dream-come-true for establishing true resident-directed care. Only then will we as caregivers be able to gift our residents with the full circle of quality of life, a quality end-of-life.
Recommendation: National workgroup with representatives from all stakeholders and peer organizations develop guidelines to clinical nutrition individualized care practice for disease management, to provide regulatory overview and interpretive protocol and invest-
igative guidance, and prepare related education materials to facilitate implementation.
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