Page 69 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
Advancing Resident Self-Determination
Working together to honor our residents’ rights to autonomy and self-determination is clearly a good place to start in building community and making resident-centered care the norm. The basics: pro-active choice agenda for facilities, regulators, residents and families; best practice defined simply by the outcome of honored choice; professionals guided by ethics emphasizing the right to choice as a foundational value. But where does it stop? How do we know we are there? That resident-centered care is now the norm? That we have created home? The answer...it doesn’t stop. It just keeps getting better. Shields shares his thoughts:
One of the hallmarks of the creation of home, self-led teams and high involvement is the respect staff gives residents--it is now standard. Yet we have to start at the beginning with every new staff person. We had a situation where a relatively new caregiver did not quite get the picture and had a temper outburst with a resident in public. The resident quietly listened to the staff person, then lifted her head and said, “You don’t get to talk to us like that here, you’ll be gone tomorrow.” And she was. The beauty of the story for me is that the resident’s assurance that “this is my home” was not damaged by the staff person’s unacceptable outburst. The resident in no way cowered or felt her home or autonomy was threatened. She was confident in her place as driver in her home and she had quiet and absolute confidence the person would be gone the next day, and she was. So while I am embarrassed by the caregiver’s actions, I am proud of how the culture of home, family, love and respect we worked so hard to create ultimately prevailed. (Shields, 2010)
And Norton shares hers:
Every resident should have home as he or she defines it. While this may seem impossible at first thought – to create home for each person with very different and even conflicting visions of home, an organization that makes this their challenge will find themselves working with great energy and pleasure. And together they will inspire and shape a true community – one which is home to all. (Norton, 2010)
Coming full circle on the deep seated issue of choice, recall the simple starting point of getting to know each resident and their choices: “What does the resident want?” “How did they do it at home?” Then act on the challenge: “How can we do it here?” Honor your residents’ self- determination, and welcome everyone home.
Recommendation: While we work together to advance quality of life and quality of care for our residents, focus on one consideration first and foremost in our work – the legal rights of the residents of long term care facilities and individualized care practices that honor those rights.
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